There are two types of benefits paid based upon disability. The first, called SSD, depends on your employment and earnings history and is based on tax contributions you have made. The second kind, called Supplemental Security Income (SSI), requires only disability. There is no requirement that you have an employment history. The rules for entitlement to these different types of benefits as well as the amount of benefits differ, but you must prove disability from working in substantial gainful activity to be entitled to either benefit.
No, you may retain some residual earning abilities. The amount that you can work and the amount you can earn are strictly limited. If you exceed those amounts, you can be disqualified from receiving benefits.
Once you qualify for SSD benefits, you also qualify for Medicare health benefits; however, there is a two (2) year and five (5) month waiting period from the date of entitlement to SSD benefits before you are eligible to receive Medicare benefits.
Yes, there is a 12 month disability period required before you can be granted SSD or SSI benefits; however, you do not have to wait for that year to elapse to apply for benefits. You do need to prove that you will be disabled from working for a minimum of one year.
To receive SSD benefits based upon employment, you do have to meet certain employment requirements including employment within a certain period of time prior to disability and employment for a certain number of calendar quarters during which you paid Social Security taxes. For SSI benefits, there is no such requirement.
SSI benefits are referred to as “asset and income sensitive.” If you have more than a certain amount of income, or assets worth more than a certain figure, you will be disqualified from receiving these benefits.
SSD benefits are not income or asset sensitive. Regardless of your financial situation, you will not be disqualified from SSD benefits based upon money or assets, which you may have or accumulate; however, if you are working over a certain number of hours or earning over a certain amount per month, then your entitlement to benefits can be affected.
There is no age requirement; however, the standard for determining disability and entitlement to benefits changes at age 50. Generally speaking, the standard is somewhat less strict at age 50 and older, and benefits are easier to obtain for people over that age.
Yes. Mental impairments resulting in the inability to sustain employment can qualify you to receive SSD/SSI benefits.
No. Your application for SSD or SSI benefits is first reviewed at what is called the local level. Depending on the nature and severity of your medical condition and your level of disability, you may be granted disability benefits at this level; however, if you are turned down, you have the option to appeal and receive a hearing. Many applications, which are denied at the local level, are later granted after a hearing is held. Legal representation at the local level is not necessary; however, for an appeal and a hearing, the involvement of a lawyer is advisable.
Not always. In fact, you should initially apply on your own at your local Social Security office since you may be awarded benefits at the local level without incurring attorney’s fees. If you receive a denial of your claim, you should contact a lawyer immediately since you only have sixty (60) days to appeal and file a Request for Hearing before an Administrative Law Judge.
Not always; however, we will monitor your Workers’ Compensation case for you without charging a fee. We are available during the monitoring of your case to answer your questions and review paperwork. The employer and insurer have access to legal counsel, so why shouldn’t you?
In most cases, your benefits will amount to 2/3 (66 2/3%) of your average weekly wage. Your average weekly wage is calculated based upon your past four (4) quarters of earnings. If you were an extremely high wage earner, you will be subject to a maximum benefit “cap” that is set by law, and if you earned less than a certain amount, you will either receive a statutory minimum or ninety (90%) of your weekly earnings.
By law, the only remedy you have against your employer is your claim for Workers’ Compensation benefits. Even if the work injury was your employer’s fault, you cannot sue your employer or get additional damages. Instead, your only remedy against your employer is through the Workers’ Compensation system; however, if the work injury was caused by the fault or negligence of someone other than your employer or a co-employee, then you can file suit and pursue a personal injury claim against that other person or company in addition to your Workers’ Compensation claim.
No. The Workers’ Compensation system limits payments to medical expenses and earnings loss. Specific loss benefits may be recoverable if you lose a body part or lose total use of a body part for all practical intents and purposes, such as a finger or hand, due to a work injury. The law simply does not allow for pain and suffering damages as part of your Workers’ Compensation claim.
Yes. It is common to enter into what is known as a Compromise and Release Settlement Agreement with your employer and the Workers’ Compensation insurer, which is a lump sum settlement of benefits. In appropriate cases, medical benefits may be retained into the future even though the wage claim is settled in a lump sum. In virtually every case, the involvement of a lawyer in the negotiation of such a lump sum settlement is advisable.
It depends. The employer has a right to insist that you go to a list of “panel physicians” if the employer has complied with certain requirements, such as posting a list of six (6) of these physicians at the workplace. If your employer complies with the technical requirements, then you may be required to treat with a panel physician for ninety (90) days before the Employer/Workers’ Compensation insurance company must pay for medical treatment by a non-panel physician.
In most cases, no, but you should discuss receipt of your benefits with a tax professional for tax implications in your specific situation.
Yes. You must give at least oral notice to a supervisor or someone in management within twenty one (21) days of the work injury to be entitled to benefits going back to the date of injury. If you do not give notice within twenty one (21) days of the injury, then you have 120 days after a work injury to report it to your employer. In that situation, your entitlement to Workers’ Compensation benefits does not begin until you give proper notice of the work injury to your employer.
Generally not. There are specific, fairly long term limitations on the period you can receive Workers’ Compensation wage loss benefits, normally a maximum of 604 weeks. In certain rare cases involving very severe impairments, this may extend for a lifetime. There is no time limitation regarding payment of medical expenses related to a work injury.
If benefits are paid pursuant to a Notice of Temporary Compensation Payable, the insurance company has up to ninety (90) days during which time the carrier can stop payment and issue a denial of your claim for any reason. After the 90 days have passed, the insurer can stop payment only in certain specific instances.
The above is only a brief summary of the law and your rights under The Pennsylvania Workers’ Compensation Act, as amended. If you have a Workers’ Compensation claim and need information and advice, or if you have any questions or problems regarding your claim, kindly contact the law office and we will assist you.