what every ssdi aorney should know about wc, stdi, and ... · •stdi & ltdi –benefits are...
TRANSCRIPT
WhatEverySSDIA/orneyShouldKnowAboutWC,STDI,andLTDI
BenefitsBillParsons
HAWKSQUINDEL,S.C.222W.WashingtonAve.,Ste.450
P.O.Box2155Madison,WI53701‐2155wparsons@hq‐law.com
tel:608‐257‐0040|fax:608‐256‐0236www.hq‐law.com
OpeningThoughts
• Understandingwhatelseisoutthereforyourclients
• Timingissues–whentoapply,whenyoumustappeal,statuteoflimita]ons
• Whatoffsetswhat?HowSSDIinteractswithWC,STDI,andLTDIbenefits
4.19.12
WhatElseIsOutThere?
• Worker’sCompensa]on–MostEmployees
– FederalEmployees
– RailroadEmployees
4.19.12
WhoisEligibleforWCBenefits?
• Employee
• SustainsanInjury
• DuringCourseofEmployment
• ArisesOutofEmployment
• NotSelf‐Inflicted
4.19.12
WhoisEligibleforWCBenefits?
• Employee– Primarytestiswhethertheallegedemployerhastherighttocontroltheallegedemployee’swork• Righttofire• Paysemployee
• Furnishesequipment
4.19.12
WhatBenefitsAreAvailable?
• Penal]es– DelayinPayment–10%
– BadFaith–200%– RefusaltoRehire–UptoOneYear’sWages
4.19.12
WhatElseIsOutThere?
• ShortTermDisabilityInsurance– OfferedThroughEmployer
– PurchasedOutsideofEmployment
– StateEmployees–IncomeCon]nua]onInsurance
4.19.12
STDI–WhatBenefitsAreAvailable?
• Variesfromcontracttocontract
• Generallyreplacesapor]onoralloflostincomeforalimitedperiodof]me– Afewweekstoafewyears
• GenerallynotavailableifdisabilityresultedfromWCinjury
4.19.12
WhatElseIsOutThere
• LongTermDisabilityInsurance– OfferedThroughEmployer
– PurchasedOutsideofEmployment
– StateEmployees–40.63&40.65benefits
4.19.12
LTDI–WhatBenefitsAreAvailable?
• Variesfromcontracttocontract
• Incomereplacementorpercentagethereof
• TypicallykicksinalerSTDIbenefitsareexhausted
• WillcoordinatewithWC
• Typicallypaysun]lage65orNRAunlesslimita]onsapply–MentalHealth/Self‐ReportedCondi]ons
4.19.12
LTDI–WhatBenefitsAreAvailable
• TwoperiodsofDisability– OwnOccupa]on• FromendofSTDIforsomeperiodof]me
• Variesfrompolicytopolicy
• 6monthstoremainderoflife
• EasierstandardthanSSDI– Canpersonperformthematerialdu]esofownoccupa]onasjobisperformedinthegeneralmarket
» Bewareunusualjobrequirements/thebadsupervisor
4.19.12
LTDI–WhatBenefitsAreAvailable
– AnyOccupa]on• Beginsalerownoccupa]onperiodends–usuallylastsun]lage65orNRA
• CanyouearnatleastXpercentofpre‐disabilityincomeperforminganyjobinthegeneraleconomy?– Basedoneduca]on,jobhistory,transferrableskills,workrestric]ons
• StandardmaybeeasierthanSSDI– EarningsthresholdmaybehigherthanSSDI“gainfulwage”
– Dependsonpre‐disabilityearnings
4.19.12
WhatElseIsOutThere?
• OtherBenefits– Sickness&AccidentBenefits– DisabilityPensionBenefits– LifeInsuranceBenefits–WaiverofPremiums
4.19.12
WhatElseIsOutThere?
• Listisnotcomplete–butagoodreference
• Importanttoiden]fyallpoten]alsourcesofdisabilityincomeforyourclients
• Checklist
4.19.12
WhenToMakeAClaim‐WC
• Assoonaspossiblealerinjury– Bestchanceofgeqngclaimapproved
– Commondenial–notcrediblebecauseclaimantwaitedtoolongtoreportclaim
–Within2years
–Within12years
4.19.12
WhentoAppeal/SOLforWC
• Appeal&SOLissameissueforWC
• Mustfilehearingapplica]onwithintwelveyearsalerlastpaymentofTTDbenefits– Ifnone–withintwelveyearsofdenial
4.19.12
WhenToMakeAClaim‐STDI<DI
• Inadvanceofleaveifplannedevent
• Assoonaspossiblealerleavebegins
• Termsgovernedbyplandocument–readcarefully
• Donotnecessarilyneedtoremainemployedtomakeclaim– Disablingeventmustoccurpriortoendofemployment
4.19.12
WhentoAppealSTDI<DI
• ERISAvs.Non‐ERISAplans– Whatisthedifference
• MostplansareERISAPlans• Excep]ons
– GovernmentPlans– PrivatelyPurchasedPlans– PayPrac]ces
» PaidbyEmployeroutofgeneralfunds–notinsured
– ERISAPlans–180daysfromdateyoureceivedenialle/er
– Non‐ERISAPlans–vary.Basedontermsofplan.Usuallyshorter.Makesuretonotethis.
4.19.12
ANoteAboutERISAAppeals
• IfplanisgovernedbyERISA–developingtheadministra]verecordiscrucial– Allyouwillhaveifyouneedtobringlawsuit– Getthegoodstuffin• Voca]onalreports• FCE• MedicalSourceStatements
• Witnessstatements
• ResponsestoIME
4.19.12
NonERISAAppeals
• S]llImportant…but– Ifdenied,youhaveeitheracontractclaimoranunpaidwagesclaim
– Inanyevent–youhavediscoverypower
4.19.12
Let’sTalkOffsets
• TakeAway–Almostalwaysmakessensetoapplyforanyotherbenefitsthatareoutthere
• WC,STDI,andLTDIwillnotreduceSSDI
• ThesebenefitsarereducedbySSDI
• Youra/orneyfeeonSSDIwillnotbeimpacted
4.19.12
Let’sTalkOffsets
• STDI<DI– BenefitsarereduceddollarfordollarbasedonSSDIbenefits
– IncludingSSDI‐Dependentbenefits– Includingretroac]veaward• Clientsneedtohangontothismoney
– Evenwithoffset–be/ertohavebothbenefits• Somethingpermonthisbe/erthannothingpermonth• Minimummonthlybenefits• TagAlongbenefits(healthinsurance/lifeinsurance)
4.19.12
Let’sTalkOffsets
• WC– FormulausedtoreduceWCbenefitsbasedonSSDIaward–includingCOLA
– Notadollarfordollaroffset– DWDwillperformthesecalcula]onsforyou– OffsetendswhenindividualtakesSSDI‐Re]rement
– Ifoffsetapplies,a/orneyfeesawardedontopofWCbenefits
–MostpeoplewithWC&SSDIhavePTDorLOECWCclaims
4.19.12
FinalThoughts
• Therearealotofbenefitsoutthereforyourclients
• Makesuretheyaregeqngthefullpackage
• Spotissuesforappeals–meetdeadlines
4.19.12