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Will My Health Insurance Continue if I File for Workers’ Comp?

By Ali Overby

Many people wonder how filing a workers’ compensation claim might affect their employment status and their benefits – especially their health insurance.

It’s important to understand that your employment relationship with your employer should remain the same even though you have filed a workers’ compensation claim for an on-the-job injury. Although you are pursuing a claim, you are still an employee of this employer and you should continue to receive benefits just as you always have. You should pay the same health insurance premiums, if any, that you are normally required to. Your employer should continue to pay their portion of your health insurance as they have been doing.

What Happens if I Go Out of Work Receiving Workers’ Compensation Checks?

If your authorized treating provider writes you entirely out of work or your employer is unable to accommodate your work restrictions, you will be placed out of work. You will stop receiving your regular paycheck and you should begin receiving weekly workers’ compensation checks from the workers’ compensation insurance company that services your employer.

This is called temporary total disability or TTD. Your TTD payments are two-thirds of your average weekly wage for the 52 weeks prior to your work injury. While you are out on TTD it is important to talk to your employer about how to maintain your health insurance coverage.

If you usually contribute to your health insurance premium through payroll deduction, your employer may not automatically notify you that you need to continue making these contributions to maintain your health insurance.

Do not assume your regular health insurance contributions are coming out of your TTD check!

If your employer continues to make health insurance payments for you, but you are not making your usual contributions, your health insurance may end up being cancelled before you ever realize you owe anything. Talk to your employer, and find out if you need to send in a check each pay period to keep your health insurance coverage current.

What Happens to My Health Insurance if I’m Fired?

Unfortunately, you can still be fired by your employer even if you have an open workers’ compensation case. If you are terminated, you can expect your health insurance benefits to end the same way that they would for any terminated employee.

You have the option of temporarily continuing your health insurance under the Consolidated Omnibus Budget Reconciliation Act (COBRA). Your health plan administrator must give you a notice stating your right to choose to continue benefits provided by the plan. You then have 60 days to accept coverage or lose all rights to those benefits.

If you elect to continue coverage through COBRA you will have to pay the full cost of the coverage plus a 2% administrative charge. If your employer was paying the bulk of your health insurance expense before your termination you can expect that health insurance through COBRA will likely be much more expensive than you are used to.

COBRA generally applies to all group health plans maintained by private sector employers (with at least 20 full-time employees) or by state and local governments. If you work for an employer that has fewer than 20 full-time employees, North Carolina has a state continuation program similar to COBRA. Either way, you may want to shop around and consider other insurance companies to find your best options for obtaining private insurance.

Get a FREE Case Evaluation from NC Workers’ Comp Attorneys

If you are concerned that your employment status or your right to health insurance benefits may have been unduly affected by your workers’ compensation case, contact one of our workers’ compensation lawyers right away. There is a lot at stake, and if you are trying to negotiate on your own against a big powerful insurance company, you are likely at a huge disadvantage.

There is no charge to call us for an initial case evaluation. It is completely FREE to you.

Click here to contact us or call 1-866-900-7078 for a free case evaluation.

P.S. Think you can’t afford a James Scott Farrin workers’ comp attorney? Click here to see why you can.

Categories: Insurance Coverage

What is a Functional Capacity Evaluation and why is it so important?

By Susan Vanderweert

Your doctor is generally responsible for releasing you back to work when your medical treatment has concluded. To avoid liability and the risk of further injury, a medical release is usually required before you return to work. If your injury was minor and your recovery was complete, it may be relatively easy for the doctor to determine that you are capable of returning to your former job. However, in many cases, it is more complicated to determine just exactly how much work an employee is capable of doing.

Sometimes the doctor will feel comfortable assigning work restrictions based on their own opinion about your physical ability. Often, though, especially with more serious or complicated injuries, doctors prefer to base your work restrictions on a Functional Capacity Evaluation (FCE), which is supposed to be based more on science and facts than thoughts or opinions. In those cases, your doctor may refer you for an FCE.

An FCE will help your doctor determine:

  • When it is physically safe for you to return to work
  • When you are physically able to do the same job you did before you got injured
  • How much physical effort you can safely perform at work without reinjuring yourself

What Does a Functional Capacity Evaluation Check For?

FCEs are performed by a physical therapist or occupational therapist. The tests generally last for several hours and involve a number of physical challenges, such as repetitive lifting, bending, walking, and stair climbing. These tests are intended to measure your exact physical strengths and weaknesses and compare them to the actual requirements of your job.

How Some Providers Have Used the FCE Against Injured Workers

Often we have come up against situations where some insurance companies have used FCEs as weapons instead of useful tools in their efforts to try to:

  • Convince the doctor that our clients were faking or exaggerating their injury
  • Send clients back to a job that was too physical for them to handle
  • Release our client from treatment before they were physically ready

When the manager of an injured truck driver tried to get him to go back to work before he felt ready, he asked for a second opinion. That’s when things got ugly and he contacted us. Read Christopher’s story here.

Unfortunately, not all FCEs are created equal. FCE standards vary from provider to provider. Some FCE tests are more accurate than others at measuring a person’s capacity for actual work over an eight- to 10-hour work day. Some FCE tests are not based on scientific standardized methods.  FCEs are not always fair, nor are some FCE providers necessarily unbiased.

Truth be told, we have firsthand knowledge that some FCEs have been intentionally manipulated by a small number of FCE providers for the purpose of denying the injured worker continued workers’ compensation benefits.  The majority of FCE providers that we have seen do attempt to do a fair and reasonable job for their patients. However, it is the small number of unfair FCE providers that can be used as weapons by workers’ compensation insurance companies to try to maximize their profits and deny benefits to injured workers.

Manipulated Tests and Provider Notes

For example, we have seen one FCE provider consistently instruct injured workers to stop the test and take a rest break. Then that provider would write in the evaluation that the person did not give full effort on the test. Another FCE provider has regularly reported that injured workers had been faking or exaggerating their injuries, when other FCE providers and physicians have reached contrary conclusions for the same workers.

On the other hand, the Catch-22 is that if you put too much effort into your FCE test when you are pushed by the FCE provider, you could reinjure yourself.

You can see that, like Christopher, your doctor may rely on the FCE test to release you to return to work before you are ready or without the proper restrictions. At James Scott Farrin, we know who the more trustworthy and reputable FCE providers are and, on the other hand, the ones who may not have your best interests in mind and who may be more interested in results that please the workers’ compensation insurance companies. For these reasons, it is very important to contact the professional team at James Scott Farrin as soon as possible, and be aware of these issues when your doctor starts talking about releasing you from treatment or returning you to work.

How You Can Help Your Case

Remember that your employer and their insurance company may want to get you back to work as soon as possible. Even if it means getting you back to work before you are physically ready. And remember too, your doctor may not necessarily know exactly what your job requires of you physically or understand the laws of workers’ compensation about returning to work.  For example, some doctors may assume that, if an injured worker cannot perform a job after a trial return to work attempt, then workers’ compensation insurance companies will be perfectly willing to restart workers’ compensation checks. That assumption is very frequently inaccurate.

To protect your own interests, it is best to get a written description of your job functions and discuss it with your doctor in detail. If you are having physical issues or taking medications that will keep you from being able to safely perform your job, you need to let your doctor know. Also tell your doctor if your physical issues on the job could create a danger to other co-workers or the public.  No one knows as well as you the physical requirements and dangers of your job.

7 NC Board Certified Specialists in Workers’ Comp Law

More than half of our workers’ comp attorneys are NC Board Certified in workers’ compensation law. Of the approximately 28,000 North Carolina licensed attorneys* only 140 are North Carolina Board Certified Specialists in workers’ compensation law. Seven of them practice right here at our firm.

What does it mean to be board certified? It means you have an attorney who shows special knowledge and proficiency in their specific area of law, having undergone additional training (and other intense analysis) to become certified as a specialist.

Get a FREE Case Evaluation from NC Workers’ Comp Lawyers

We believe in caution and prudence. And there is a lot to know about workers’ compensation law and the system is extremely difficult to navigate successfully on your own.

That is why we urge anyone who has been injured on the job to contact us or call 1-866-900-7078 immediately after their injury. We will try to ensure that all the necessary measures are taken to preserve your right to workers’ compensation benefits and hopefully help you find medical providers who have your best interests in mind.

*  Figures provided by the N.C. State Bar as of December 31, 2016.

What If I'm Injured While Driving on the Job?

By Barry Jennings

The Law Offices of James Scott Farrin regularly handles cases for people who are injured in accidents where the injured person can pursue both a personal injury negligence claim and a workers’ compensation claim.

Injured While Driving on the Job

Typically what we might see while someone is driving for work are auto or truck accidents.  For instance, I have represented sales people who have been injured in a car accident while traveling from one sales call to the next. In those circumstances, the individual would likely have both a workers’ compensation claim and a personal injury claim against the individual that caused the wreck.

Other Workers’ Comp and Personal Injury Claims

Other types of accidents can also result in two claims being pursued at the same time. These might include construction accidents, accidents with faulty equipment, and other types of accidents that occur when someone acts unreasonably and causes a person to be injured.

It is important to consider legal representation if you are injured in an accident where two separate parties may be responsible for paying your damages. Things can get very complicated very fast because of the many entities involved. If you try to handle your claims without legal help, it can result in one party taking advantage of the other party’s payment of benefits, potentially causing you to receive less than the maximum you may be due by law.

How Do I Pursue a Workers’ Comp and Personal Injury Claim at Once?

Generally speaking, when an accident occurs which is the fault of another individual, and that accident occurs when the injured person is working, the workers’ compensation insurance carrier is responsible for payment of medical expenses and wage replacement while the injured person is unable to work.  Typically (hopefully), the workers’ compensation insurance carrier begins paying benefits immediately. That is one of the significant benefits of filing a workers’ compensation claim.

The individual or other party that caused the injury will not normally begin paying any sort of damage at the beginning of the claim. Instead, that claim would be pursued separately while the workers’ compensation claim is moving forward. Then, once the injured person’s medical treatment stabilizes and their future medical treatment needs become clearer, it may then be appropriate to pursue payment of damages from the party that caused the injury.

When pursuing these types of claims, it is very important to consider how the workers’ compensation payment of benefits affects the other party’s responsibility for payment of benefits. In most cases, the payment of benefits by the workers’ compensation insurance carrier will be evidence of the injured person’s damages and used to try to prove that injured person’s case against the negligent party.

However, the workers’ compensation insurer will have a legal right to seek repayment from the negligent party. If the resolution or settlement of these claims is not coordinated for the benefit of the injured person, then the injured person could lose substantial potential damages.

As you can see, these types of cases can become very complex very fast and there are a lot of moving parts and changing scenarios that need continual monitoring.

James Scott Farrin Personal Injury Lawyers

We often work with our personal injury lawyers in a collaborative effort to try to ensure our clients get the maximum they are potentially due for their damages under the law.

Our personal injury attorneys fight for you inside and outside the courtroom. They have won awards and have been recognized for community, civic, and legal advocacy in many settings, including the North Carolina Advocates for Justice (NCAJ), a state-wide legal advocacy group.

Every year since 2006 one of our personal injury attorneys has achieved the designation of “Super Lawyer” by North Carolina Super Lawyers Magazine*, and since 2008, Best Lawyers in America’s* “Best Lawyer.” In 2016 that same attorney also achieved Best Lawyers in America’s* “Lawyer of the Year” designation for the Raleigh area, and Business North Carolina’s*Legal Elite in 2015.

One of our attorneys is the author of a number of published legal articles and helped write a part of the North Carolina Personal Injury Liens Manual. Many have spoken at seminars for legal and advocacy organizations, and one is admitted to practice before the U.S. Supreme Court.

We also have an attorney who is a Johns Hopkins-educated and trained registered nurse. She leads our medical review team – uniquely valuable in many tough cases.

Our legal expertise has been sought for coverage in the media for both English and Spanish-speaking outlets.

With roughly one million Hispanic/Latinos in North Carolina, we think it’s important to have attorneys, paralegals, and administrators on staff who are bilingual. We have over 30 bilingual staff that help serve our Hispanic/Latino community.

James Scott Farrin Workers’ Comp Attorneys

Best Lawyers 2018 badgeOur firm was named one of the “Best Law Firms” for workers’ compensation by U.S. News – Best Lawyers® for the greater Raleigh area* in 2018.

That doesn’t happen by accident. So who’s on this team?

  • Former defense attorneys and paralegals for insurance companies who have worked inside the insurance companies (they know what you’re up against).
  • More than half our workers’ comp attorneys are NC Board Certified Specialists in Workers' Compensation law. This is a NC State Bar certification denoting a high level of proficiency in a particular practice area, and less than 4% of licensed NC attorneys can make that claim**.
  • We have two former North Carolina Industrial Commissioners. The North Carolina Industrial Commission (NCIC) is the impartial agency that administers and enforces workers' compensation laws.
  • We have a former North Carolina State Senator who was elected to serve four terms. He also helped write some of North Carolina’s workers’ compensation laws.
  • Many of our attorneys have been acknowledged by colleagues and peers. They are often asked to speak at seminars for other workers’ compensation attorneys. Others are accomplished authors of scholarly articles and two have received coveted awards for workers’ compensation, including Best Lawyers “Best Lawyer*” and NC Super Lawyers Magazine’s “Rising Star*.” One was named NC Super Lawyers Magazine’s “Super Lawyer*” three times and Best Lawyers “Lawyer of the Year*” for Raleigh twice.
  • Our attorneys are givers and champions of the underdog. Many of them join our side because they are advocates for those without a voice. And that is often the injured worker. Of our 13 workers’ comp attorneys, 12 are members of the North Carolina Advocates for Justice, an organization dedicated to improving the quality of legal representation in our state. Many are active members in their communities – from teaching at local colleges, to counseling the Hispanic/Latino community.

NC Lawyers Offer FREE Case Evaluation

All of our attorneys are advocates dedicated to fighting tooth and nail for each and every client.

It is almost always a good idea to speak with us about your circumstances, especially in a situation that involves both workers’ comp and personal injury. Contact us today or call 1-866-900-7078 to learn how working with both a workers’ compensation lawyer and a personal injury lawyer from the Law Offices of James Scott Farrin could potentially benefit you.

 

* For more information regarding the standards for inclusion for “Best Law Firms,” visit www.usnews.com; “Best Lawyers” and “Lawyer of the Year,” visit www.bestlawyers.com; “Rising Star” and “Super Lawyers,” visit www.superlawyers.com; “Legal Elite” visit www.businessnc.com.

** Figures from the N.C. State Bar as of December 2016.

Be Safer on NC’s Rural Roads. Here’s How.

By Jennie R. Glish

Driving on rural roads in North Carolina can be a spectacular experience, especially during autumn. But these roads can also be challenging particularly in poor conditions such as at night and during rain and fog.

Unfortunately North Carolina has the dubious distinction of having the third most rural road fatalities in the country, behind California and Texas. The 855 rural road deaths in NC account for 62% of the 1,379 overall traffic deaths recorded statewide.

NC Ranks #3 in Rural Road Fatalities

Rural Road Fatalities, top 3 statesWhether maneuvering the Great Smokey Mountain’s circuitous path to the summit, or taking in the salty air along NC 12 on the Outer Banks, traveling safely is a priority. The Tar Heel state boasts some truly amazing landmarks, but the path to get us there often finds us on two-lane rural roads. While inviting, these rural roads can often put travelers in harm’s way if they don’t follow some basic safety and travel guidelines.

We offer some insight here on what to expect while driving on rural roadways and guidance about how to arrive at your destination safely.

Expect the Unexpected on Rural Roads

Being aware of your surroundings and paying attention are keys to staying safe. Here are some routine hazards you can sometimes expect when driving along North Carolina’s rural roads.

  • Sharp twists and turns, blind turns, steep hills, and dips
  • Poor visibility of road signs, faded roads signs, signs hidden by trees or bushes and even knocked down
  • Narrower roads which can be harder to maneuver or to pass other vehicles
  • No or low shoulders and sometimes no guard rails
  • Crossing wildlife and farm animals
  • Slow-moving vehicles, including farm vehicle crossings (some 50,000 farmers use North Carolina’s rural roads)
  • Rough pavement, potholes, and uneven surfaces
  • Rocks and other debris
  • Poor lighting making for harder visibility at night and in poor weather

Top 3 Causes of North Carolina Crashes

The top three causes of all traffic accidents in North Carolina in 2015 were due to speed, lane departure, and distracted driving*, according to North Carolina 2015 Traffic Crash Facts. These infractions can be particularly dangerous on rural roads because of the potential hazards above.

3 Tips For Driving on NC’s Rural Roads

Stay Alert and Watch For

  • Speed limit and other roadway signs that indicate upcoming road conditions or sharp turns
  • Animals, deer, and small critters can run across roads with little warning. Click here to learn how to try to avoid hitting a deer, and if you cannot, what you should do.
  • Other drivers who may be swerving or driving unsafely

Stay Prepared and Check For

  • Sufficient gas and cell phone charge. You don’t want to end up stranded, especially at night or on a road with no shoulders.
  • Proper tire traction
  • Roadside tool kit. Always carry a spare tire, a jack and lug wrench, flashlight (and extra batteries) and roadside flares or beacons, jumper cables, duct tape, a multi-purpose tool, an escape tool, and water at the minimum. Depending on weather conditions where you live, you might also want to include something to keep warm, a rain poncho, a candle and lighter. And if you travel with your family, include items they may need – diapers and wipes if you have a baby, non-perishable food, medications, etc.

Share the Road and Prepare For

  • Enough space between cars
  • Anything you might suddenly happen upon in the road, such as an animal, fallen rock, limb or tree, huge pothole, or standing water

Get a FREE Case Evaluation From NC Accident Lawyers

If you sustained a car accident injury due to another driver’s negligence on any kind of road in North Carolina, contact us right away or call 1-866-900-7078 for a free evaluation of your case. We work on a contingency basis, so you pay no attorney’s fee unless we recover for you.

*P.S. Click here to read a fascinating blog on why our brain’s chemical makeup compels us to look at incoming texts.

Social Security Disability Attorney Rick Fleming Answers Client Concerns

As you might imagine, we get a lot of questions about the Social Security Disability process, who qualifies and why or why not. We sat down with Attorney Rick Fleming who leads our Social Security Disability department and is a NC Board Certified Specialist in Social Security Disability law. He offered some thoughtful answers to help dispel some common misconceptions.

Over the 15 years I have worked in Social Security Disability for the Law Offices of James Scott Farrin I have heard my share of false assumptions when it comes to applying for and being granted benefits through Social Security Disability. It helps when an applicant knows the right steps to the approval process.

Disability is a government-funded program that has strict guidelines. If there’s one thing I try to let our clients know, those working in Social Security Disability determination offices must be uncompromising. They have to be. They don’t work for the public, they work for the government. If your case doesn’t meet strict government guidelines, it won’t be approved.

How does the federal government define disability?

Social Security Disability Attorney Rick Fleming Answers Client Concerns

Disability, according to the government, is the unquestionable inability to perform work for at least 12 continuous months. It is important for clients understand that those 12 months must be ongoing or have already passed before someone applies. They also may qualify if it is highly likely that they will be expected to be unemployed for the next 12 months.

There must be a finding of a severe medical impairment.

The Social Security Disability Determination Services expects proof of impairment through medical records. Medical diagnosis and prognosis may be either physical or psychological and they are both covered under Social Security Disability. Clients are often concerned because they do not know what evidence they should use to prove they need Social Security Disability benefits.

Those suffering from disabilities are unable to participate in the kind of work they have done before, or any work in the national economy. When we ask clients if they have the ability to work in the national economy, it doesn’t just mean North Carolina, it means nationally, in all sectors of business in America. The reality is the job simply has to exist. It doesn’t necessarily have to be a job the applicant could actually get. The law wants to know if you have the ability to theoretically work if given the opportunity.

I get a lot of calls from prospective clients who are working and earning substantial wages yet wish to apply for disability benefits. Social Security Disability says that if you are able to work and earn a certain amount of money, then you are not disabled no matter what’s going on physically or psychologically.

Disability can be determined solely on annual income. In 2017, if you are able to earn $1,170 per month gross you are probably not disabled. Even with a physical or psychological impairment, working for that much money means you are likely not entitled to disability compensation.

Is there a difference in applying with an attorney vs. without one?

I would say yes.

It’s a complicated procedure that can be unclear to people because, let’s face it, we don’t grow up learning the Social Security Disability process. If someone has impairment, they may not comprehend all the things required in the application process or be in too much pain to even have the energy to put together a strong case.

They may miss items on the checklist and get something from Disability Determination Services (DDS) called a failure to cooperate denial. If an applicant receives one of these, they did not do all the things they were supposed to do in the application and may need to start over from scratch. That’s nothing to be ashamed of when you’re going through something of this magnitude, and you shouldn’t be penalized for it. This is can be an overwhelming situation to handle. A lot of times it helps to have someone else in your corner who’s making sure your i’s are dotted and t’s are crossed.

Our duty is to be a strong and knowledgeable advocate for you.

Do a client’s assets and resources have an impact on the outcome of the case?

There’s a complex answer there, but I’ll try to explain it simply.

There are two kinds of disability. Title II Disability, or regular Social Security Disability, is something you pay into through payroll taxes. When you look at your check you will see either a FICA or Old Age Survivor’s Disability Insurance (OASDI for short) deduction. Both the employer and the employee pay into this type of Social Security benefits.

If you have a Title II case, then what you own or have does not matter as long as you are applying for a benefit for which you’ve contributed throughout your working life. It’s like making a claim on your medical insurance or car insurance or homeowners insurance – you’ve paid the premium, and now you’re making a claim.

However, applicants under Title XVI (16) or SSI (Supplemental Security Income) are in a hardship or poverty program. This program is for people who have not worked enough or recently enough to qualify for Social Security Disability or Title II, and are poor enough to qualify due to a lack of assets or resources. Under Title XVI you cannot have more than $2000 in assets or other resources as a single citizen, and married couples must have less than $3000 in assets or other resources to qualify. As a side note for people married to a working spouse, you are reviewed with the income of your household. Assets of one spouse are legally deemed available to the other spouse. Married couples with two vehicles and anything worth more than $3000 exceed the asset quota, automatically receiving a technical denial.

We often get calls from parents or guardians who stay at home to take care of children or family members. If they’ve stayed at home long enough that they are no longer insured for Title II, their only option is SSI. If that is your situation, contact us at 1-866-900-7078 and have an experienced Social Security Disability attorney review your situation for free.

What determines the amount of money the client could potentially receive? Do disability benefits correlate to their last salary and benefit arrangement?

Social Security Disability benefits are based on work history. So if you are someone who made minimum wage, your benefit (if you qualify) will be lower than someone who earned six figures. Benefits also depend on how long you paid in to the system. Someone found disabled at age 26 after beginning to work at age 16 has only 10 years of contribution, whereas someone who has worked 30 to 45 years with high earnings is likely to have more money coming their way from Social Security Disability. That being said, Social Security benefits are modest and average only $15,329 a year for disabled workers.

When a client hires an attorney, does that speed up the claims process and potentially increase chances for approval?

It does not result in an automatic approval. Although, because we know what documentation and evidence to present and how to make sure it is completed properly and meet deadlines, it may potentially help get to an approval.

It may also hasten the process, in that we do everything we can to try to ensure nothing falls through the cracks. There should be open communication between the Social Security Administration, and the attorney representing the applicant or claimant. This networking and experience makes us confident in our ability to potentially win cases. We do our best to try to make sure things will not be forgotten, and therefore the process should go smoother and run more efficiently in most cases. Also, as an attorney I’m expected to frame the issues and use the correct kind of medical evidence that tries to build an unquestionable case of disability.

On our website readers can learn more about Social Security Disability wait times.

Do attorneys make the decisions regarding who is and is not disabled?

No. At the initial reconsideration level, the case goes to a place called Disability Determination Services and the case is assigned to a disability examiner, and either physical or psychological doctors, depending on the variables of the case. It’s that team at Disability Determination Services that makes the decision on the first and second level of appeals.

Each of our paralegals was a Disability Determination Services employee before joining our Social Security Department. They know very well what the agency is looking for and how to try to ensure your paperwork is properly submitted.

If the person is denied at both those levels, the case goes to the hearing level.

The hearing is where an administrative law judge (ALJ) holds a hearing that may include expert witnesses and is responsible for reviewing the applicant’s case and previous reasons for denial. After the hearing level, if the judge’s decision coincides with the lower determination and denies benefits, an applicant may seek to have their case sent to the appeals council where Administrative Appeals Judges (AAJs) make the determination. Here, it will again be decided if the case should be approved, denied, or remanded for a new hearing.

If you do not have success at this level, you can file a civil action in the United States District Court, where an Article III judge will make the decision. Afterward, those denied may apply to the circuit court, which for North Carolina residents is the Fourth Circuit Court of Appeals in Richmond, Virginia. If you’re not successful there, you can attempt an appeal to the U.S. Supreme Court in Washington, D.C.

When you are denied you, the applicant, or the attorney if you have one, have a duty to file an appeal within 60 days.

How long does each process take?

Wait times vary considerably depending on the level of your filing.

At the reconsideration level it’s going to be about six months for a decision.

At the hearing level it’s going to be about two years. At the district court level, it’s probably about one year, and the circuit court level it could be one to two years. The Supreme Court could have multiple factors determining the timing of decisions.

Some people are of the opinion that attorneys hold up cases to get more money. Is this true?

Of course not.

The truth is the Social Security Administration has too few employees and hundreds of thousands of cases to process. At present the backlog of cases awaiting a hearing before an ALJ is over one million. While our paralegals have a history of knowing how to work effectively in most situations, sometimes there’s nothing we can do, and these backlogs cause the process to take time.

What people don’t realize is that stalling the system doesn’t bring us or the client any more money because the government caps our fees.

In Social Security Disability cases fees are capped at 25% of back-due benefits or $6,000, whichever is less.

So if we did delay cases, we would actually be billing more hours than the fee cap provides. So if you’re talking about a case that lasts six months vs. 36 months, at some point we are losing money because we have more time and money in than we can possibly get out. Believe me, we would rather win sooner than later.

Since all employees are obligated to pay into the system, are they entitled to receive back taxes as disability benefits?

They will be entitled to retirement income in the form of Social Security, once they reach retirement age, but there is no entitlement to disability until you meet the strict requirements of disability under the Social Security Act. Think of it like health insurance or car insurance. Yes, you have paid for it, but they may deny it if your claim doesn’t meet the requirements.

Will applying for Social Security Disability assure payment?

No. Not one penny is received for disability until after you are seen as disabled under the law.

What are the keys you look for in a solid case, and what are the red flags.

Going back to some of the things we talked about before, there is a list I can use to initially screen an eligible candidate.

  1. Are you working? Have you had a break in employment already or do you have an impairment that is so severe, it is reasonable to assume you will be out of work for at least 12 continuous months?
  2. Does what you allege as a prospect, make sense medically? If you allege for example that you are blind, but you say you can drive to our office to meet with me to discuss the case, I’m going to know you cannot be found to be blind if you offered to drive to my office.
  3. Do you have medical evidence? Social Security Disability is grounded in medical evidence and you, the claimant, have the burden of proof – you must provide medical evidence to support your case. If you have never been to a doctor in your entire life, then there is no medical evidence to support your allegations of a severe medical impairment. No proof, no disability.

Do factors like a history of drug use or criminal charges factor into receiving Social Security Disability?

Yes.

This is a great question because it all depends on the perspective or reason for the disability claim.

If a client says, “I am disabled because I see and hear things,” and you see in their records they’ve tested positive for LSD then there is a problem. LSD causes one to see and hear things, thus drug use would be a factor to their disability and they could be barred from receiving any sort of benefits.

The flipside is if someone has a diagnosis of bipolar 1. Any psychiatrist is probably going to tell you that part of being bipolar is having some sort of a lack of impulse control, leading to some proclivity to drugs or alcohol use. So in that case it is different. It may be that it’s not the drug or alcohol causing them to be bipolar. Rather, substance abuse is a symptom of the bipolar disorder. One does not cause the other; this is to say that if the person stopped using drugs or alcohol they would not stop being bipolar.

Now criminal behavior is simple. If the injury was caused while in the process of a crime, they cannot receive any benefits. Let’s say, for example, during the course of a bank robbery the bank robber fell and broke both legs and tore the ACL in each knee. In this case the bank robber cannot claim disability for these impairments because it happened during the commission of a felony.

However, if their disabling impairment has nothing to do with the commission of a crime then they could potentially receive Social Security Disability benefits.

What is the cut-off age for receiving Social Security Disability?

In this case it is important to remember the right to disability ends at full retirement age, which you can find by clicking here.

For most of the population right now this means after 66+ years, the only benefit you can receive is retirement and not disability. If someone is working up until 70 and wishes to file for disability they can’t.

If a client dies from terminal illness, can their family assume the pending claim?

What we can do is file a special claim for the ill client. A claim marked TERI (terminal) which expedites the case to receive a quick decision. Assuming the case is approved, the disabled person would collect benefits until they passed. Then benefits would end. But if this client is a parent of minors, their children would be considered survivors of the deceased. This scenario brings Old Age Survivors Insurance in to play. When the client passes, their children are to receive benefits as a survivor under their parent’s social security number until their 18th birthday.

Another scenario is when a person dies while their case is pending. In some situations we can substitute in a proper party (a surviving spouse, parent, or child) and allow the case to proceed to a decision. Any benefit won would be for the time period prior to the death of the deceased claimant.

What would you say to those who say, “I know I’ll get some sort of compensation because my friend or relative got it for the same situation”?

We hear that a lot and it’s often that these people don’t know the specifics of their friend’s case. If for example the person has a low IQ, or met a certain listing, or if there is some fact that they don’t know about their neighbor, then they are comparing apples and oranges.

Are there any patterns you see in people who get accepted or denied?

No.  Just that they meet the requirements of the statute. The most important thing is to have consistent medical evidence and support of doctors.

For people who have to take medicine for diabetes, thyroid, or other illness, is there a way they could be declared disabled?

No. Taking a lot of expensive medications is only part of the analysis. In and of itself it is not conclusive evidence of disability.  When people say their condition has caused their doctor to restrict them from driving, does this mean they are disabled.

No. You can take public transportation, catch a ride with a friend, or call Uber. Whether you can drive or not is irrelevant. As long as there is a job that exists that you could reasonably do you are not disabled Under the Social Security Act.

If people are working to put food on the table, but they feel like they are disabled, are they?

Not according to the government. People who think they should receive disability because they are only working to pay rent or to feed themselves or family are missing the point of disability.

It doesn’t matter why you are working, it only matters that you are working.

That’s where the analysis stops for a perspective client. The government does not care why you are working. This is probably the most common conversation we have, and it is sad. We understand these situations – we see them all the time. Essentially, the analysis ends there and they cannot apply. Click here for information on working and applying for Social Security Disability benefits.

Before people contact us about a case what should they think about first?

I would tell them to ask themselves if they meet the conditions under the definition of disability.

If you can drag yourself to work two more days, six more months, five more years, or as long as you can, do it! You’ll probably get more money working than you will from Social Security Disability. The benefits are modest at best.

Do you have documented proof of your condition? You need to have strong medical proof (documentation) of your disability and meet the guidelines set forth by the Social Security Administration. If you can provide evidence that you fall under the legal definition, you should expect proper compensation, and you have the right to!

What should people do if they want a case evaluation?

If you've become disabled, don't be afraid to file for Social Security Disability benefits. It's your right. Just as importantly, don't think you will necessarily receive these benefits without a strong case that is backed with thorough medical evidence.

We offer FREE case evaluations and we are available 24/7. Our experienced lawyers and paralegals respond to the call of many clients statewide that have trouble dealing with their disability. Click here to contact us or call 1-866-900-7078 for a free evaluation of your Social Security Disability case.

P.S. Don't feel like you can't afford to hire Social Security Disability attorney. At the Law Offices of James Scott Farrin, we work on a contingency basis, so you don't owe us an attorney's fee if we don't get you compensation for your claim.

Click here for other frequently asked questions.

Workers’ Comp Benefits Stopped for No Reason? That May Be Against the Law.

By Michael F. Roessler

We’ve seen and experienced our share of insurance horror stories – the deceptions, delay and deny tactics, even outright lies in some cases. So many in fact that we developed a book called Insurance Companies (and Others) Behaving Badly.Insurance Companies (and Others) Behaving Badly

So it is not surprising to us when a client contacts us because they’ve been abruptly and for no apparent reason cut off from receiving medical treatment or cut off from their paychecks.

Unfortunately, this can be an all too typical scenario:

You’ve been hurt at work, and the insurance company has been paying for your medical treatment. Then, one day, your medical treatment stops. The doctor’s office calls to tell you that your appointments have been canceled and they will no longer have your prescriptions refilled.

Dumbfounded, you call the adjuster from the insurance company assigned to your case to find out what’s going on. She tells you, “We’ve closed your file.”

What gives? Can the insurance company do that? Can they just stop your medical treatment without your knowledge?

No. But that doesn’t mean they won’t try.

The experienced workers’ comp attorneys at the Law Offices of James Scott Farrin are here to fight for you when an insurance company tries to take advantage of you and deny you the benefits you may potentially be owed. We suspect some insurance companies are banking on the fact that you don’t know they can’t do that.

Your insurance company cannot close your case just because they no longer want to pay for doctor appointments or send you regular checks.

But just like other types of infractions, that does not stop them from trying to get away with it. Sadly, some do.

Your Right to Medical Treatment as an Injured Worker

If the insurance company has accepted responsibility to pay for your injury, the law requires them to pay for the medical treatment recommended by your doctor. Sometimes, however, the doctor’s recommendations may be expensive and the insurance company may not want to pay. We have seen such circumstances in which the insurance company has canceled appointments outright, putting the onus on the injured worker to challenge them. (That is when many turn to us for help.)

But they don’t have the right to just cut you off. You have the right to get the medical treatment you need to heal so you can try to get back to work. Sometimes, you may be forced to hire an attorney to fight for you to protect that right.

Your Right to Treatment May Extend to 2 Years after You’re Declared “Healed”

If an insurance company tries to deny you medical treatment, the attorneys at the Law Offices of James Scott Farrin can request that a workers’ compensation judge order the insurance company to pay for the treatment you need to try to get better.

Depending on the facts of your case, you may also have a right to get medical treatment for your work injury up to two years after your last doctor’s visit. This is important to know because even though you and your doctor may initially think you are fully healed from a work injury your condition might worsen over time. We see this happen a lot.

If that happens to you, you may have the right to go back to the doctor for up to two years after the last date the insurance company paid for any treatment.

What we’ve seen happen to some injured workers is that when they contacted their insurance company within that two-year timeframe, they were told their case had been closed.

Your right to medical care might continue for two more years even after your treating doctor says he has nothing more to offer.

Your Right to a Second Opinion

Injured workers like you also have the right to request a second opinion from another doctor. We typically urge our clients to take advantage of this opportunity. If the request is approved, a second opinion can help to try to make sure nothing has been missed and no other treatment is available that might help improve your condition.

The insurance company may try to ignore your request for a second opinion and try to tell you after your doctor releases you that your case is closed.

Your Right to Benefits Checks

Insurance companies can’t close your case because they’re tired of sending you a benefits check every week. In most all circumstances, once the insurance company starts sending you a weekly benefits check, they must continue to send that check until you’ve returned to work or the insurance company has been given permission by the North Carolina Industrial Commission to stop the checks. Even then, you may have the right to start getting the benefits checks again if you have to go out of work. The insurance company can’t close your case just because they stopped your check once.

Can Your Workers’ Comp Case be Closed Without Your Knowledge?

The only time your case can be closed without your knowledge is when more than two years has passed from the time you either made the claim or benefits were last paid. This is the statute of limitations in workers’ compensation cases.

Don’t fall victim to delay, deny, and defend tactics of some insurance companies.

NC Workers’ Compensation Lawyers Offer FREE Case Evaluation

If you have questions about whether your case has been closed for any reason, we advise you to contact the Law Offices of James Scott Farrin.

The sooner you contact us after your job injury the better. We can try to answer your questions about your situation. Any delay in contacting us could give your adjuster a chance to deny, delay, or potentially stop benefits.

Based on our team’s 150 years of combined experience, it is almost always a good idea to speak with us about your circumstances. Our confidential case evaluations are free, and you may learn that you’re entitled to more than the insurance company claims.

If you’ve been injured in a work accident or know someone who has, contact us today or call 1-866-900-7078 to learn how a workers’ compensation lawyer from the Law Offices of James Scott Farrin could potentially benefit you.

Can I Get Fired for Filing a Worker’s Compensation Claim?

By Doug Berger

Many injured workers are afraid if they file a workers’ compensation claim they’ll be fired. You cannot be fired for making a workers’ compensation claim. Not legally, anyway. But it happens. A lot.

I’ve seen it happen over and over for more than 22 years in the worker’s compensation field. I saw it when I was Deputy Commissioner at the North Carolina Industrial Commission where, for 10 years, I presided over 500 hearings for workers’ compensation disputes. (The North Carolina Industrial Commission (NCIC) is the impartial agency that administers and enforces workers' compensation laws.)

North Carolina worker’s compensation laws were designed to help protect injured workers. I should know. I helped write some of our state’s worker’s compensation laws as a four-term North Carolina senator.

Yet unfortunately, some employers do sometimes bend and break these laws. And it is not uncommon for an employer to fire an injured worker who makes a claim.

If you were my sister and you were injured on the job, I would arm wrestle you until you cried UNCLE and promised to contact a lawyer. (What can I say, I’m a rebel. Read my bio.) Experience tells me you’re frequently on the losing side of a worker’s comp claim without a lawyer. Being on the losing side can put you and your family in a downward spiral fast. I’ve seen these spirals and they’re ugly. Even more frustrating, many of these spirals could potentially have been prevented with the right legal guidance.

File a Complaint with the N.C. Department of Labor

If you believe you have been fired for making a worker’s compensation claim, file a complaint with the North Carolina Department of Labor. You can’t obtain the legal right to sue your employer for wrongfully terminating you without filing this complaint first. And you must make sure you file the complaint so that the Department of Labor receives it within 180 days from the date you alleged your employer retaliated against you for making a workers’ compensation claim.

Click here for instructions on how to file a complaint with the N.C. Department of Labor.

Even if you do file a complaint, you may still have an uphill battle ahead of you. What our firm has experienced over our many years of representing injured workers is, the Department of Labor will most likely do a minimal investigation and then close your file. Of course, they will likely interview the employer to determine what they “claim” was the basis for your termination. As you might expect, employers typically will not admit they terminated you because you made a workers’ compensation claim. They know that is illegal. More than likely they will defend their termination by alleging misconduct or some such similar claim.

(Are you beginning to see why we suggest you contact a workers’ compensation lawyer?)

Document. Document. Document.

Another important thing to consider. Document anything and everything related to your termination grievance. Document all evidence related to your injury and your employment (including past reviews, especially if they are positive), emails, and anything that supports your case.

Your “Right to Sue”

While the North Carolina Department of Labor rarely takes an employer to court for wrongful termination, they may at least issue you a “right to sue” letter. You then have the legal right to take your employer directly to court to have a jury decide whether your employer retaliated against you because you filed a worker’s comp claim. If you prevail, you may win your job reinstatement and receive back lost wages.

This is another area of workers’ comp law where you would be prudent to hire a lawyer, as this reinstatement does not always bode well for the reinstated employee. We’ve seen some who have been “reinstated” only to be fired again for any number of reasons. Since North Carolina is an “at will” state, your employer can fire you for no reason (with some exceptions).

Being Fired Under Family Medical Leave Act (FMLA)

When can your employer legally fire you for being out of work? When you have remained out of work due to a workplace injury.

As long as workers who are out of work due to workplace injuries are treated the same as employees who are out of work for non-work related injuries, the North Carolina Department of Labor does not consider such a termination a violation of the law. Employers generally terminate employees who are unable to return to work after they exhaust their Family Medical Leave Act (FMLA) leave. In this particular instance, while you may not be able to keep your job, you may be entitled to receive workers’ compensation benefits until you are able to find a new job.

There are so many nuances and ways to interpret workers’ compensation law. And there are many good workers’ compensation lawyers in North Carolina. If you do decide to hire one, click here to download key questions to ask before making your choice. Here are just some of the things we believe set us apart.

What Makes the Law Offices of James Scott Farrin Different?

Our firm was named one of the “Best Law Firms” for workers’ compensation by U.S. News – Best Lawyers® for the greater Raleigh area1 in 2017. This recognition is based on client and peer reviews. We have strength in numbers and strength in knowledge.

  • Many of our workers’ comp attorneys have been acknowledged by colleagues and peers. They are often asked to speak at seminars for other workers’ compensation attorneys. Others are accomplished authors of scholarly articles and two have received coveted awards for workers’ compensation, including Best Lawyers “Best Lawyers in America 3” for 2017. One was named NC Super Lawyers Magazine’s “Super Lawyer4” four times (2014, 2015, 2016, 2017) and Best Lawyers “Lawyer of the Year5” for Raleigh twice, (2015 and 2017).
  • More than half our workers’ comp attorneys are N.C. Board Certified Specialists in Workers' Compensation law. This N.C. State Bar certification denotes a high level of proficiency in a particular practice area, and less than 4% of attorneys licensed in N.C. can make that claim2.
  • We have two former North Carolina Industrial Commissioners.
  • As stated earlier, I was a four-term North Carolina State Senator for eight years and helped write some of North Carolina’s workers’ compensation laws.
  • Our attorneys are champions of the people. Many of them joined our side because they are advocates for those without a voice. And that is often the injured worker. Of our 13 workers’ comp attorneys, 12 are members of the North Carolina Advocates for Justice, an organization dedicated to improving the quality of legal representation in our state. Many are active members in their communities – from teaching at local colleges, to counseling the Hispanic/Latino community.

N.C. Workers’ Compensation Lawyers Offer FREE Case Evaluation

If your employer terminates you while you have a workers’ compensation claim, or even if you think you might be fired as a result, contact us. Even if you are fired while receiving treatment, stop to consider if your employer may be firing you because of your claim.

We have been in the workers’ comp industry a long time – always championing the individual worker over the employer or insurance company.

I won’t attempt to arm wrestle you and make you cry UNCLE, but I do urge you make a call to our firm if you suffered a work related injury.  A phone call costs nothing, and our confidential case evaluations are free.

If you’ve been injured in a work accident contact us today or call 1-866-900-7078 to learn how a workers’ compensation lawyer from the Law Offices of James Scott Farrin could potentially benefit you. 

1 Visit www.bestlawfirms.com for more information about criteria for inclusion

2 Figures from the N.C. State Bar as of December 2016

3,5 For more information regarding the standards for inclusion, visit www.bestlawyers.com

 4 For more information regarding the standards for inclusion, visit www.superlawyers.com

Why We Are Not Wired to Multitask and Drive

North Carolina Distracted Driving Accident AttorneysBy Sidney Fligel

What is Multitasking?

You know what multitasking is. Everyone does. It’s almost a given these days. I don’t care what task you are performing you are probably in the habit of multitasking while doing it.

I’m multitasking right now.

I’m answering a colleague’s question, kicking off my shoe under the desk, while I am typing this sentence. Meanwhile, Taylor Swift is whining on Spotify about some guy who’s so mean all he’s ever gonna amount to is mean. But she’ll be livin’ in a big ol’ city. Oh… and I just got a ping from my cell – my sister wants me to drive to her house this weekend (150 miles). Her peaches are coming in fast and she has to pick them before the birds eat them. So now I’m also weighing the pros and cons of fighting holiday traffic for a bag of fresh-picked peaches.

But I am stationary behind my computer screen. I am not behind the wheel of a two ton vehicle traveling 60 miles per hour with many other innocent drivers and bystanders nearby.

Do I multitask behind the wheel?

Do you?

Unfortunately we all do. And we may not even realize we do it.

Back in the day it used to be fine to sip a soft drink while driving, and maybe even change the radio “dial” or “roll down” our windows. But that was before seven-lane highways rife with left turns, commuting bicyclists, roadway signage everywhere, and millions of cars on the roads with minivan-wielding soccer moms filled with distracting kids rushing from practice to Chik-fil-A and on to the next practice.

And cell phones. Texting. Bluetoothing.

Our driving habits have become a real mess.

Who’s Guilty of Distracted Driving?

We are all guilty. Teens. Moms. Dads. You. Me.

Many people think distracted driving is a teenager problem. Not entirely. All of us become side-tracked and distracted without even realizing we’re doing it. Or realizing what a mistake it can mean to your life or someone else’s.

I was shopping in a locally-owned shop recently when the owner learned I work at the Law Offices of James Scott Farrin in personal injury. She shared her tragic story of why she had to go back to work after she’d retired. Her husband was hit by a distracted driver, suffered a severe brain injury and had to leave his job as CEO of a major corporation. Their lives took an abrupt about face as they lost nearly everything they had due to medical bills. (He did not hire a lawyer, unfortunately.)

The at-fault driver was a teenager. He was texting.

The woman shared with me how very sad she felt for that teen who was not only unrepentant, but snarky about what his carelessness did to her family.

I was stunned.

One careless mistake and an entire family’s path went south.

Multitasking Behind the Wheel is Epidemic

Distracted driving has become epidemic. National Highway Transportation Safety Administration (NHTSA) statics show distracted driving was the highest cause of “human choice” accidents, with six of 10 caused by distractions.

Cell phones, as we all know, are a common distraction (and one of the most deadly). In the era of Smartphones, one of the most common causes of accidents has been distractions from texting and using apps behind the wheel – even a map app.

Why Our Brains are Not Wired to Multitask

According to numerous research studies, our brains were not designed to focus on multiple tasks at once. Psychologists who study what happens inside your brain when people try to perform more than one task at a time have found that we are not wired for heavy-duty multitasking.

Switching between tasks (multitasking) can cause a whopping 40% loss in brain productivity, and the National Safety Council underscores why multitasking is particularly dangerous behind the wheel.

If you can walk and chew gum at the same time, why can’t you drive and talk on your cell phone? Walking and chewing gum involve both thinking and a non-thinking task. Driving while talking on your phone are two thinking tasks that involve many areas of the brain. Your brain rapidly switches between two cognitive activities rather than processing both simultaneously and some things can get lost or minimized in the switching.

Isn’t talking on a cell phone the same as talking to someone in the car? No. Drivers talking on cell phones are more oblivious to changing traffic conditions because they are the only ones in the conversation who are aware of the road. When you are talking to another adult in the car (with another set of eyes) they may be able to help you remain aware of traffic.

Isn’t using hands-free devices safer than a cell? Research shows it is not. As different parts of our brain share tasks, activity in one part will decrease as activity in another part increases. If you focus on a conversation, whether it’s with another passenger, using a hand held device, or cell phone, activity in the parietal lobe will decrease by as much as 37% says a Carnegie Mellon University study.

When you use a cell phone you get what is known as “inattention blindness.” You look but you may not see. You can miss seeing up to 50% of your driving environment.

Drinking and driving vs. driving while distracted. A study by the University of Utah illustrated in a controlled simulator that using a cell phone while driving is just as dangerous as driving with a blood alcohol level of 0.08, which is the legal limit behind the wheel in North Carolina. Just like alcohol, people can become addicted to their cell phones. Click here to find out the fascinating biological reason why.

Text behind the wheel and you are 23% more likely to cause a crash says the National Highway Transportation Administration (NHTSA) website, nhtsa.gov. As a matter of fact, it’s the same as drinking four beers. Both cause distraction and impaired driving that can result in following too closely, not being able to brake on time, or weaving into oncoming traffic.

We’ve all seen those cars that drift outside their lane. The RAC Foundation, a British motoring research organization, reports that texting while driving reduces steering control by 91%. And it decreases reaction time by 35%.

Multitasking Results in TMI

All of this is a result of too much information causing cognitive overload – our brain’s inability to hold so much information.

We are wired to have a working memory that can retain only two to four pieces of information at a time.

When more is required, our brain replaces the old with the new or it borrows from the auditory and visual parts of the brain.

Even when contemplating the next task, researchers discovered that an interruption – be it a phone call or deciding to check your email can cause you to take up to five minutes to refocus on your work.

Here’s a trivia question for you. What is the #1 distraction behind the wheel? (Keep reading for the answer.)

Just Drive

  • Don’t put your car in drive until you and your passengers are settled in and ready to go.
  • Take the time to check your surroundings and make sure anything you may need while driving is in reach so you won’t need to look for them on the road
  • If you need directions, get them before you put your car in gear

Keep your hands on the wheel and eyes on the road and just drive.

Tell Us Your Good Driving HabitsGet a FREE Case Evaluation from an N.C. Car Wreck Lawyer

If you or a loved one were the victim of any kind of distracted driving accident, we strongly encourage you to seek legal help. We don’t want anyone to end up in a situation like the shop owner whose husband was incapacitated and didn’t hire a lawyer which could have potentially helped save his family from financial ruin as a result of that car wreck.

Studies have shown that, on average, car accident victims who hired a personal injury lawyer received 3.5 times more compensation for their loss than they would have on their own*.

Contact us or call 1-866-900-7078 for your free case evaluation.

Trivia answer. The #1 distraction behind the wheel, according to Safestart.com? Wandering thoughts.

* Insurance Research Council 1999

I’ve worked all my life. Why aren’t I eligible for Social Security Disability Benefits?

Not everyone is eligible for Social Security Disability Insurance (SSDI) benefits. Only those who have worked and paid FICA taxes within five of the past 10 years and meet the government’s disability requirements.

Here is a simplified explanation of what you need to know if you’re thinking of applying for Social Security Disability benefits.

SSDI is Insurance for Disabled Workers

Social Security Disability Insurance is just what its name implies. Insurance.

When you work, a portion of each paycheck goes into a federal insurance fund (FICA, which stands for Federal Insurance Contributions Act). This is a fund for SSDI. Just like medical insurance or car insurance, you hope you never have to use your SSDI. But if you’ve paid into it (which you are required to if you receive a paycheck) you will be covered for benefits if you become disabled and the Social Security Administration determines that you are unable to work.

Spotty Work History?

What if you were working but you stopped temporarily to raise your children through elementary school? Or what if you were laid off and subsequently unable to find a suitable job for several years? What if you’ve been out of work due to a work injury?

Whether you may get SSDI depends largely on the date you last worked.

The government considers this very important date as the last date you would potentially be eligible for SSDI. To determine whether you may be eligible you must pass a "recent work" test. There is only one question on this test, so you either pass or fail.

Have you worked five of the past 10 years (or in government jargon, 20 of the last 40 quarters?

If you become disabled after your date last insured (DLI) has passed, you cannot get SSDI benefits. It would be similar to getting in a car accident after you stopped paying for car insurance.

Here is an example of DLI. If you worked up until five years ago today, your DLI would be today’s date. If you worked up until two years ago, your DLI would be three years from now. If you haven't worked for six years, your DLI passed one year ago and you are no longer eligible for SSDI unless you are found disabled before your DLI.

Show Me the Money

Occasionally we have seen instances in which someone assumed they were not eligible for SSDI. Yet upon closer inspection and reviewing their work and payment history, we discovered that a client’s employer failed to pay the employer and employee taxes and sought to correct the error. (Of course, payment is subject to IRS provisions on the ability to amend tax returns or file late.) While this doesn’t happen often, it serves as a reminder of how we have been able to help people uncover benefits they did not know were available to them*.

What if You Do Not Qualify for SSDI?

If you do not qualify for SSDI, you may be eligible for Supplemental Security Income or SSI benefits, provided you meet the extremely low income and asset requirements threshold.

SSI is for people who have never worked or haven't worked enough to qualify for SSDI. You can only get SSI if your income and assets are extremely low.

For 2017, the federal benefit rate is $735 per month for individuals and $1,103 for couples (and this is subject to reductions). Some states supplement the federal amount. North Carolina is not one of them.

Think You Can’t Afford a Social Security Disability Lawyer?

Think again. Uncle Sam limits the contingency fees for all Social Security Disability lawyers to 25% of back-due benefits or $6,000, whichever is less.

Get a FREE Case Evaluation From N.C. Social Security Disability Lawyers

We know applying for Social Security Disability can be a confusing and lengthy process. (It can take nearly two years in N.C. just to get a judge to hear your case – 23 months in Charlotte, 22 in Greensboro, 20 months in Fayetteville, and 19 in Raleigh.)

We understand from firsthand experience what you are up against.

Nearly every person on our Social Security Disability team has worked inside the Social Security Administration.

We know how the system works, what they look for to accept a claim, the importance of filing the correct forms and meeting strict deadlines, and what medical records to present. And sometimes we know where to look for benefits you may not be aware of.

If you are considering applying for Social Security Disability, contact us as soon as possible or call 1-866-900-7078 for a free case evaluation about your unique situation. We’re available 24/7.

*Each case is unique and must be evaluated on its own merits. Prior results do not guarantee a similar outcome.

I’ve Been Given a Workers’ Comp Rating. Should I Close My Case?

Workers Compensation Attorney North CarolinaBy Jacob Goad

One of the questions we often hear from injured workers is whether they should accept what the workers’ comp insurance company is offering to pay them, based on a rating of the injured person’s body part or parts.

That’s a good question. The answer can often depend on your unique circumstances. And sometimes on how much a doctor knows about North Carolina Industrial Commission (NCIC) ratings guidelines. We had a case a while back that illustrates this point.

A hip replacement is generally considered to be worth a 40% rating, according to NCIC guidelines. Surprisingly, not all doctors know about these NCIC guidelines. One doctor who did not know about the NCIC guidelines gave our client a rating significantly below 40% for a hip replacement. We sent the client for a second opinion with a knowledgeable doctor who assigned the more appropriate rating of 40%.

Just about every body part that you can imagine is named in the Workers’ Compensation Act, and is given a value in weeks of compensation. Here’s an illustration of hand, arm, leg, eye, hearing, and foot injury ratings, according to the North Carolina Industrial Commission (NCIC) ratings guidelines. (It is interesting, and in my opinion somewhat disturbing, to know that every finger on your hand has a value.)

NCIC Payments for Various Body Parts

Thumb 75 weeks Arm 240 weeks
First or index finger 45 weeks Foot 144 weeks
Second or middle finger 40 weeks Leg 200 weeks
Third or ring finger 25 weeks Eye 120 weeks
Fourth or little finger 20 weeks Hearing (one ear) 70 weeks
Great toe 35 weeks Hearing (both ears) 150 weeks
Any other toe 10 weeks Back 300 weeks
Hand 200 weeks

Whether You Should Settle Depends on Your Circumstances

Many people contact us with questions about whether they should settle based on a rating, and the answer to that question will vary depending on your circumstances. Here are some of the things we consider:

  1. Do you intend to continue working with the employer where your injury occurred?
  2. Are you receiving a weekly check from the workers’ compensation company?
  3. Do you have a substantial need of medical treatment?
  4. Have you undergone a functional capacity evaluation, and has your employer offered you employment that is appropriate for your injury?
  5. Have you been informed about your rights to file a Form 18M (an Employee’s Application for Additional Medical Compensation)?
  6. Is the impairment rating given by the doctor (often chosen by the insurance company) reasonable in light of your injury?
  7. Would you benefit from a second opinion by another doctor that is agreed upon by both you and the insurance company, and is paid for by the insurance company?

When You Settle Your Workers’ Comp Claim

The first step to resolving a case based solely on an impairment rating is by signing a Form 26A.  A Form 26A is an employer’s admission of the employee’s right to permanent partial disability to a body part or parts. We urge you to contact an experienced workers’ comp attorney before settling on a rating. You simply don’t know what you don’t know. One recent case comes to mind that illustrates this point.

We represented an injured worker who enjoyed her job and was looking forward to going back to it. The workers’ comp insurance company stood in the way of that goal however. Its guidelines for a full settlement of the claim stated that you must also resign from the company where you were working when you got hurt. Our client did not want to resign. So she decided to settle based on a rating alone. This would not have been in her best interest, so we embarked on extensive research that uncovered a gold nugget of information, which subsequently favored our client. Because of this new information, our client received much more than she would have otherwise based on her rating alone*. And she got to go back to a job she loved!

N.C. Workers’ Comp Lawyers Offer Free Case Evaluation

Case evaluations are free. Furthermore, we work on a contingency basis, which means if we don’t get you compensation, you don’t owe us an attorney’s fee. We urge you to contact us if you are considering settling based on a rating – or settling period.

PS…There are lots of good N.C. workers’ comp attorneys you could choose from. Here are five important reasons we believe you should consider hiring us.

*Cases or matters referenced do not represent the law firm’s entire record. Each case is unique and must be evaluated on its own merits. The outcome of a particular case cannot be predicated upon a lawyer’s or a law firm’s past results. Client identity has been removed or changed to protect client’s privacy.

Contact Information

Raleigh Law Office

4325 Lake Boone Trail, Suite 100
Raleigh, NC 27607
Phone: 919-834-1184
Toll Free: 1-866-900-7078

Durham Law Office

280 South Mangum Street, Suite 400
Durham, NC 27701
Phone: 919-688-4991
Fax: 800-716-7881

Fayetteville Law Office

517 Owen Drive
Fayetteville, NC 28304
Phone: 910-488-0611
Toll Free: 1-866-900-7078

Charlotte Law Office

1001 Morehead Square Drive, Suite 350
Charlotte, NC 28203
Phone: 704-599-1078
Toll Free: 1-866-900-7078

New Bern Law Office

1505 South Glenburnie Rd, Unit P
New Bern, NC 28562
Phone: 252-634-9010
Toll Free: 1-866-780-3422

Greenville Law Office

702 G Cromwell Dr.
Greenville, NC 27858
Phone: 252-355-5205
Toll Free: 1-866-780-3227

Greensboro Law Office

300 N. Greene Street, Suite 850
Greensboro, North Carolina 27401
Phone: 336-665-7072
Toll Free: 1-866-900-7078

Goldsboro Law Office

214 South William Street, Suite 3
Goldsboro, NC 27530
Phone: (919)-731-2581
Toll Free: 1-866-900-7078

Henderson Law Office

514 Dabney Drive, Suite 200
Henderson, NC 27536
Phone: 252-492-4600
Toll Free: 1-866-900-7078

Roanoke Rapids Law Office

709 Julian R. Allsbrook Highway
Roanoke Rapids, NC 27870
Phone: 252-537-9670
Toll Free: 1-866-900-7078

Rocky Mount Law Office

3202 Sunset Avenue, Suite B
Rocky Mount, NC 27804
Phone: 252-937-4730
Toll Free: 1-866-900-7078

Sanford Law Office

703-B South Horner Boulevard
Sanford, NC 27330
Phone: 919-775-1564
Toll Free: 1-866-900-7078

Wilson Law Office

2315 Airport Blvd Suite A
Wilson, North Carolina 27896
Phone: 252-246-9090
Toll Free: 1-866-900-7078

Winston-Salem Law Office

301 N. Main Street, Suite 2409-C
Winston-Salem, NC 27101
Toll Free: 1-866-900-7078