An older worker from Pendleton injured his back several years ago while lifting a heavy box of freight. Sadly, he herniated a disc and needed surgery, and the surgery was denied by SAIF. He contacted us and we won his case. But, SAIF appealed. While there is an appeal, a workers' compensation insurer must pay temporary disability, but they need not pay for medical treatment until their appeal is denied. Well, we won on appeal and his claim was finally accepted. He had surgery, but the disc was pinching the nerve as it exited his spine for too long, and there was permanent nerve damage and disability. SAIF was on the hook, and had to pay for this permanent disability. The amount was to be rather large. In the meantime, the injured worker had applied for social security. He asked for my help on this claim. I reviewed his case and told him we would likely win his social security benefits. (Later, we did win.) He asked what would happen to his workers' comp pay when he got his social security. I explained: Workers’ compensation may reduce your Social Security benefits. If you get workers’ compensation pay and Social Security disability benefits, the total amount can’t exceed 80 percent of your average current earnings before you became disabled, if it does your Social Security benefit would be reduced. For example, you earned $4,000/month at the time of your injury, and workers' comp pays 66% of that amount for temporary disability, $2,640. Therefore, the maximum Social Security would pay you each month would be $560. (Because %80 of our $4,000 wage would be $3,200.) In this case, your Social Security, if you were not getting workers comp, was supposed to be $2,200/month. So each month, you are losing $1,640 in Social Security benefits, because of your work comp pay. He asked: Well, is there anything that can be done? I explained: Yes. If we get SAIF to pay you in a lump sum settlement, you can get your full Social Security. The type of settlement is called a Claims Disposition Agreement (CDA), and since 1990, half of Oregon WC cases were settled a CDA. With a CDA the worker gets an immediate payment of the lump sum, but gives up rights to all other benefits, except for the right to medical expenses directly related to the injury. Most importantly, in a CDA the worker's attorney can specify a monthly amount based on life expectancy that the lump sum is supposed to compensate. In other words, your settlement may be $75,000, but since you are were expected to live 26.3 more years, 315.6 months, it amounts to $237.6/month for the rest of your life. Social Security must act as if you were getting $237.60/ month, instead of $75,000 all at once. This means you get all the work comp money in a lump sum up front, and your full Social Security monthly payment of $2,200. So, you can get both workers' comp and Social Security. Our client in Pendleton Oregon was very happy. If you have a question about workers compensation or social security please call Ransom, Gilbertson, Martin and Ratliff for a free consultation.
The Social Security Administration has two main benefit areas for U.S. citizens who qualify: Social Security Income (SSI) and Social Security Disability Insurance (SSDI). The receivers of these benefits sometimes have overlapping situations, such as old age and disability. SSDI pays benefits to people considered disabled. SSI pays benefits based on financial need, which isn't always related to health costs. Age, health, and past jobs all play a role in both branches. For our purposes, we'll focus on Social Security Disability Insurance. This benefit type applies to disabled and permanently injured people who previously worked. These people must be "insured," meaning they worked long enough and paid social security taxes. Several other factors go into qualifying for SSDI, which we'll discuss below.
What It Means to Be DisabledThe term "disabled" is subjective because there are several disability benefit programs. Each benefit provider defines disability in different ways. According to the Social Security Administration, partial or short-term disability does not qualify you for benefits. Administration rules state that disabled persons meet the following criteria:
- They cannot perform work that they used to do
- They can't adjust to other work because of any medical condition(s)
- Their disability has lasted a certain amount of time and will continue to last or result in death
How to Apply for Disability BenefitsWhen it comes to applying for benefits, it's always important to apply as soon as you become disabled. Procrastinating your application can cause several problems. You could lose necessary documentation, or you could no longer qualify for benefits. No matter how intimidating you find the process, you deserve to see it through. The application process is complex for a reason; it's important to deter people who just want a free ride. Many people deserve these benefits, but getting them is often another matter. Follow the basic outline below to get an idea of where to start. Steps to Apply First, familiarize yourself with the application process.
- Visit the Social Security Disability website (http://www.ssa.gov/dibplan/#sb=3).
- Read through their various helpful publications (http://www.ssa.gov/dibplan/dapply.htm).
- Complete an online application.
- Call the toll-free number (1-800-772-1213) with any questions.
- Visit the nearest Social Security office (https://secure.ssa.gov/ICON/main.jsp).
- Original birth certificate
- Proof of citizenship
- Medical documentation: records, doctor reports, test results Recent and valid W-2 forms or self-employment tax forms
- Valid pay stubs, award letters, or settlement agreements
- Proof of any temporary or permanent benefits (including workers' compensation)
- Military discharge papers if you served before 1968
- An official adult disability report
Why Previous and Existing Benefits MatterThose applying for benefits often ask whether it's possible to have multiple benefits. There are several types of financial aid for disabled persons. Each one has its own rules, requirements, and regulations. These aid programs include:
- Workers' compensation
- Public disability benefits Civil service disability
- Temporary state disability
- Other government retirement benefits based on disability Social Security Disability Insurance