Workers Compensation - Marcotte Law Firm

Workers Compensation vs. Social Security Disability (SSDI)

Marcotte Law Firm LLC — Wed, 23 Dec 2020 15:20:43 GMT

Many people ask about the difference between Workers Compensation benefits and Social Security Disability Benefits (“SSDI”). While there are certainly differences between them, what many people don’t think to ask is whether you can collect from both programs at the same time. The answer might surprise you. If you have been injured at work and have or are receiving Workers’ Compensation, you may also be eligible for disability payments under Social Security’s SSDI program. Because there are no asset limitations for SSDI, getting Workers Compensation payments does not automatically preclude you from qualifying for SSDI. However, that does not mean that there will be no impact on any potential SSDI benefits. In most situations, Social Security requires that SSDI benefits be reduced or “offset” so that the total monthly amount that a disabled worker receives is no more than 80% of the amount she/he earned when she/he was fully employed (“average current earnings”). In order to calculate the offset amount, Social Security will first determine the maximum total monthly amount of combined benefits that the recipient is allowed to get under federal law. This is known as the “applicable limit.” If, in any given month, a claimant receives money exceeding the applicable limit, then Social Security will offset SSDI payments in the amount required to bring the total back down to the applicable limit. An offset is most common among individuals who earned lower incomes when they were working. This is due to the fact that their applicable limits are lower and more easily exceeded once the worker starts to receive both SSDI and workers compensation. For most SSDI recipients, Social Security finds average current earnings by using what is known as the “high one” test. The “high one” test takes the average monthly earnings from your single highest-earning year from any one of the five calendar years before the individual stopped working due to their impairments. Let’s take a look at an example of how this works: John Smith was seriously injured at work on January 1, 2020. His highest one year of earnings over the previous five years was in 2018, when he earned $48,000, which averages to $4,000 per month. This is his “average current earnings.” Through Workers’ Compensation, he receives $2,4000 a month. Remember, a disabled worker cannot receive more than 80% of his average current earnings. For Mr. Smith, 80% of his average current earnings ($4,000) is $3,200. Therefore, his Workers’ Compensation combined with SSDI cannot exceed $3,200. If we subtract his $2,400 a month Workers’ Compensation payments from $3,200, we are left with $800. This is the offset amount and the most Mr. Smith is eligible for under SSDI. The above example applies to instances where you are receiving monthly Workers’ Compensation payments. But what if you settled on a lump sum payment? SSA will still offset your SSDI amounts in a similar fashion. The most common way this is done is by converting the lump sum into a monthly payment for purposes of establishing the offset amount. Without that conversion, you will likely be unable to collect Social Security for many months, if not years, after your settlement. Therefore, there will likely be a “Sciarotta” application, where the money is broken down to a monthly payment for the rest of your life. Your lawyer will calculate your life expectancy and use that to calculate your monthly allocation. For example, a 45 year old man who has a lump sum settlement of $20,000.00 will have a Social Security Disability offset of just $45.41 per month.

In order to reduce your offset and maximize your Workers’ Compensation and SSDI benefits, you should consult with an experienced attorney who can draft a settlement agreement that leaves you with the most money possible each month. Attorneys try to draft Workers’ Compensation settlement agreements to minimize any offset of benefits. Social Security may review the settlement agreement when deciding how much of the settlement is subject to offset. Attorneys will also draft the settlement agreement to exclude medical and legal expenses from the lump sum that is counted for Social Security.

What is Workers Compensation?

Marcotte Law Firm LLC — Mon, 26 Oct 2020 11:51:47 GMT

Most people know that if you were injured at work, you may be eligible for what is known as “Workers’ Compensation.” But, oftentimes, injured workers don’t know what kind of benefits are available, and they don’t always know how to qualify. What is Workers’ Compensation? Workers’ Compensation is a form of insurance that every employer is supposed to have to cover injured employees. While there are many types of benefits available, the two main types of benefits provide wage replacement and medical benefits to employees injured during the course of employment. One of the good things about Workers Comp is that it is supposed to provide you benefits right away. The system was set up this way because when a worker is injured, he/she might not be able to pay rent or put food on the table if they go too long without a paycheck. However, there is a tradeoff for these “quick” benefit. Under the Workers’ Compensation system, the employee forfeits the right to sue his or her employer for negligence. Should I get an attorney for my Workers’ Compensation claim? According to the Commonwealth of Massachusetts, half of all injured worker claims are not disputed by an insurer or employer. This means that you should receive your benefits without having to “put up a fight” with the insurer or employer. If the insurance company agrees to pay the claim without any pushback, you can get your first check in a week or two, and then either weekly or bi-weekly after that. However, this doesn’t mean you don’t need a lawyer. Even in undisputed claims, having Workers Comp attorney can help facilitate the process with the insurer and get you your payments as soon as possible. The attorney can make sure you’re getting the right amount of benefits. Your lawyer will also be able to tell you when it’s best to think about settling your case. In short, Workers’ Compensation can be complicated and having an attorney on your side can help you navigate through these issues. Many people who come see us are not as lucky. The insurance company that’s supposed to pay for your injury denied your claim. If that’s the case, it is a good idea to work with an attorney to protect your rights and interests right away. In these situations, you have to file a claim with the Department of Industrial Accidents (“DIA”), which oversees the Workers’ Compensation system in Massachusetts, and have your case heard in front of an Administrative Law Judge (“ALJ”).Going in front of a judge and getting your benefits can take up to five (5) months, so waiting to hire an attorney is never advised. What does the claim appeal process look like? In the event you and your employer’s Workers’ Compensation insurer can’t agree on your claim, the DIA will help settle the dispute through a four-step process:

Conciliation – A conciliation is an informal meeting between you, your attorney, the insurer’s attorney, and a conciliator from the DIA.
Conference – A conference is where the judge makes an initial determination about your claim. It is still an informal process, despite the ALJ’s presence. At the end of the conference, the ALJ will issue an order.
Hearing – If the conference order is appealed, the case will go to a full evidentiary hearing. This hearing is similar to a trial. Witnesses are called, and a stenographer records testimony.
Reviewing Board – If a hearing decision is appealed, the DIA’s Reviewing Board hears the appeal. Three (3) ALJs will examine the hearing transcripts. The reviewing board has some discretion as to how the review will proceed. They can ask for oral arguments.

They can affirm the hearing decision with no discussion or they can send a decision back to the administrative judge for further findings of fact. The process can be a long one and it can be in your best interest to have an attorney at your side. If you’ve been hurt on the job, it’s important to find an experienced Workers Compensation Attorney quickly so that you can get your benefits as quickly as possible.

Pay Without Prejudice

Marcotte Law Firm LLC — Tue, 07 May 2019 22:07:38 GMT

When you’re hurt on the job and you can’t work, the insurance company should be paying your wages. However, what many people don’t know is that an insurance company can decide to stop paying you without much notice.

This is called the “Pay Without Prejudice” period. For the first 180 days you receive Workers Compensation, the insurance company can decide to stop paying you with only about a week’s notice. If you’ve been on Workers Comp for more than 180 days, the insurance company can’t stop your benefits without getting approval from the Department of Industrial Accidents. Since this process can take a few months, it gives workers time to plan their finances.

The one thing to watch out for is that sometimes insurance companies ask workers to extend the 180-day period. The insurance company will still pay you, but they’ll still have the option to stop paying you with only a week’s notice, as opposed to a few months.

If you’re injured on the job and you’re receiving Workers Compensation, you might think that you don’t need a lawyer. Unfortunately, circumstances can change very quickly. It’s best to have a lawyer in place before you need him/her. That way, should something happen, the lawyer is ready to take action as soon as possible.

WC Payment Delay

Marcotte Law Firm LLC — Fri, 24 Aug 2018 21:49:59 GMT

The workers compensation system was created to make sure that injured workers can get quick and fair compensation when a work injury keeps them away from the job. But whenever you throw insurance companies into the mix, it’s not always that easy.

At Marcotte Law Firm, we always tell our clients that there are two ways to get workers compensation benefits. First, the insurance company can pay you voluntarily. Second, you can file a claim and get a judge to force them to file benefits. Obviously, the first option gets a check in your hand much faster than the second.

If the insurance company agrees to pay you voluntarily, you can get your first check in a week or two, and then either weekly or bi-weekly after that. If you have to file a claim and force the insurance company to pay, it can take up to 5 months to get in front of a judge.

At Marcotte Law Firm, we always counsel our clients with the goal of getting them benefits as quickly as possible. We understand that it’s not always an option to go 5 weeks without a paycheck. Therefore, we do our best to get insurance companies to voluntarily pay our clients while at the same time building a case to file a claim if necessary.

If you’ve been hurt on the job, it’s important to find a lawyer quickly so that you can get your benefits as quickly as possible.