Puzzled over Workers' Comp and when to file for SSDI

[Wink]

Hey, Everyone.

This is my deal: The Workers' Comp Commissioner recently awarded me Permanent Total Disability with the maximum 500 weeks...AND Lifetime Open Medical Benefits! My lawyer said that the defense would more than likely appeal, but not to worry. OK..So I wait and see what happens with that.

Now...what I'm concerned about is this: a few months before my WC Hearing I emailed my lawyer and mentioned that I wanted to file for SSDI. The answer I received back via email was, "It will cost you THOUSANDS of dollars and the Insurance Carrier will not settle with you as Medicare will place a lien on your file. In essence, you will be SCREWED if you file for SSDI before your WC case is over. You will file for SSDI AFTER you're settled with Workers' Comp, then we will work on the SSDI". How will I lose thousands if I file for SSDI before the WC is settled?

What is everyone's take on this? 0f course, I have more questions, but later on.

Thanks for your time and thoughts!

Wink
South Carolina

[Barb]

Winky

I think most on the other board are thinking of the set aside amount - but if you have lifetime open medical on your injury then medicare shouldn't be out any cost for your injury at all and that is the main concern for medicare to begin with is my understanding.

I have already applied, but I started the process awhile ago because of health reasons including the work related reasons. Like you said - someday my story will be a good one. Lets just say my last IME was 12 pages long..... lol

My wc attorney is fully aware of the ssdi claim as so is the defence attorney and my ssdi attorney is fully aware of the wc claim. It gets complicated but you have to keep everyone in the loop as to what is going on.

If I were you, I would discuss with your attorney exactly why he feels you would lose out of thousands in settlement if you have lifetime open medical in your case and medicare wouldn't be out any monies to begin unless he feels that you will have to fight for treatment in the future.

[angel1954]

Hi
I had called about getting ssi started for my son who is borderline retarded with cognitive disorder and I was telling the social security office about how I dont work now and about my arm and the rsd and they said it sounded like I needed to also apply for myself.I told them it was workers comp. They asked about a settlement and I told them I hadnt settled yet and they said if I would apply and get disability then they would get a portion of my settlement. I really dont know why though and I didnt mention the open medical my attorney wants to go for. Also,in the state of Illinois my attorney said the only way you can get open medical is by a settlement hearing and its like a trial and the judge decides the settlement amount. Thats kind of scary. I am supposed to have rsd so will always need to see drs.I still dont know why social security would take part of your settlement though. That doesnt seem fair.Angel

[wildone2mo]

S.S will take a portion of you settlement to treat your condition from your injury, set aside money it is called after all the goverment does not want to pay for your injury so they set aside money from your settlement for it. I would apply for SSDI or SSI to think you can be rich off of WC is a dream, you will need some help as long as you have your settlement worded right to say the money from your settlement is broke down to show lifetime benifit. for ex: lets say you have 40 years left on life time chart goverment uses and you know you can make 80% of your wages befor you got hurt so you can collect SSDI,SSI and WC checks as long as they equal 80% of what you made at your old job. so take your last 40 hour pay stub 80% from that is what you can make a week.

[Wink]

S.S will take a portion of you settlement to treat your condition from your injury, set aside money it is called after all the goverment does not want to pay for your injury so they set aside money from your settlement for it. I would apply for SSDI or SSI to think you can be rich off of WC is a dream, you will need some help as long as you have your settlement worded right to say the money from your settlement is broke down to show lifetime benifit. for ex: lets say you have 40 years left on life time chart goverment uses and you know you can make 80% of your wages befor you got hurt so you can collect SSDI,SSI and WC checks as long as they equal 80% of what you made at your old job. so take your last 40 hour pay stub 80% from that is what you can make a week.
wildone~

I didn't say anything about thinking I was gonna get rich--or that I was "dreaming". I simply stated some facts and a question.

Wink

[Wink]

Hey, Pooh~

It's just that I'm harping on this thing (gathering all the info I can) BEFORE I reapproach my lawyer--armed with knowledge just in case he tries to blow smoke up my derriere. See? He's been an excellent lawyer thus far...but still...I've learned in my lifetime NOT to be completely trusting of anyone but myself.

Wink

[wildone2mo]

well even if you settle and then apply for SSDI you will still haft to pay them money, after all they will not pay for your work injury. Hey did your lawyer tell you IC will probably appeal your verdict too? Just asking and as for open medical you do know the IC can give you a hastle with that right anytime they want to they can do the IME again..GOOD LUCK GOOD FOR YOU for winning...

[Wink]

Wildone~

Yes, I was told by my lawyer that that the IC would more than likely appeal--I mentioned that in my original post. In fact they've probably already done that. I just haven't been in touch with my lawyer about the latest yet. He did tell me earlier, that if it goes up for appeal, it'll be in front of 3 commissioners and that normally they don't go against the single commissioner's original decision...unless the commissioner was somehow erroneous in legalities, etc.

Thanks for the good wishes. I'm not familiar with your case, but I hope things work out for you, too.

Wink

[wildone2mo]

Hey Wink I hope that you WIN the IC is all about the money if they can have that money sit in a bank a day longer for intrest is all they care about, good for you WINK for getting this far I know we all deserve more than what they offer I wish we could get it, for all the BS we haft to go threw because of the IC trying to screw us. Wink my case is one of thoughs complicated ones, once they got a diagnoses they did not like they went into trying to make me look like a faker and someone who is crazy mode, I did not let them win that and am in it for the long run...I believe they made me worse, Wink the system is always against us even with SSDI the goverment wants to control your settlement. I hope you can get in touch with your lawyer soon and he walks you through this, if anything WINK get a hold of a S.S lawyer I have one firm that only handles WC cases that is all they do and one firm that just does S.S. cases both lawyers will work with each other when the time is right, I just believe I want a firm that does not spread them selves out to far..any way if you see a S.S lawyer it wont cost anything for a meeting in case you need them..

[Wink]

Hey, Wildone~

Yes, I guess I do need to find a good SSDI lawyer and have a good "sitdown" with him/her. It's like I told Pooh--I'm just trying to gather all the info that I can from good folks like you and others BEFORE I question my lawyer or retain a SSDI lawyer. Knowledge...is as they say, "power"--and having such power when it comes to matters like we are going through will leave us less vulnerable to mistakes lawyers tend to make at times--whether they're made intentionally or unintentionally. :)

[caudaequinasyndrome]

listen to your lawyer, sounds like he is giving you good advice.
if your settlement closes medical , than you have to set aside monies for medicare.
in new york state almost all settlements include medical being terminated, therefore medicare doesn't want to get stuck with workers comp medical bills.
in nys you don't have to settle ,ever.
if your settlement leaves medical open than most likely you would not have to set aside for medicare, since WC is still on the hook for your medical,
ask your lawyer to explain the reason why heis advising you this way

[Wink]

Hey, backless~
It's real good to hear from you! Backless, I have always been in South Carolina--and my case is here too. Yep, the Commissioner handed me a good decision. I'm just waiting to see what's going on with the appeal from the "other side". My lawyer said not to worry...that they appeal for the **** of it.

As you know, I'm concerned about what my lawyer told me regarding me filing for SSDI. I want to trust him, but I can't help but question him anyway. I just don't want to SCREW myself by making the wrong move. It's like Bad Boy said over at: http://www.workerscompensation.com/c...d_Worker_Forum "Well, I have to say since Winky brought up such question, I have spent hours on end trying to find the answer. Can always find the answer if one is on SSDI before their settlement, but never anything to the fact if one waits till after their settlement to apply for SSDI. Once found a small reference point on reduction, and Medicare reduction where the injured worker then pays all medical in regards to such injury. But was to vague to mention. Not enough material to base a fact on. Now I have been hearing people say their Attorney said not to apply for SSDI at this time, or wait till after they settle their WC case. Why...I have not one single idea. Is it the work it takes if one is on SSDI they don't want to deal with? Or is it truely a fact you will save money by waiting? We don't know, nor have we had any person yet come forward and say they done that that way. Will one gain, or will one lose? We are simply now got to the point of wanting to find out, to share the knowledge of wealth with many others. It surely will help others someday down the road. Join in if you all like, for Winky and I have been driving ourselves crossed eyed trying to find this information. So we welcome anyone to help".

BTW, my screen name is "Winky" over there.

I hope you're doing alright these days! Talk to you later!

Also, Thanks everyone for you thoughts!

[jitterbug]

I'm from Mi. & my husband just settled his workmen's comp claim in July. Now the answer to your question may depend on your state you live in. Each state has there own workmens comp laws.
In Mi when you settle you have to appear in front of a workmens comp judge.

You know the thought I have when reading your first post is will you make more on SSDI than workmens comp.. They figure your monthly workmens comp income & only pay you up to the SSDI level you would normally get. My husbands SSDI total & workmens comp total was almost the same. At approx $2000.00/mo your monthly your SSDI benefit would have to be pretty high.

Are you going to try to settle with workmen's comp? If not, why not apply for SSDI, at least you would get medicare but your workmen's comp injury would be covered under the workmens comp insurance. Another thing you may want to ask your lawyer is: My husband was told workmens comp benefits do not stop at retirement age, they continue to pay right along with the Social Securiy. If you do decide to settle Social Security it only requires a portion of the settlement, if any, to offset future medical bills for your workmens comp injury.

My husband did apply for his SSDI prior to the settlement but SSDI refused him on the first round (which is normal) & now we are waiting for the appeal. When he settled the workmens comp judge on the case decided not to withhold any money for future social security.

Our lawyer also advised us to settle before the SSDI was approved for the same reason your lawyer gave not to file.

While working we received a yearly letter from Social Security stating approximately what our benifits would be at retirement or disability. You could check that letter if you received one
or call your local Social Security office to find out the info.& you would know where you stand.

There is also a retired disability examiner on this web site maybe she can point you in the right direction also.

I hope I helped...Good Luck
TJ

[graymatters]

In NY, SSDI puts a lien on your settlement anyway. WC will not pay for anything related to the injury, no matter if before or after settlement of a WC claim.
That can get complicated.

Say you have a knee injury from the work related claim. In 6 months your hip starts acting up because of the knee. Is it WC or another medical issue.
My lawyer said,even though they generally do not recommend applying till after settlement there are reasons why you should.

COBRA runs out.
*You have another medical condition requiring health insurance.
*You have dependents who will get benefits because of you reduced income from WC.
*In NY the max WC is 400 a week. You could possibly get more from SSDI.
*Establishing your medical status at the time of a SSDI claim can potentially eliminate issues of prexisting clauses, as the example of the knee and hip prob. They did not exist at time of SDDI approval. Who knows how an injury can progress over time. Sometimes it only takes a few months for things to deteriorate medically.

In my case it is a disaster since we throw in a third party lawsuit. There are liens on liens and everyone wants a piece of the pie.
All I want is a weekly check and my medical covered. Medicare is not a great place to be in, but a WC injury is a pre-existing injury to all insurance carriers, even if you are the spouse of someone with medical coverage.
I did not get approved for SSDI on the first try. It took an emergency hardship appeal to be approved.
Interestingly enough, Medicare will pay for a drug my private health insurance won't!

[~abc~]

Your Attorney is probably trying to get you to settle without SSDI so he can take a larger chunk of the settlement. You should apply for SSDI. Attorney had your best interest at heart he would tell you to do the same also. If you are leaving Medical open for life, a Medicare Set A Side is not needed. Plus your Attorney can add the Utica-Mohawk Language to offset the amount you may lose to SSDI. You will then get your settlement, and still receive your SSDI payments.

I am receiving W/C and SSDI. I don't get my full amount of SSDI because it would add up to more than I brought home at the time of my injury(80%between the two - SSDI is offset). If you have any children under the age of 18, they are also eligable to receive a check each month.

By not filing you are only adding to the negative - the time that SS uses to figure your benefit. When you apply they will only go back 12 months from the date of injury to award benefits. If you are denied, file for reconsideration, if denied again file an appeal for a hearing. It took me over three years to be awarded SSDI benefits - the process can be a long one.

You can actually make more after you are awarded SSDI while you are collecting W/C (atleast in my state). My SS check almost equals my W/C check.

Here's a link, maybe not from your state, but pretty much sums up settlements/SS.

http://www.illinoiscomp.com/medicare/HRVA%205-11-05%20Social%20Security.pdf

[mariah]

It's so hard to keep everything straight isn't it? My medical card is paying for my pain medication, and they know I will be getting a settlement soon ( I hope). They told me (Social Security) that when I get my settlement, to let them know, that they will suspend my check until I've spent the money, to save all my receipts showing what I spent the money for, and when I've spent it all ( I can keep $2,000.00 cash) to let them know and they will reinstate my monthly benefit. I asked them, if I will have to reapply, etc., etc., and they said no.

[Mariaa]

I have been on SSDI for 7 years now and have future med on low back since early 80's. I worked for much of the time since that award so didn't utilize those benefits for a while.

I was just sent a letter from the IC and was asked if I wanted to do a compromise and release or medicare set aside and it looks like either way one is screwed and esp. if it's a retroactive situation re SSDI and medicare set aside. Ouch..

My preference is just to keep things as they are for now and not do anything differently except eventually have the surgery that was authorized (3rd spine surgery) and then see where things are at.