|
Patrick R. Griffin
Attorney
120 North main Street
Suite 110
West Bend, WI 53095
Tel: (262) 306-2999
Fax: (262) 306-9590
E-Mail: griffinlawcenter@westbendlawyer.com
|
Free Consultations
No Attorney's Fees Are Charged
Unless Your Case Is Won Or Settled!
Personal Injury
Auto
Social Security Disability
Boat
Uninsured Motorist
Motorcycle
Workers Compensation
Product Injury
Wrongful Death
|
INJURED WORKERS OFTEN UNAWARE OF BENEFITS AVAILABLE
In 1911, Wisconsin became the first state to enact worker's compensation laws. Before the worker's compensation laws were adopted an employee who was injured while he or she was working could only obtain compensation by suing the employer. When an employee did sue the employer, the employee still would not be compensated unless he or she was able to prove that the employer was negligent in causing the injury.
When the worker's compensation system was adopted, it eliminated the need for injured workers to sue their employers in order to obtain compensation. The laws also eliminated the requirements that injured workers prove that their employer was negligent as a condition of recovering. In exchange for eliminating the requirements that an employee sue the employer and prove negligent, employees gave up the right to recover damages for their pain and suffering. Benefit to injured workers were paid only for economic losses (primarily lost wages and medical expenses) and modest limits were placed on the amounts of the benefits which were payable.
The system was designed in principal to work without lawyers. Today, in many cases, employees are still able to receive all of the worker's compensation benefits to which they are entitled, without the assistance of an attorney.
The worker's compensation benefit system is relatively simple. When an individual is injured in the course of his employment, and is forced to miss work, the employee is entitled to be paid two-thirds of his average weekly wage from the date of injury until the employee reaches a healing plateau. There is a cap or ceiling on these benefits, known as temporary total disability benefits at the present time of $450.00 per week.
In addition to being paid lost time benefits, 100% of all reasonable and necessary medical expenses are paid by the employer or worker's compensation insurance carrier.
Where the employee does not make a complete recovery and is left with some permanent disability, the employee is paid an additional benefit. The amount of the benefit payable for this permanent disability is determined by a rather complicated formula under the worker's compensation laws.
If an employee is left with a significant disability, which prevents the return to the former job, and the injured employee has no job skills to earn a comparable pay in another line of work, the employee may be eligible for a retraining program, which is designed to restore the employee's earning power. A worker in this position applies for assistance from the Wisconsin Division of Vocational Rehabilitation. When a partially disabled worker is accepted for a retraining program, the state normally pays for all books and tuition for the schooling program.
In addition to having the individual's books and tuition paid by the state, the employee is also entitled to collect temporary total disability benefits during the period that the employee is in school. These are paid by the employer or insurance carrier. The employee is also paid for all necessary mileage for travel to and from school and compensated for the cost of meals consumed while at school.
For example, take the case of an employee who was engaged in heavy construction work, earning $20.00 per hour at the time of a moderate back injury. If, at the end of the healing period, his doctor indicates that his disability is rated at 5% of the whole body, under the state formula, he would be entitled to be paid $7,200 for his permanent disability. Now, however, assume that because of this construction work, which he previously did. Even after this employee completes a program of vocational rehabilitation, we find that he still is able to earn a maximum wage of $10.00 per hour. Since this employee could earn $20.00 per hour after the accident, he has sustained a 50% loss of earning capacity.
Under the worker's compensation laws, a worker in this position could make a claim for additional benefits based on this loss of earning capacity. The injured worker in this illustration would be entitled to recover an additional $64,8400.00 for a total disability of $72,000.00.
Finally, there is a small class of workers who become totally disabled and unable to perform any gainful work activity for the remainder of their lives. Employees in this situation are entitled to collect what are called permanent total disability benefits. These workers are paid a weekly benefit, just like temporarily disabled workers. Benefits are payable for the injured worker's life.
In theory, the worker's compensation system works well. However, over time, insurance companies have developed strategies and tactics, which are employed to limit the amount of worker's compensation benefits paid to injured employees. Under the law, the insurance carrier or employers have a right to have an employee examined by a doctor of their choice. There are a number of doctors who devote a substantial portion of their practice to examining injured workers at the request of the insurer and then writing medical reports for the insurance carrier or employer. If the insurance company's doctor indicates that the employee should be able to return to their job, the insurance company can stop making the weekly temporary disability benefits, This is true, even where the employee's own treating physician indicates that the employee should not be working.
With respect to permanent disability benefits, the treating physician normally assigns a percentage disability rating. Less frequently, a physician hired by the employer or insurance carrier will indicate that the injured employee has either no permanent disability or a substantially smaller percentage of permanent disability than indicated by the doctor.
Many injured workers find their temporary disability benefits cut off after a visit to one of these doctors. Many worker's in this position are unaware of their right to file a claim for ongoing disability benefits up until the time that the treating doctor indicates the employee is able to return to work or has reached a healing plateau. The injured employee also has the right to make a claim for the full amount of permanent disability benefits which are payable for the permanent disability indicated by the treating doctor or chiropractor.
Many worker's who are unable to return to their former jobs, are not aware of their option of pursuing a retraining program through the Division of Vocational Rehabilitation. Most injured workers who have suffered a loss of earning capacity are also unaware of their right to pursue a claim for this additional compensation.
An injured worker has no need to hire a lawyer as long as he or she is receiving all temporary and permanent disability benefits indicated by the treating doctor or chiropractor. It is only when a dispute develops as to the insurers responsibility to make additional disability benefits or pay for additional medical expenses that injured employees need the assistance of an attorney.
Most attorneys who handle worker's compensation claims agree to see individuals for a consultation without charge. Normally these cases are handled on a contingent-fee basis, which means that no attorney's fees are payable unless the case is won or a satisfactory settlement is obtained.
Worker's compensation disputes do not go through the regular court system. Instead, a request for a hearing is filed with the Worker's Compensation Division of the Department of Industry, Labor and Human Relations. The hearing will be set before an administrative judge who will decide the case.
Many cases are settled before reaching the hearing with the administrative law judge. An administrative law judge must approve if the injured worker and the insurance company agree on a settlement, before it becomes final.
The hearing is relatively inexpensive. Instead of having to pay a doctor to come to court and testify at considerable expense, the employees have the option of obtaining a simple report form from their treating doctor and filing the report at the hearing, instead of offering the doctors testimony.
The length of time it will take to resolve a case with the Worker's Compensation Division will vary, depending on the backlog of cases at the time a hearing application is filed. Typically, it is six to eight months before a case is resolved.
This article is intended only as an overview of the worker's compensation system in Wisconsin, If a reader believes that he or she may have a claim for additional worker's compensation benefits, it is strongly recommended that the reader consult with an attorney who is experienced in handling worker's compensation cases.
Patrick R. Griffin has been handling Worker's Compensation cases successfully for more than twenty-three years. He is well known and respected by the Judges who decide Worker's Compensation cases. Just as importantly he is also known and respected by the attorneys who represent the Worker's Compensation insurance companies. As a result, most of his cases are settled without having to go through a hearing.
Griffin Law Center provided free telephone and office consultation. No attorney's fees are charged unless your case is won or settled. We can be reached at (262) 306-2999.
|
SOCIAL SECURITY DISABILITY BENEFITS
Most Americans do not realize that they are covered by a disability insurance plan. The plan is operated by the federal government. Each time a worker receives a pay check approximately 20% of the Social Security taxes deducted are paid into the federal government's Social Security Disability Insurance plan.
In order to be eligible for these benefits, you must have paid in sufficient payroll taxes in 20 of the last 40 calendar quarters. In other words, you must have worked for approximately half of the last 10 years.
Social Security Disability is not a welfare program. There is no restrictions relating to your wealth or income from sources other than work.
Social Security Disability benefits range between $300.00 and $1,800.00 per month. after a recipient of disability benefits has been disabled for 29 months, he or she receive Medicare coverage.
SUPPLEMENTAL SECURITY INCOME (SSI)
There is another program operated by the federal government which provides monthly income benefits to poor people who are disabled. The program is called Supplemental Security Income or SSI.
The maximum SSI benefit is about $600.00 per month. This benefit is reduced by the amount of any other income received by the disabled person. This is more of a welfare program and it is only available to people with minimal assets. Persons who qualify for SSI benefits also qualify for Medicaid or Title 19 medical coverage.
QUALIFYING FOR BENEFITS.
An individual is considered to be disabled and eligible for benefits only if his or her physical or mental impairment or impairments are of such severity that the person is unable to do his or her previous work and cannot, considering the person's age, education and work experience, do any other kind of substantial gainful work which is available in the national economy. The question is not whether the person could get hired to do the job, but whether the person could perform the job on a regular and sustained basis.
If a person has a physical or mental impairment or impairments which prevent the person from working, the condition must be such that it will last at least 12 months or is expected to result in death.
The Social Security Administration has prepared a "listing of impairments" of qualifying medical conditions. If a person is not working and has one of the "listed impairments", the person qualifies for disability benefits.
Many people do not have a listed impairment, but are still disabled and are unable to work. These people are eligible for benefits if they are unable to perform their past relevant work, and because of a medically documented physical or mental impairment, are unable to do any other types of work which are available in significant numbers in the national economy. In making this determination, consideration is given to the person's age, education and work experience. There is an age bias in the rules for determining disability. As a person gets older ( beginning at age 50 ), it becomes easier to prove the person is disabled. For people under age 50, it is difficult to establish disability in many cases.
HOW TO OBTAIN BENEFITS
In order to apply for disability benefits, a person must contact their local Social Security Administration Office. An applicant is then required to complete a rather lengthy application, if they disagree with the denial. Approximately 17% of those whose initial applications are denied are granted benefits after requesting reconsideration of their case.
For those whose request for reconsideration is denied, there is an opportunity to appeal the denial reconsideration, by requesting a hearing before an administrative law judge.
In a hearing before an administrative law judge, a person is entitled to present all evidence which supports a claim for benefits. Administrative law judges are independent from the Social Security Administration and are not bound by the previous denials of benefits. Just over 60% of those who request hearings before an administrative law judge are granted benefits .
A person who loses a hearing before an administrative law judge does have the right to file an additional appeal to the body known as the Appeals Council. Very few of those who file appeals with Appeals Council are successful.
A person who loses an appeal to the Appeal Council has a right to further file an appeal in Federal Court. Less than 1% of all claims files are reviewed in the Federal Court.
SHOULD I HIRE AN ATTORNEY
We generally recommend that people file their initial application on their own. When a person files an application, the Social Security Administration gathers the person's medical records. This is done at no expense to the applicant. The approval rate on initial applications is low, and only the most severely disabled people are granted benefits. Those who are able to obtain benefits at this stage are so disabled that they do not need an attorney to help prove their case.
We also generally advise clients to request reconsideration on their own. When reconsideration is requested, the government again obtains updated medical records for the applicant, at no cost to the applicant. Since only 17% of reconsideration requests are granted, only the obviously disabled people obtain benefits at this stage. These people do not need a lawyer.
In most cases, a disabled person will benefit greatly from having a lawyer represent them for a hearing before an administrative law judge. An experienced attorney can review the medical evidence and determine whether there is sufficient evidence to prove a case. A skilled attorney is also able to obtain additional medical evidence to help prove the case. By having doctors write additional reports, or, in some cases, order additional tests, the attorney provides additional medical evidence to prove a case, which evidence was not in the Social Security file previously.
At the Griffin Law Center, we have had successful results in approximately 95% of the Social Security disability claims we have handled.
ATTORNEY'S FEES
Clients are only charged attorney's fees if we are successful in obtaining disability benefits. The fees are 25% of the benefits the Social Security Administration owes the client. Normally, the maximum fee charges is $5,300.00. The client is also responsible for reimbursing our firm for any costs incurred in the handling of the case.
There is no charge for an initial telephone or personal consultation. Attorney's fees cannot be charged unless the client first signs a written contract and we are successful in obtaining benefits for you.
|
FOR ADDITIONAL INFORMATION PLEASE CALL
(262) 306 - 2999
HOURS
MONDAY - FRIDAY
8:00am to 12:00pm
1:00pm to 5:00pm
24 HOUR MESSAGING
|
|