Thursday, February 28, 2019

Disability Benefits

If you're injured and unable to work, there are several state, federal, and private benefit programs that may be available to help you.  However, navigating and differentiating these programs can be difficult, especially when you're injured and in pain.  And the fact that many of these very different programs sound nearly identical (e.g. SSDI, SSI, and SDI) only make it harder. My goal here is to provide some of the most common programs, explain broadly the differences between them, and discuss their requirements in general.  Please note that all of these programs are complicated, and you are best to seek legal assistance when determining which programs are available to you.

Social security disability is the name for two similar federal programs: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). For both of these programs, you must show that you are unable to work for 12 months or more. SSDI also requires that you have paid into the Social Security system, and that your injury occurs while you are still "covered" by that system. If you are approved for SSDI benefits, then you should begin to receive your full retirement amount from around the date of your disability, subject to some certain restrictions. Even if you haven't paid into the Social Security system, you may still be eligible for SSI. SSI requires that you have limited assets, as calculated by the Social Security Administration. If you approved for SSI benefits, you will receive a monthly payment (for 2019, this payment, for an individual, is $771.00).       

State Disability Insurance (SDI) is a state (California) program, run by the state Employment Development Department (EDD) that provides temporary benefits for persons unable to work due to an illness or injury (it also provides some benefits for maternity leave). These benefits typically, but not always last for one year. In order to qualify for SDI, you generally must get certification from your qualified health care provider regarding your diagnoses, recovery time, etc. EDD also runs a similar program for those persons unable to work not because they are injured, but because they can't find a job: unemployment.

Workers' compensation is another program that can provide benefits if you are injured at work.  These benefits can include medical treatment, payments for lost wages, and lump sum payments for future medical care. Some of these benefits can be referred to as total or partial disability, which should not be confused with State Disability Insurance, or Social Security Disability. The workers' compensation system can be difficult to navigate, and legal assistance is recommended.

There are also private long term and short-term disability programs, that you may have enrolled in yourself, or have been enrolled in by your employer. Again, although these programs are disability programs, they are distinct from the government and administrative programs described above. The benefits provided by these programs vary, and you can get more information about any programs that you may be eligible for from the program administrator or your human resources department.

Often, you may be eligible for more than one of these programs. It's not uncommon for someone hurt at work to receive workers' compensation benefits, state disability benefits, and social security benefits. However, these programs can interact with each other in complicated ways, and may even affect the payments that each program pays to you. For this reason, and others, it is always a good idea to seek legal assistance when dealing with these programs.

Thursday, January 10, 2019

The Basics - Workers' Compensation

Workers' Compensation  What is it?

If you get hurt on the job, your employer is required to provide workers’ compensation benefits. To be covered by workers’ compensation, the injury must occur while in the course and scope of performing your job duties, or arise out of the performance of your job duties.

There are two types of injuries; specific or cumulative. 

Specific: A specific injury is an injury that occurred at one instance or occurrence.
            Example: Trip and fall.   

Cumulative: A cumulative injury is an injury that has built up over time. 
            Example: Repetitive motions causing injury, such as carpal tunnel. 

Workers’ compensation covers some, but not all psychological injuries caused by your job. The injury must be at least 51% industrial (meaning the injury was caused by work). 

It’s a Work-Related Injury – What’s Next?

After suffering an injury, you must notify your employer and file a claim. 

To file, you must complete a DWC-1 Form (  Claims are distinguished on occurrence of injuries rather than parts of the body injured or types of injuries. 

The current statute of limitations for filing a claim is 1 year from the date of injury or awareness of injury. It’s important to file a claim to preserve your right to benefits. 

You’ve Filed a Claim – What are the Potential Benefits?

Medical Care 
Your employer pays for medical care for your work-related injury or illness. Medical care is determined by medical treatment guidelines. Medical care that is “reasonably required to cure or relieve” the effects of the injury. 

Initially, your claim may go under review for 90 days. During review of your claim, necessary treatment is authorized up to $10,000. 

Temporary Disability Benefits
If your injury prevents you from doing your usual job while recovering, you may be eligible for Temporary Disability (TD) benefits. TD benefits serve as a partial reimbursement of lost wages due to your injury. 

Loss of wages can occur when your treating doctor indicates you are unable to return to work or the doctor believes you may work but only with restrictions, and your employer cannot accommodate your restrictions. 

Permanent Disability Benefits
Permanent Disability (PD) provides for payments if you don’t completely recover. This occurs when your treating doctor believes you will never recover completely or will be limited in your capacity at work. You may then be entitled to a PD award.
Supplemental Job Displacement Benefit
This benefit will come in the form of a voucher to help pay for educational retraining and/or skill enhancement, at eligible schools. This voucher can be used for tuition, fees, books, or other expenses required by the school. 

In California, you may also be eligible for a one-time cash payment through the Return-to-Work Supplemental Program. 

Death Benefits
This benefit will provide payments to your spouse, children or other financial dependents, if you should die from a work-related injury or illness. 

Generally, a dependent would need to commence proceedings for the collection of death benefits within a year from the death of the injured party.

Still Have Questions?

Please understand this is a brief overview of the workers’ compensation system and does not contain all information and materials necessary to assist you in a worker’s compensation case. Each applicant and case will have a different set of facts and circumstances. 

If you wish to seek legal advice, have any questions or seek further information, please do not hesitate to contact our office online or by phone at (916) 446-4692.