WhatEverySSDIA/orneyShouldKnowAboutWC,STDI,andLTDI

BenefitsBillParsons

HAWKSQUINDEL,S.C.222W.WashingtonAve.,Ste.450

P.O.Box2155Madison,WI53701‐2155wparsons@hq‐law.com

tel:608‐257‐0040|fax:608‐256‐0236www.hq‐law.com

OpeningThoughts

• Understandingwhatelseisoutthereforyourclients

• Timingissues–whentoapply,whenyoumustappeal,statuteoflimita]ons

• Whatoffsetswhat?HowSSDIinteractswithWC,STDI,andLTDIbenefits

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WhatElseIsOutThere?

• Worker’sCompensa]on–MostEmployees

– FederalEmployees

– RailroadEmployees

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WhoisEligibleforWCBenefits?

• Employee

• SustainsanInjury

• DuringCourseofEmployment

• ArisesOutofEmployment

• NotSelf‐Inflicted

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WhoisEligibleforWCBenefits?

• Employee– Primarytestiswhethertheallegedemployerhastherighttocontroltheallegedemployee’swork• Righttofire• Paysemployee

• Furnishesequipment

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WhatBenefitsAreAvailable?

• TheBasics:– LostWages

– Disability–MedicalExpenses

–Mileage

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WhatBenefitsAreAvailable?

• OtherBenefits– Retraining– LossofEarningCapacity– Disfigurement

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WhatBenefitsAreAvailable?

• Penal]es– DelayinPayment–10%

– BadFaith–200%– RefusaltoRehire–UptoOneYear’sWages

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WhatElseIsOutThere?

• ShortTermDisabilityInsurance– OfferedThroughEmployer

– PurchasedOutsideofEmployment

– StateEmployees–IncomeCon]nua]onInsurance

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STDI–WhatBenefitsAreAvailable?

• Variesfromcontracttocontract

• Generallyreplacesapor]onoralloflostincomeforalimitedperiodof]me– Afewweekstoafewyears

• GenerallynotavailableifdisabilityresultedfromWCinjury

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WhatElseIsOutThere

• LongTermDisabilityInsurance– OfferedThroughEmployer

– PurchasedOutsideofEmployment

– StateEmployees–40.63&40.65benefits

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LTDI–WhatBenefitsAreAvailable?

• Variesfromcontracttocontract

• Incomereplacementorpercentagethereof

• TypicallykicksinalerSTDIbenefitsareexhausted

• WillcoordinatewithWC

• Typicallypaysun]lage65orNRAunlesslimita]onsapply–MentalHealth/Self‐ReportedCondi]ons

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LTDI–WhatBenefitsAreAvailable

• TwoperiodsofDisability– OwnOccupa]on• FromendofSTDIforsomeperiodof]me

• Variesfrompolicytopolicy

• 6monthstoremainderoflife

• EasierstandardthanSSDI– Canpersonperformthematerialdu]esofownoccupa]onasjobisperformedinthegeneralmarket

» Bewareunusualjobrequirements/thebadsupervisor

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LTDI–WhatBenefitsAreAvailable

– AnyOccupa]on• Beginsalerownoccupa]onperiodends–usuallylastsun]lage65orNRA

• CanyouearnatleastXpercentofpre‐disabilityincomeperforminganyjobinthegeneraleconomy?– Basedoneduca]on,jobhistory,transferrableskills,workrestric]ons

• StandardmaybeeasierthanSSDI– EarningsthresholdmaybehigherthanSSDI“gainfulwage”

– Dependsonpre‐disabilityearnings

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WhatElseIsOutThere?

• OtherBenefits– Sickness&AccidentBenefits– DisabilityPensionBenefits– LifeInsuranceBenefits–WaiverofPremiums

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WhatElseIsOutThere?

• Listisnotcomplete–butagoodreference

• Importanttoiden]fyallpoten]alsourcesofdisabilityincomeforyourclients

• Checklist

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TimingIssues

• WC,STDI,andLTDI

• Whentomakeaclaim?

• Whentoappeal?

• StatuteofLimita]ons

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WhenToMakeAClaim‐WC

• Assoonaspossiblealerinjury– Bestchanceofgeqngclaimapproved

– Commondenial–notcrediblebecauseclaimantwaitedtoolongtoreportclaim

–Within2years

–Within12years

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WhentoAppeal/SOLforWC

• Appeal&SOLissameissueforWC

• Mustfilehearingapplica]onwithintwelveyearsalerlastpaymentofTTDbenefits– Ifnone–withintwelveyearsofdenial

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WhenToMakeAClaim‐STDI&LTDI

• Inadvanceofleaveifplannedevent

• Assoonaspossiblealerleavebegins

• Termsgovernedbyplandocument–readcarefully

• Donotnecessarilyneedtoremainemployedtomakeclaim– Disablingeventmustoccurpriortoendofemployment

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WhentoAppealSTDI&LTDI

• ERISAvs.Non‐ERISAplans– Whatisthedifference

• MostplansareERISAPlans• Excep]ons

– GovernmentPlans– PrivatelyPurchasedPlans– PayPrac]ces

» PaidbyEmployeroutofgeneralfunds–notinsured

– ERISAPlans–180daysfromdateyoureceivedenialle/er

– Non‐ERISAPlans–vary.Basedontermsofplan.Usuallyshorter.Makesuretonotethis.

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ANoteAboutERISAAppeals

• IfplanisgovernedbyERISA–developingtheadministra]verecordiscrucial– Allyouwillhaveifyouneedtobringlawsuit– Getthegoodstuffin• Voca]onalreports• FCE• MedicalSourceStatements

• Witnessstatements

• ResponsestoIME

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NonERISAAppeals

• S]llImportant…but– Ifdenied,youhaveeitheracontractclaimoranunpaidwagesclaim

– Inanyevent–youhavediscoverypower

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Let’sTalkOffsets

• TakeAway–Almostalwaysmakessensetoapplyforanyotherbenefitsthatareoutthere

• WC,STDI,andLTDIwillnotreduceSSDI

• ThesebenefitsarereducedbySSDI

• Youra/orneyfeeonSSDIwillnotbeimpacted

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Let’sTalkOffsets

• WC–it’scomplicated

• STDI&LTDI–it’snotcomplicated

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Let’sTalkOffsets

• STDI&LTDI– BenefitsarereduceddollarfordollarbasedonSSDIbenefits

– IncludingSSDI‐Dependentbenefits– Includingretroac]veaward• Clientsneedtohangontothismoney

– Evenwithoffset–be/ertohavebothbenefits• Somethingpermonthisbe/erthannothingpermonth• Minimummonthlybenefits• TagAlongbenefits(healthinsurance/lifeinsurance)

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Let’sTalkOffsets

• WC– FormulausedtoreduceWCbenefitsbasedonSSDIaward–includingCOLA

– Notadollarfordollaroffset– DWDwillperformthesecalcula]onsforyou– OffsetendswhenindividualtakesSSDI‐Re]rement

– Ifoffsetapplies,a/orneyfeesawardedontopofWCbenefits

–MostpeoplewithWC&SSDIhavePTDorLOECWCclaims

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FinalThoughts

• Therearealotofbenefitsoutthereforyourclients

• Makesuretheyaregeqngthefullpackage

• Spotissuesforappeals–meetdeadlines

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Ques]ons

BillParsonsHAWKSQUINDEL,S.C.

222W.WashingtonAve.,Ste.450P.O.Box2155

Madison,WI53701‐2155tel:608‐257‐0040|fax:608‐256‐0236

wparsons@hq‐law.comwww.hq‐law.com

4.19.12