Social Security: New Proposed Rules not so good?

Over at a Social Security blog it was indicated that the feds are seeking new rules in the handling of Social Security claims. Will it improve the system? Would you call it an improvement if it saves money? Seems like this may mean less benefits being paid out and more denials of cases according to this writer. Hope he is wrong but he does provide a link to the new proposal and it does show a savings. I just hope it is not at the expense of the disabled. The writer is saying thousands more may be denied benefits. I certainly think the current system needs improving and increased efficiency as delays are terrible. I know that the Social Security system is underfunded and needs more Judges and dollars in their budget so perhaps the savings is more administrative but if not then it is ominous for claimants.
http://socsecnews.blogspot.com/search/label/Procedural%20Rules

Stats, stats and more stats for the curious

Over at the Colorado Division of Workers Compensation website they post some very interesting information. The entire workers comp statutory law is there. The rules issued by the Division of Workers Compensation are there as are forms, publications and various other things. On one page numerous statistics are provided with links to the source of those stats. For example nearly 25% of all claims are contested at the beginning and stay contested. That forces the claimant to either give up or seek a hearing. Anyway here is the link to peruse that page for stats which were noted by the Division. I am especially intrigued by statistics which make you wonder what is going on. When the population goes up but claims and hearings go down it does make you think about it.
http://www.coworkforce.com/DWC/CuriousAbout.asp

Final Admissions

In Colorado when a Final Admission of Liability is filed in a workers comp matter this is an extremely important document. In essence the insurance or self-insured party/employer is saying that they wish to close the claim based upon precisely what they state within the Final Admission itself. It may provide for permanent benefits or not. It may provide for further medical care or not. It may say any number of things which you might wish to question. The key thing to realize is that you are on a deadline of 30 days from date of mailing to act as provided by the law or your claim will likely be closed as provided in the Final Admission. Now there can be exceptions where the Final Admission is defective and can be struck down but that is very rare. So anyone receiving a Final Admission should know they must act promptly to question it. And this does not mean just calling up someone at the insurance. The required language on these Final Admissions sets forth how to properly act to object and follow through on the objection. Since this is usually a complicated matter consult with an attorney or at least call the Division of Workers Comp customer service for further information. Their number is 1-888-390-7936. At my office we routinely object to any Final Admission and go further to protect the claimant, such as moving to obtain a Division IME (doctor through the state to examine and provide another opinion). If we do not seek a DIME doctor we still usually then apply for a hearing if appropriate. It is a judgement call we make depending on the circumstances for our clients. However the important thing here is to realize you do not have to accept the insurance company position in the Final Admission but must act fast. Almost always when we object and go forward it is to obtain more benefits. Additional benefits possible include more medical treatment and more compensation but again it is a call we make on a case by case basis. Simply put: beware of any Final Admission!

Termination Issues

When you have a Colorado workers comp claim the issue of job termination may come up. Colorado statute indicates that if there is a termination and it is the claimant's responsibility then his claim for temporary benefits is in trouble. Quitting even if you believe it is justified or you are being harassed is very dangerous. If you are terminated for cause it is also a major problem. So if the boss says to check in or imposes more on you after an injury you had better be on your best behavior. In other words try hard not to give them a ground to fire you. You may feel stressed and unfairly treated but being in a legal fight to keep receiving temporary benefits is not a place to be. Once benefits are stopped it can take a hearing to restart them and if the Judge rules against you then you don't get them unless your condition worsens. None of this is pleasant and it can be financially devastating to some claimants especially when you are months away from closing your case. Plus in some of those cases you also may not obtain unemployment benefits so it can really hurt. I disagree with this law and recall what it was like before the law was passed. Back then if you lost your job for any reason you were still usually disabled and trying to find a new job was difficult so in most cases you could keep receiving temporary benefits. I also disagree with it because in my view many terminations are pretextual, that is they target you to find a way to call the termination your fault. Bottom line: cover yourself! If you feel you are being set up be careful and you may wish to document the situation. Better still get a lawyer if at all possible. One last thing usually termination does not affect your permanent claim for benefits in an admitted case but those benefits can be months away.

Social Security News Blog

Here is link to a blog with only Social Security news by an author of a legal publication for lawyers. It is a bit detailed but gives you an idea or overview of the things which interest some of us about what is going on with Social Security these days.
http://socsecnews.blogspot.com/

Colorado Medical Fee Schedule

I am providing a link below to the medical fee rule but must tell you that it is a long pdf (Adobe Acrobat) document. As of January 1. 2008 these will be the new fees chargable by physicians and other providers. From my perspective I watch the charges for meetings with doctors and testimony at a hearing. The current rate is that a doctor called to testify in a workers comp proceeding in Colorado can charge $400.00 an hour portal to portal. That means from the time he leaves his office until he returns so it includes travel and waiting around time. The new rate will be $450.00 an hour. So when an injured worker has to call a doctor to testify the expense will usually exceed $1200 and often reaches $2000.00 but it all depends on the time involved. Come January it will be a 12% higher expense. This expense is charged to the person calling the doctor. So you pay it if you call the doctor. Fortunately in many cases we can set aside some extra funds to help cover this but in the end it all is charged to the client. It is something to avoid if possible but at times it is necessary. If the attorney just meets with a doctor it is billed at $300 an hour. I realize the doctor has to charge. My concern is that I feel all this is caused by the insurer disputing something and burdening the claimant. It really should be part of the covered costs and paid by the insurer. This can raise insurance rates but it could equalize the legal fight since insurers often spend quite a bit to fight on medical issues. Especially with an unrepresented claimant they can overwhelm his resources to fairly fight. To have the insurer bring one or two doctors to a hearing and the claimant have nobody can mean an unfair advantage. I expect insurance people would strongly disagree with me as many seem to think an injured worker is costly enough but to me due process is important and I believe in a fair fight when there is a dispute. Justice should not be based on the size of your wallet. One last item mileage reimbursement for medical related travel by the claimant is going to .40 a mile.
http://www.coworkforce.com/DWC/Rules/Rules%202007/Adopted%20Rule%2018.pdf

Medical Care in Workers Comp and Social Security

Unless you qualify for medicare or medicaid or other state assistance a claimant seeking Social Security disability gets no medical care except any he can obtain on his own. Often in my town an impoverished person can try for Peak Vista which is a community facility manned by hard working dedicated people. Once you obtain SSDI (the typical Social Security disability) then medicare is possible (it kicks in after you've received 2 years of benefits but this could be soon if you were entitled to back amounts). What I do mean to point out is that you have no right to medicare until it kicks in but sometimes the agency will send you for an examination on your case. It is not treatment. In workers comp the process is different. Even in a contested case you may be able to obtain medical care though it is not always extensive until the claim is admitted or ordered to be covered. My problem is that in workers comp even in an admitted case there can be controversy over the extent of care. Insurers love to question causality by suggesting maybe the problem is not work related. Insurers love to second guess even the dedicated doctors by saying the surgery or expensive treatment requested may not be reasonable or necessary. I recall one time where my spouse using her health coverage had a knee operation many months before my workers comp client had his knee surgery. Delays seem to cause more expense and even medical complications. Of course in workers comp a covered treatment is paid 100% but nothing by the claimant. Also in workers comp long term care can be covered for life at zero expense to the claimant if it is appropriate. But for me I keep thinking that we should all have a national health plan and then all we would quibble about in workers comp is the extent of disability not wait while we dispute the treatment. Some physicians have a website calling for this at :

http://www.pnhp.org/