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A Brief Guide to Workers' Compensation and Social Security Disability Claims The questions and answers below give you an idea of what to expect if we represent you. The following information is meant to be general in nature and should NOT be construed as specific legal advice on any individual case. Workers' Compensation information applies ONLY to Pennsylvania Workers' Compensation claims.
About Workers' Compensation What is Workers' Compensation? Pennsylvania passed its first Workers' Compensation Act in 1915 to provide monetary compensation to workers injured in the course of doing their jobs, regardless of fault. The term "injury" includes occupational disease, repetitive and wear-and-tear type injuries, as well as traumatic injuries, such as hearing loss. Who files my Workers' Compensation claim? Blaufeld Schiller & Holmes files the claim on your behalf with the Bureau of Workers' Compensation in Harrisburg. We also see that your employer and employer's insurance company receive copies of the petition. What happens after the claim is filed? You and our office will be notified that the petition has been assigned to a Workers' Compensation Judge. Four to six weeks later, the Judge will notify you of when and where your hearing will occur. Typically, the location is somewhere in the county in which you live. Read notices carefully so you appear at the right place and time. We will confirm the information with you as well. When do I meet with my lawyer? We will meet with you before your first hearing and any subsequent hearings. How many hearings will there be? Typically, there are more than one, sometimes as many as three or four. Your employer may present witnesses at a second or later hearing. What should I expect at a hearing? We will prepare you before the hearing where you will testify under oath about your injury or disability. In addition, a lawyer for your employer or employer's insurance carrier will cross examine you. Be sure to arrive at the hearing location at least 30 minutes early so you and your lawyer can make final preparations. If your disability involves more than 52 weeks of compensation, we will ask your doctor to testify. This usually takes place in a deposition at the doctor's office under oath before a court reporter. Your lawyer and the employer's lawyer each question the doctor. In Workers' Compensation cases, most medical evidence is gathered in this way. If your disability involves fewer than 52 weeks of compensation, however, your doctor's reports are sufficient. In addition, either side may have other witnesses testify by deposition. All testimony is considered in the Judge's final decision. How long does it take to receive a decision? It is not unusual to receive a decision one year or more after the petition is filed. Many factors can influence the course of a case, including availability of witnesses, the Judge's schedule and the complexity of the case. Once the case is filed, the Judge, not our firm, controls the schedule. When the Judge makes a decision, he/she will send the written decision to you, our firm and the other parties. Can I appeal the Judge's decision? Yes. Anyone who disagrees with any part of the decision may appeal, including you. If there is an error of law in the Judge's decision, it can be overturned on appeal. However, no new evidence is taken during an appeal. Appeal arguments are held before the Workers' Compensation Appeal Board. You will be notified, but need not appear. We will represent you at the appeal and file a supporting brief. Will I be paid benefits during the appeal process? Usually the defendant (your employer) requests that no benefits be paid during the appeal process. This request is called a Petition for Supersedeas. However, we will file an opposition. If the Appeal Board denies your employer's petition, you will be paid benefits during the appeal if you won. The decision on Supersedeas is an interim order and cannot be appealed. Who actually pays my Workers' Compensation benefits? If your case is successful, your employer or the employer's insurance carrier will pay your benefits, usually bi-weekly along with all reasonable and necessary medical expenses resulting from work injury. Can I also collect for pain and suffering from my injury? No. Workers' Compensation does not cover pain and suffering or lost fringe benefits. While this may seem unfair, it is important to remember that the issue of negligence is removed by law from Workers' Compensation. You do not have to prove that your employer's negligence caused your injury and disability. Even if your own negligence caused the injury and disability, your employer cannot use that as a defense to avoid paying the claim. How are my benefits determined? Your benefit rate is based on your average weekly wage during the twelve months preceding your injury. You will receive two-thirds of that amount, up to a State maximum. We receive a fee only if we win your case. It is all explained in a written fee agreement you sign when you retain our firm and which is presented to the Workers' Compensation Judge at the first hearing. The Judge orders the attorney's fee to be paid only if we are successful. The fee is usually 20% of your award or settlement. Once I start receiving benefits, do I still need a lawyer? Many things can happen after benefits are awarded. There may be changes in the Workers' Compensation Law and/or your right to receive benefits. The employer or insurer may try to terminate compensation benefits or may begin vocational rehabilitation. In any of these situations, it is important that you be represented.
About Social Security Disability
SSD is disability coverage for injured workers. SSD is not need-based; rather it is based on quarters of coverage worked. Typically, you are covered if you have worked in twenty of the last forty quarters. What is Supplemental Security Income (SSI)? SSI is disability benefits for disabled children or adults who have not worked enough to be eligible for SSD. SSI is a need-based program. To be eligible, you must be disabled and have no other forms of substantial income or property to meet your needs. How do I file for Social Security Disability or Supplemental Security Income? You can file your claim in person or over the telephone at your local Social Security office. It does not cost anything to file a claim. What happens after I file a claim? The Social Security office obtains information from you and your doctor to determine if you will be found disabled. Social Security also may choose to send you for a medical examination. When the Social Security office has gathered all the relevant information, it makes an initial determination of disability. Most people are denied at this level. Yes. The next step is to file a Request for Reconsideration. We will file this on your behalf with Social Security. Social Security may eliminate the Reconsideration level. If so, the next step is a Request for Hearing. Can I appeal again if I am denied? Yes. This time, we file a Request for Hearing on your behalf. This results in a hearing before an Administrative Law Judge (ALJ). We prepare you for the hearing and represent you there. We also obtain reports from your doctors in an attempt to prove your disability. Why do I need a lawyer at my hearing? Social Security has many complicated regulations that govern the determination of disability. It is important to understand those regulations and apply them appropriately to your case. In addition, it is essential to apply your age and work history in your favor. After my hearing how long will it take to receive a decision? It may take several weeks or months to receive a decision. After the hearing, the ALJ reviews the testimony and medical evidence in order to make a decision about your disability. The written decision will be sent to you and our office. If I lose before the ALJ, can I appeal again? We do not appeal every case. However, if we think that an appeal is warranted, we can pursue your case to the Appeals Council of Social Security and then to the Federal District Courts. If I win my case, when do I start to receive benefits? It usually takes 30 to 60 days for your checks to begin. Your first check will represent benefits due from the onset date of your disability to the month in which the first payment is made. Then, you will receive a monthly benefit check. Remember, the first five months of disability are unpaid. Usually, you are eligible for Medicare coverage two years from the date your benefit payments began. How are my benefits determined? Benefits are generally based on the amount of money you made while working. SSD also may provide benefits for your spouse or dependent children. We receive a fee only if you get benefits. This means the fee is contingent on winning your case and it is all explained to you in a written fee agreement you sign when you retain our firm. The fee is usually 25% of your past-due benefits.
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