Worker's Compensation
What benefits are provided?
A. Medical Care Benefits: The injured employee is entitled to receive all necessary first aid, medical, surgical and hospital services reasonably required to cure or relieve the effects of the injury or disease. Where necessary, the employee is also entitled to receive appropriate physical, mental or vocational rehabilitation.
B. Temporary Total Disability Benefits: Employees who must lose time from work in order to recover from the injury or disease are entitled to receive weekly payments until they are able to return to work that is reasonably available to them.
The payments represent two-thirds (66 2/3%) of the employee's average weekly earnings during the year before the accident or last exposure, subject to certain limits.
No compensation is payable for the first three working days, unless the lost time continues for 14 or more calendar days from the date of injury.
If temporary total disability benefits are not paid within 14 days, and the employer cannot justify the delay in payment, the employer may be required to pay a penalty to the employee.
C. Permanent Disability, Disfigurement and Death Benefits: When the employee has sustained an injury or disease which results in permanent disability, scarring or other disfigurement, additional benefits are provided to the employee.
If the injury or disease results in the employee's death, certain members of the employee's family are entitled to benefits.
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Disability Under Social Security
Disability under Social Security is based on your inability to work. A person is considered disabled if he cannot do work he did before and the Social Security Administration decides that he cannot adjust to other work because of his medial condition(s).
The disability also must last,or be expected to last, for at least a year or to result in death.
You should be familiar with the process the Social Security Administration uses to determine if you are disabled. The Social Security Administration uses a step-by-step process involving five questions. They are:
1) Are you working?
If you are, and your earnings average more than $800 gross per month, you generally cannot be considered disabled. If you are not working, the Social Security Administration proceeds to the next step.
2) Is your condition severe?
Your condition must interfere with basic work-related activities for your claim to be considered. If it does not interfere with basic work-related activities, the Social Security Administration will find that you are not disabled. If your condition does interfere with your basic work-related activities, the Social Security Administration will proceed to the next step.
3) Is your condition found in the list of disabling impairments?
The Social Security Administration maintains a list of impairments for each of the major body systems that are so severe they automatically mean that you are disabled. If your condition is not on the list of disabling impairments, the Social Security Administration has to decide if it is of equal severity to an impairment that is on the list. If it is, the Social Security Administration will find that you are disabled. If it is not, the Social Security Administration proceeds to the next step.
4) Can you do the work you did previously?
If your condition is severe, but not at the same or equal severity as an impairment on the list of disabling impairments, then the Social Security Administration must determine if it interferes with your ability to do the work that you did previously. If it does not, the Social Security Administration will deny your claim. If it does interfere with the work that you did previously, the Social Security Administration will proceed to the next step.
5) Can you do any other type of work?
If you cannot do the work you did in the past, the Social Security Administration has to determine if you are able to adjust to other work. The Social Security Administration considers your medical conditions and your age, education, past work experience and any transferable skills that you may have. If you cannot adjust to other work, your claim will be approved. If you can, your claim will be denied.
If My Claim Is Denied?
If your claim is denied or if you disagree with any part of the decision of the Social Security Administration, you may appeal the decision. The Social Security Administration office will help you complete the paperwork.
You have 60 days from the time you receive the denial letter from the Social Security Administration to file an appeal. The Social Security Administration assumes that you receive the denial letter five days after the date on it, unless you can show the Social Security Administration that you received it later.
Many people contact Gesmer Law Offices, P.C. after receiving a denial letter from the Social Security Administration. We assist our clients in the appeal process and there is no fee unless you are awarded benefits.
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