Social security applicants and receipients who have worker’s compensation claims would be well advised to consult with a worker’s compensation attorney and/or social security attorney prior to settling their worker’s compensation claims. 

In Indiana most worker’s compensation settlements are comprised of compensation for a person’s permanent partial impairment (“PPI”).  PPI is defined through case law as a loss of physical function.  PPI compensation is not based on a person’s past or future income loss and is not a wage replacement benefit.  It is often paid to an injured worker in a lump sum. 

Despite this, the Social Security Administration views worker’s compensation settlements, even just PPI settlements, as income and will use this income to off-set the social security benefits due to a claimaint.  However, this offset can be minimized by the use of particular language in the worker’s compensation settlement documents.  This language theoretically spreads the worker’s compensation settlement proceeds througout the claimant’s life expectancy, typically resulting in no or a much lesser offset amount. 

Without this language, the Social Security Administration will likely use a person’s temporary total disability rate to offset the social security disability benefits due.  This could reduce a claimant’s monthly benefits drastically. 

Claimants should be sure to avoid an offset to social security benefits (or potential benefits) by consulting with an attorney about the appropriate language to include in a worker’s compensation settlement.

New ODAR processing times have been released. Unfortunately, the Indiana ODAR offices continue to rank at the bottom of the list. As of May 28, 2101, the National Ranking Report ranks the Fort Wayne office number 111, the Indianapolis office number 120 and the Evansville office number 128.

Average processing time for the Fort Wayne office is 485 days. The Indianapolis office registers 501 days, and the Evansville office has slipped to an average processing time of 514 days.

Of note, I recently had two claims that were transfered from handling by Indianapolis to San Antonio ODAR. The hearings on these claims occurred in Danville, IL. This sped up the process for these claimants and helps to relieve some of the back up in Indianapolis.

I talked in my last post about the importance of continued medical treatment in Social Security Disability and SSI cases. It is a familiar scenario that many of our firm’s worker’s compensation clients lose their employer-provided health insurance when they are not able to return to work after they exhaust their FMLA or disability leave. Although they usually are entitled to continued coverage under COBRA, most of our clients cannot afford to pay the hefty premiums.

This week Congress passed a bill that might enable many of our clients to afford continued health coverage under COBRA. (Yes, believe it or not, Congress IS actually passing some bills these days!) In 2009, Congress included a provision in the stimulus bill (ARRA) under which the government reimburses the COBRA provider for 65% of the premium cost, so that the worker only has to pay 35% of what their premium otherwise would be. Originally it only covered workers that were involuntarily terminated from Sept. 1, 2008-Dec. 31, 2009, but in the bill passed this week (the “Temporary Extension Act of 2010”), it now also covers people who are terminated from 9/1/08-March 31, 2010. Premium reductions last for up to 15 months.
As you can guess, there is lots of fine print, so clients that this might pertain to will need to contact their employer’s COBRA provider to see if they qualify. Here’s a link to the DOL website that explains in more detail:

http://www.dol.gov/ebsa/cobra.html

At one of my recent disability hearings, the ALJ stopped the hearing after only 5 minutes of questioning and announced that he was approving the claim.  Although the Judge offered several reasons for the decision, the very first one mentioned was the Claimant’s consistent medical treatment throughout his claimed period of disability. 

If you have serious physical and/or mental conditions that prevent you from working, the most important reason for continuing to seek medical treatment is your health, not the outcome of your disability claim.   But it bears mentioning that the judge deciding your disability claim may well be skeptical about the severity of your condition(s) if you aren’t trying to do something to get better. 

Of course, most ALJs live in the real world, and understand (at least in theory) that sometimes uninsured, poor claimants lack the funds to pay for medical treatment.   They also understand that sometimes people may give up hope in the medical or psychiatric profession after they’ve failed to get better in spite of such treatment.  But I think many judges still feel, at least at some level, that if things are really that bad, the claimant would at least try to do something to alleviate their suffering.   

So for the sake of your health, if not for your disability claim, you need to persist over the many obstacles that might get in the way of your efforts to continue to receive medical treatment.  If lack of insurance or finances is the issue, you should go to your local Indiana FSSA office and apply for free or reduced cost health insurance. Indiana offers many options to help disabled Hoosiers obtain health insurance, including traditional Medicaid, to M.E.D. Works (a Medicaid ”buy-in” program for working people with disabilities), to the Healthy Indiana Plan (“H.I.P.,” which covers basic health services for a modest financial contribution).   

Another option for those with limited means is to obtain care from a free or reduced-cost health clinic.  Our office maintains a list of clinics and hospitals throughout the state.  Contrary to many people’s assumptions, you usually can obtain excellent care at these establishments, and, as a bonus, many of these medical providers actually are more willing to help claimants obtain necessary documentation for their disability claims than are many private physicians. 

Finally, if you aren’t getting ongoing medical care because you’ve “given up,” remember that you can always get a second opinion.  You should also keep in mind that the medical landscape changes rapidly in our country, and new treatments become available on a frequent basis.  But it’s unrealistic to expect your doctor to automatically think of you when discovering a newly-available treatment if they haven’t seen you in 6 months to a year!

The most recent processing statistics for the 3 Indiana Offices of Disability Adjudication and Review (ODAR) are out.  The good news is that the Evansville ODAR is one of the most efficient offices in the nation in terms of processing time, ranking 7th out of the 143 ODARS in the nation.  The bad news is that Indianapolis and Ft. Wayne continue to rank as two of the lowest in the nation (130th and 135th out of 143, respectively).   Indianapolis ODAR is trying to speed up its processing time by sending some cases to other offices to be “worked up” (i.e., get ready for hearing).  December’s numbers suggest that this approach seems to working because the Indy ODAR had been ranking 139th the month before.

Here are the processing times for each of the 3 Indiana ODARS as of December 2, 2009:

Indianapolis — 579 days

Ft. Wayne — 593 days

Evansville — 298 days