How is total disability decided by wc? - Printable Version
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How is total disability decided by wc? - WARPED - 12-26-2009 08:18 PM
State of GA. I know that ssdi and wc are 2 entirely diff things. But what if an IW has never had health problems before their work accident and then apply for ssdi? The initial SSDI app was based on the injury and medicals supporting the injury were sent in with the app.
When appealing first denial 2-3 other problems are added. Then SSDI is awarded and letter goes into detail about back damage/problems. I have been deemed disabled by SSA and my Neuro has written that I will never return to prior profession. A statement by him says I have been permanently disabled since DOA.
I have been fighting WC for some many months now and just recently won ALJ hearing which is being appealed by ER. My question is why can't the award of SSDI be used in my favor for lifetime benefits? My attorney is talking possible settlement of back pay + 1-2 years future benefits, no medical. I am nearing 60 yrs now and I am aware of the medicare setaside.
I know I will never work again as I can barely get around and have constant pain, severe depression,bilat polyneuropathy,radiculopathy, aggoraphobia, panic attacks, can't sleep, severe muscle cramps, impaired gait, etc, etc, etc.
How am I expected to settle with no future medical? I think it's crazy.
Any constructive advice appreciated.
RE: How is total disability decided by wc? - 1171 - 12-26-2009 09:22 PM
SSDI criteria can be used for WC lifetime benefits. All you have to do is change Georgia state work comp laws and make them retroactive to your date of injury.
Failing that you have to abide by the current Georgia work comp laws which state very specifically how disability is to determined. Nowhere does it defer to federal SSDI laws. The Georgia code specifically designates the AMA guides to rating impairment as the sole basis of work comp disability determination.
what you know and how the AMA guides determine a disability rating are totally different. Neither the injured worker nor the employer are trusted to decide the extent of disability.
You need to get a rating from your doctor. anything less then 100% will be permanent partial disability.
RE: How is total disability decided by wc? - WARPED - 12-26-2009 10:03 PM
I have looked at the GA codes and there is where I became interested in catastrophic injury (totally disable). Look at 34-9-200.1 (g) (6). If I am interpreting it correctly it says that the SBWC can take into acount the fact that one has been awarded SSDI or SSI.
I think if the SSDI was awarded based on, say someone who had a specific disability (attributed to a work injury)which qualified him for SSDI/SSI then it could be presented as a reason for a designation of catastrophic injury, lifetime benefits.
SO, since I have qualified for SSDI, regardless of any other maladies I own, the work related injury was the catalyst for the disability. If not for that I would still be able to do something, even with my othe problems. The back injury and nerve damage is what is causing the disability and is what the SSDI award was mainly based on.
All I am asking is, is it reasonable to think this might be an avenue to address. I'm trying to gleen from all of this what a fair settlement might entail. I have not been rated for WC purposes as yet, but have been told I don't need one to make a settlement. I am worried about medicals.
RE: How is total disability decided by wc? - 1171 - 12-27-2009 01:58 AM
social security information can be submitted to the board as evidence when seeking a determination of your condition as a catastrophic injury for the purposes of receiving rehabilitation services.
The code doesn't state that a catastrophic injury designation is an automatic finding of life time benefits.
For disability benefits the determination is the AMA guide as specified: 34-9-263(d).
RE: How is total disability decided by wc? - Still in Limbo - 12-27-2009 10:51 AM
I was Approved the First Time for SSDI at the Age of 43, in 3mos./3wks. without an Attorney, and w/c is still Fighting Me.My SSDI Application only Included My Injury and slight High Pressure! But w/c continues to Fight, as with My Age the Settlement would be Sizable, and Naturally They don't want to Pay!! My Judge when I won 11 1/2 out of 12 Petitions, after 2 1/2 Years of Fighting went to My Workplace and saw a Job that was Offered Me that was "So Easy a Caveman Could do it" and even Ruled that I couldn't do that Job for 4 Hours a Day, 5 Days a Week! And They Still Keep Fighting Me, and Work to Prove I'm not Disabled!! I'm in Pa., and I'm Sure the Laws are Different Here than They are in GA., and I Wish You My Best!! I Hope You get Things Straightened Out!!
RE: How is total disability decided by wc? - WARPED - 12-27-2009 11:24 AM
1171- thanks for the info. Still in Limbo- I was awarded back/continuing benefits by ALJ which ER/IC has appealed. My attorney is confident we will prevail (but ER will just appeal again) so I can see what a long road might lie ahead. It has been 3+ years for me so far. I don't know what a painfree moment feels like and my quality of life has diminished greatly. The neuropathy in my feet/legs is so painful and it is very difficult for me to walk or stand. Wearing shoes is a horrible experience now. I must weigh anything I do against how much pain I will be in afterwards. I appreciate your time and hope your situation will be resolved soon.
RE: How is total disability decided by wc? - Bad Boy Bad Boy - 12-27-2009 03:27 PM
Everytime an Appeal takes place, one must present new Evidence in order for an appeal to even happen. An appeal works both ways also, as you also can appeal.
RE: How is total disability decided by wc? - WARPED - 12-27-2009 04:44 PM
I was told the opposing atty is actually introducing one of the same points brought up in the hearing. He is claiming the ALJ was wrong. All points addressed by the ALJ were addressed fully and backed up with facts and law. There is no new evidence that I am aware of. Just atty saying ALJ was mistaken.
RE: How is total disability decided by wc? - Still in Limbo - 12-28-2009 06:17 PM
In My Case We Appealed a Wage Issue, and the Defense Appealed the Entire Rulings of the Judge, All 12 Petitions, because by doing so, it would Technically Keep All 12 Petitions Open, and They wouldn't have to Pay Me any Penalty Monies Awarded by the Judge! The Close of the Case was 04/08, and They have kept These Games Up for so Long, They Still Haven't paid Me My Penalty Money!! I Just had to File a New Petition to try and get My Back Monies Owed, and Hopefully get the Judge to See the Games, and Award Me More Penalty Money on the Penalty Money They Owed Me!! Confusing as He**, Huh??