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WC and SSDI
#21
Thanks MJ. I know they are already paying me the minimum cause of the WC I am receiving but they would have to come up with the whole amount if I settled. LTD was also supposed to help me get retraining and I was supposed to get a small lump sum from them if I went back to work. Now I am sure that would all go out the window if I get on SSDI. Sometimes I dont know how these people can look themselves in the eye in the mirror for lying so much. Everytime I turn around it is something new.
I see you have had a lot of back surgery, MJ, how long ago? My doctor at first wanted me to have an anterior fusion L5-L6 but with a plastic surgeon involved as well as a vascular surgeon. That is what WC is arguing about. I have heard anterior is better to heal, does anyone know if there is alot of difference in recoup time.
 
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#22
Smile 
Genegene,

All the surgeries listed under my signature has been since 2000 with my last back surgery in March of this year.

You said if you settle your case that LTD has to pay you your full amount. That is not exactly correct. I setteled my indeminity portion of WC, LTD took an offset up to my life time expectancy and they are also taking the offset from SSDI. Guess what, I am still getting the minium amount. They take $365 offset of my WC settlement and they take an offset from my entire SS. I do not think that is fair and I don't feel they should be able to take the SS offset. My reason being they are seperate from SS when a person is rated totally and permantely disabled. They do not care what SS has to say regarding your disability and they do their own figuring if you are disabled. They will continue to hound and hound your doctors to try and get them to say you could do some type of work. SS says that you have to be able to maintain a gainful and LTD says as long as you can do any type of work, it does not matter what. With LTD if you can work 2 days a week and earn minium wage that is good enough for them. I went through hell fighting my LTD company because they cut off my benefits. They hounded my docs so bad that the docs gave in and said I could do sedentary work with restrictions coming out my rear end. I asked who is going to hire me and their reply was we don't care that I would have to look for a job. I fought an appeal with them for a bit over a year. My psych doc is the one who saved me with his report. After over a year of fighting, they had to restart my benefits. I will tell you this much......LTD companies are hell to deal with and that comes from my own experience.

I guess we have to take it a day at a time and move forward with whatever bridges we will have to cross when the time come. Hope you are doing ok. Take care and God Bless.

Cajun Hugsssssssssss,
MJC
Lumbar Laminectomy L5 - S1, Lumbar Disectomy L 4 -5, Cervical Microdisectomy C-4 -5, Cervical Anterior Fusion C 4 -5, Cervical Anterior Fusion C 5 - 6, Lumbar Disectomy, Laminectomy and Foraminotmy L 3 - 4, Cryo Surgery Lumbar. --Ongoing Problems.. Permanently Totally Disabled.
 
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#23
If you are not currently a Medicare Beneficiary, there is no reason to "shut down" your SSD application unless your total settlement is expected to equal or exceed $ 250,000. In that regard, if your settlement is $ 250,000 or more, and you have a "reasonable expectation" of becoming a Medicare Beneficiary within 30 months, Medicare's interest MUST be protected via a Medicare Set Aside Trust arrangement ( WCMSA ) approved by CMS. If under $ 250,000 and under 62 yrs of age... go ahead and keep SSD application going.

If and when the settlement is approved it is imperative that language be placed in the settlement papers prorating the lump sum over your life expectancy, otherwise SSA will not give you any money for several yrs.

I always try and get my clients into the SS system BEFORE the WC settlement so I know they have a monthly income coming in.
 
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#24
I dont understand why they can take offsets from both either but I have already figured out they can get around most anything and get away with it. I dont understand what you are saying about getting the indemnity portion of WC. My so-called attorney hasn't mentioned anything but a lump sum with open medicals for a year. They still have me classified as temporary total disabled (whatever that means). It looks like it would be permanent since I have alredy been told I c an never go back to what I have always done for employment.
I'm like you MJ, even if I get where I could go back to work, who would hire me, and I sure would never be able to get insurance anywhere. Thats why I have been fighting everyone for the SSDI, at least I would have some sort of insurance for the rest of my ills.
When do you get the indemnity portion? Is that just the coverage for your disability rating or your lifetime earnings? I have no idea.
Are you still on WC, MJ? If you have been on this mess for 7 years I feel so sorry for you. I've only had to deal with them for 2 and that is way too long.
I will update when I talk to SS tomorrow. Thanks to everyone for their help. We have all got to stick together to get well and protect ourselves.
I have been told that Ga WC laws are some of the worse in the U.S. and I believe it. They dont pay as much as other states in weekly benefits and they sure dont take care of their injured workers or they wouldn't let some of this stuff go on.
 
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#25
Mr. Jaffman: I have been told that the lump sum settlement + the years open medicals will add up to the $250,000. I don't think the medicals should count against the figure though. I don't know. That is the main reason they are wanting me to shut down the SSDI. I was told SS would take the whole settlement for a set-aside if I didn't shut it down and I would get nothing and would never be able to touch the settlement except for medicals.
You wouldn't want a Ga client, would you?
 
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#26
Although I appreciate the "offer" I am only licensed in PA and NJ and limit practice at the current time to PA WC and SSD/SSI in PA and NJ.

In all honesty, it doesnt sound like you are getting the best advice from your attorneys, but the problem with this current system is there is no right to appeal the CMS WCMSA approval process. If there is a sufficient amount of yrs of medical left open it is unlikely that they would require the entire amount of the indemnity award to be placed into the WCMSA.

However, given all the surgeries you require, I would not be pushing for a settlement until I knew that the surgeries were a success. What if there is a complication and you are worse off than you were before? I NEVER recommend a settlement until my clients surgery has been completed and he/she has had enough time to figure out if the surgery was a success.

Remember, you never HAVE to settle your WC case.
 
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#27
Thanks Mr. J, Didn't mean to sound pushy. It just sounds like you work for your clients and that just doesn't seem to be the case with my attorney. I am going to find a new attorney today as soon as I talk to SS and have more info. I hate to start this process over again but I have got to find someone I can trust. They are only wanting to leave a year open and I had to have a fit to get that, they wanted me to take a settlement and pay for my own surgeries. I did my own research at the hospital and surgeon and rehab costs and I was going to come about 40,000 in the hole.
I keep being told that it is a great offer for the state of GA. I thought it was figured by your lost wages and disability ratings not by the state you are in.
I just want everything to be on the up and up with no surprises at the end of this mess. I don't want to settle now but they keep pushing. Latest push is that if I have the surgeries my rating will go down and the offer will go down. I dont know if that is true or not.
Thanks so much for the imput.
 
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#28
rjaffman Wrote:Although I appreciate the "offer" I am only licensed in PA and NJ and limit practice at the current time to PA WC and SSD/SSI in PA and NJ.

In all honesty, it doesnt sound like you are getting the best advice from your attorneys, but the problem with this current system is there is no right to appeal the CMS WCMSA approval process. If there is a sufficient amount of yrs of medical left open it is unlikely that they would require the entire amount of the indemnity award to be placed into the WCMSA.

However, given all the surgeries you require, I would not be pushing for a settlement until I knew that the surgeries were a success. What if there is a complication and you are worse off than you were before? I NEVER recommend a settlement until my clients surgery has been completed and he/she has had enough time to figure out if the surgery was a success.

Remember, you never HAVE to settle your WC case.

HI RJAFFMAN

CAN YOU PLEASE READ MY LAST POST (THE LONG ONE) AND TELL ME YOUR OPINON. I KNOW YOU ARE IN PA AND I AM IN CALI, BUT ISN'T IT ABOUT THE SAME THING THAT GENEGENE IS TALKING ABOUT. AME HAS SAID I CAN NO LONGER WORK FOR MY COMPANY. I SAY I HAVE BEEN WORKING FOR THE PAST 4 YEARS, SINCE MY KNEE SURGERY. LAWYER SAYS IT DOESN'T LOOK GOOD . BUT WHEN I ASKED HER IF I SHOULD APPLY FOR SSDI SHE SAID NOOOOOOOOO! IT WOULD MAKE A MESS OF EVERYTHING SINCE SHE IS SUPPOSE TO BE FIGHTING FOR MY JOB. AFTER READING THESE THREADS AND HAVING TIME TO GET OVER THE ITNITIAL SHOCK I AM LEANING TOWARDS TAKING A MEDICAL RETIREMENT AND JUST SAY FORGET IT ALL. THE ONLY PROBLEM WITH THAT IS I AM ONLY 50 AND MY MEDICAL RETIREMENT WOULD NOT BE NEARLY ENOUGH. SO CAN YOU PLEASE READ "HOW LONG AND WHY" AND TELL ME WHAT MY CHOICES MAY BE.


THANK YOU


RHOLMES
 
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#29
Thats more or less what my lawyer told me too was that SSDI would just mess everything up and that was after he told me to apply. I don't have a job to go back to though since they fired me after my 3rd surgery. Someone told me that it is according to the state you live in, I don't know. I have figured out that my attorney will not get any of the set-aside if you are on SSDI so I figure that is why he is pushing me to drop my app. Thats why I like to hear from everyone in here, not only have they been through it but they have no stake in the outcome except to help get us through this maze known as workers comp
 
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#30


Gene...read Limbo's post to me about medicare set-asides. It's very explanatory. You may have hit something with your attorney. My husband told his attorney he was applying for SSD. He had no problem with it and when he was denied his attorney was the one who was by his side to get a hearing. He was finally after a good 2 years, maybe more awarded SSD. It had nothing to do with messing up his WC case. His attorney did get something from hubby's SSD backpay, and hubby couldn't have cared less because the man has worked hard for both of us. You know Gene, this system is bad enough. Can't trust anyone BUT whe nit comes a time that you can't trust your attorney that is really beyond the scope of what we go through.


CAP
 
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