Relationship between Social Security Disability and Workers’ Compensation
If you are injured on the job and you anticipate applying for Social Security Disability benefits there is an important relationship between these two programs. How you settle your workers’ compensation case is very important when Social Security Disability is involved. Many times when an injured worker is receiving workers’ compensation benefits they will have reduced monthly Social Security Disability benefits as a result of that. This is called the Social Security offset. There are ways to avoid this, and this is where decades of experience can make a big difference in terms of your bottom line.
What do I do if I get hurt on the job?
Report the injury right away.
By far the most common mistake injured workers make is not reporting their injury to their employer. Although the law says you have 90 days to report the injury, the reality is the longer you wait the more likely your claim will be denied.
Believe me, we know the reason why people don’t report their injuries—they’re afraid they’re going to upset their boss or lose their job.
Let us tell you what will happen if you don’t report that injury.
- You will not get your medical bills paid for, including surgery.
- You won’t get paid for any time off you need, so your family will not have money to pay your bills.
- You are much more likely to lose your job.
Report your injury right away and get it in writing. Tell co-workers as well, especially a supervisor or foreman.
KEEP GOOD RECORDS
Be sure to record the injury on a calendar, notebook or diary. Write down what happened, who was there and who you reported the injury to. If you see the company nurse or first aid person be sure to write down what was done for you. Write down the date and time of each visit to the nurse or first aid room. If you are sent to a doctor, hospital or physical therapy be sure to record the date, time and place in your notebook or on your calendar. If you are given a slip from the doctor to take back to the employer be sure to stop and make a couple of copies for your records. After you leave the doctor’s office write down what was done and what the doctor told you.
Many times upon return to the workplace an employer will tell you to perform work above and beyond your medical restrictions. KEEP YOUR MEDICAL RESTRICTIONS IN YOUR WALLET! That way you can show the foreman or supervisor exactly what they are and the reason you cannot perform that particular task. Working beyond your restrictions can be dangerous and cause further injury that you will have to live with, not your employer.
MEDICAL CARE – Right to See a Qualified Doctor
If you are hurt on the job you not only have the right to see a doctor but you have a right to see a doctor who is qualified to treat your condition. The employer must provide you with all the necessary care you need. If you have a back injury and a general practitioner is not helping, you do have a right to ask for a referral to a specialist.
For years, workers’ groups have tried to change this law. As a small compromise Iowa workers can now petition the Workers’ Compensation Commissioner to allow alternate care by some other doctor. This is especially true if the employer wants you to travel a long way to be treated. In such a case a telephone hearing is usually held within 10 days.
If the employer denies the injury you are free to see any doctor you like but workers’ compensation will not pay. In most cases you can have your health insurance pay the bills on disputed workers’ compensation medical charges.
The employer has the right to select the doctor but not the treatment. Sometimes employers will try to dictate whether the doctor will do certain tests or if surgery will be done. The treatment is up to you and the doctor, not the employer.
If the doctor selected by the employer refers you to another doctor that doctor is also authorized and the insurance carrier is not allowed to interfere with that choice.
MILEAGE AND MEDICAL EXPENSE
The employer or its insurance company has to pay you for each mile you drive to see a doctor or other medical provider. The amount paid is set each year and is the same that state employees are paid. If you keep good records you will be able to submit a bill for your total miles. The employer also has to pay for all of your prescriptions and expenses such as braces or crutches.
WHAT IS A CUMULATIVE INJURY AND IS THAT CONSIDERED WORK-RELATED?
Many work-related injuries happen because of a single accident on incident—but most do not. Most work injuries happen over the course of time, usually by performing similar or repetitive duties for a long period of time. Repetitive injuries affect all parts of your body—back, shoulder, hands, elbows, hip, legs, and feet.
Cumulative injuries are covered under Iowa Workers’ Compensation. If your symptoms are persistent, report the injury right away and ask that a paper report be filled out.
HEALING PERIOD BENEFITS OR TEMPORARY TOTAL DISABILITY
If you are hurt on the job and the doctor says you cannot work or the employer does not have work that you can do with your restrictions you are eligible for weekly “healing period” checks.
Here are a few things to remember: Your benefits start on the fourth day of your disability. If you are off work for more than fourteen days you will be paid for the first three days. There is not a waiting period for healing periods. Saturdays, Sundays, holidays and vacation periods count. Benefits are paid on a seven day week. The checks must be paid weekly. The employer is subject to a penalty if they have unreasonable delays in getting your check. The employer must give you a thirty day notice before it discontinues your checks.
THE CORRECT WEEKLY RATE
There are several ways to figure your correct weekly rate of benefits. The most common method is to average out the thirteen weeks immediately prior to the injury. The employer cannot count short weeks. Incentive pay is included but premium pay such as night shift bonus is not. Overtime hours are counted as straight time.
If you have not worked thirteen weeks the employer must compute the rate as though you had. The employer is required to use all wages you earned in the twelve months immediately prior to the injury if you are working part time or at a lower rate of pay than normally earned by those in your occupation. If you have a full time job but are injured on a part time job, the rate has to be computed on your total earnings.
The rate is to be computed so that you receive 80% of your spendable income. Workers’ compensation benefits are not taxable.
TEMPORARY PARTIAL BENEFITS
If you are returning to work and earn less than you were earning at the time of your injury the employer must pay 66/23% of the difference. This will continue until a doctor has said that you have reached “maximum medical improvement” or until you have a disability rating.
Death benefits are determined in the same manner as other weekly benefits and are only payable to the dependents of the employee. If the employee has no dependents the employer does not have to pay benefits. Benefits are first payable to the surviving spouse for life or until remarriage. Dependent children are entitled to the benefit until they reach age 18, or age 25 if they are actually dependent. Upon marriage, if there are no dependent children, the surviving spouse is entitled to a two year lump sum settlement.
PERMANENT PARTIAL DISABILITY (PPD)
Many workers have thousands of dollars coming to them as a result of the damage done to their bodies and their loss of earning capacity.
If your injury leaves you with an impairment to your arm, hand, leg, foot, toe, finger, ear or eye you are due some additional benefits from workers’ compensation. Each of the body parts listed above are worth a set number of weeks of workers compensation. If you were to lose your hand at the wrist you would only receive 190 weeks of workers’ compensation no matter what you do for a living. You could be a concert pianist and lose a hand and only receive 190 weeks of workers’ compensation.
If you lose a thumb you would receive 60 weeks of workers’ compensation, the first finger would be 35 weeks, the second finger 30 weeks, the third finger 25 weeks, fourth finger 20 weeks, and arm 250 weeks, great toe 40 weeks, any other toe 15 weeks, a foot 150 weeks, a leg 220 weeks, an eye 140 weeks, hearing in one ear 50 weeks, hearing in both ears 175 weeks and permanent disfigurement of the face or head 150 weeks under certain circumstances.
If you suffer an injury to the trunk of your body such as your back, neck, shoulders, chest, stomach, hip or groin you could be eligible for industrial disability which is meant to compensate you for a loss of earning capacity. To determine the amount of compensation a lot of factors are taken into consideration such as the impairment rating given by the doctor, your age, education, work history, the effect the injury has had on you, your motivation and the employer’s efforts to return you to work or help you with rehabilitation.
So many times an employer will hand you a check covering the impairment that the doctor has given you and consider the matter settled. You should have your case reviewed by an experienced workers’ compensation attorney to see if you have any more benefits due. You should keep in mind the two year and three year rule.
THE SECOND INJURY FUND
If you have impairments to two extremities (legs, feet, arms or hands) you may be eligible for industrial disability from the Second Injury Fund which is administered by the State of Iowa. The first injury does not have to be work related but can be a birth defect, childhood injury or the like. The second injury has to be work related and has to have happened separately from the first injury. Both extremities must be related as impaired by a doctor. This is a state fund that is there to help the disabled.
STATE VOCATIONAL REHAB
The Iowa Department of Education provides an agency to help those with disabilities find their way back to the work place. You can call the Iowa Division of Vocational Rehabilitation Service. This agency can help you with formal retraining, on the job training or can help you to start your own business.
If you are unable to return to your work or if the employer will not take you back you are eligible for unemployment compensation. This is true even though you may have work restrictions. In order to receive unemployment benefits you have to be able to do some work, not necessarily your old work. If you have been off work on workers’ compensation for a long time you might not be eligible for unemployment under the normal rules. It may be possible for Job Service to back up your claim to a period where you are earning wages.
Remember you can receive weekly PPD checks and unemployment benefits at the same time, but not healing period and TTD payments.
If you have credit disability insurance on your car payment, loan payments or house payment you should go ahead and turn in a claim. Many workers have made it through a period of disability with their payments being made by insurance.
A lot of life insurance policies have a premium waiver provision that will pay your premiums during your period of disability. If you will be totally disabled you should check into your pension plan’s disability pension.
COLLECTION FOR UNPAID MEDICAL BILLS
Under Iowa law, medical providers cannot try to collect a bill resulting from a contested workers’ compensation claim. The medical provider can only send an itemized bill. If you are having problems with unpaid medical bills, you should call our office immediately.
Under Iowa’s workers’ compensation laws each body part has a certain value which is set by the state legislature. When a doctor gives an impairment rating expressed in a percent, an injured worker would receive that percent of the injured body part.
Here are the values of the body parts:
- Thumb – 60 weeks
- First Finger – 35 weeks
- Second Finger– 30 weeks
- Third Finger – 25 weeks
- Leg –220 weeks
- Loss of Hearing (1 ear) – 50 weeks
- Loss of Hearing (2 ears) – 175 weeks
- Hand – 190 weeks
- Body as Whole/Industrial Permanent Disfigurement, Disability – 500 weeks
- Face or Head – 150 weeks
- Arm – 250 weeks
- Great Toe – 40 weeks
- Any Other Toe – 15 weeks
- Foot – 150 weeks
- Eye – 140 weeks