Experienced -- Successful -- Caring

Frequently Asked Questions

Workers' Compensation

• What monetary benefits are available?
• Who pays the benefits?
• Can I get rehabilitation and retraining services?
• What if I have problems getting these benefits?

Social Security Disability

• Who is entitled to Social Security disability benefits?
• Do I need an attorney to apply for or receive benefits?
• How much does it cost to hire an attorney?

STD/LTD

• My benefits have been denied what happens now?
• What information do I need to send in for my appeal?
• How long does the insurance company have to decide my appeal?
• My doctor says I'm disabled why isn't that good enough?
• When do I need a lawyer?
• I am receiving Social Security benefits why am I still being denied?
• The denial has been upheld on appeal, know what?

Workers' Compensation

What monetary benefits are available?

Workers' compensation insurance pays for your health care costs that arise out of a work-related injury or illness.  It also replaces some of your wage-loss resulting from the following types of work-related disabilities:

• Temporary Partial Disability (TPD)
• Temporary Total Disability (TTD)
• Permanent Partial Disability (PPD)
• Permanent Total Disability (PTD)
• Death/dependency benefits

If your disability prevents you from doing any work (TTD or PTD), the amount of your benefits is generally 2/3 of your weekly wages at the time the injury occurred or illness began.  If you are able to work despite your disability but cannot earn as much as before the injury or illness (TPD or PPD), then you are partially disabled and your benefits are 2/3 of the difference between your pre- and post-injury weekly earnings.  When a worker dies as a result of a work-related injury or illness, his or her spouse, children and/or dependents are entitled to death benefits and burial expenses.

Who pays the benefits?

Benefits are paid by your employer’s insurance company or by your employer (if self insured).  Employers must display the Employee Rights and Responsibilities poster, which includes the name of their workers' compensation insurer.  If you cannot find the poster at your workplace or if the insurer's name is not on it, ask your employer.  You can also call the State Insurance Verification unit at (651) 284 5170 or 1-800-342-5354 to learn the insurer's name.

Can I get rehabilitation and retraining services?

Yes, if your disability prevents you from doing your old job, or if your employer has no jobs that you can do, you may be entitled to vocational rehabilitation or retraining benefits.  You may choose your own Qualified Rehabilitation Consultant (QRC) or the insurer may refer you to a rehabilitation consultation.

What if I have problems getting these benefits?

If you have questions or if you feel you are not receiving the correct benefits, follow these steps:

• Call the insurance claims adjuster.  Write down the date, time and adjuster's name for your records.  Explain the problem and try to work it out.  Some problems can be fixed with a telephone call.
• Discuss your problem with a Customer Assistance specialist at the Department of Labor and Industry.  The Customer Assistance specialist will try to help resolve your problems.
• If the Customer Assistant Specialist cannot resolve your problem, contact us immediately for assistance.  Remember, the insurance company representatives have significant training and you likewise need trained professionals on your side.

Social Security Disability

Who is entitled to Social Security Disability benefits?

The two main categories of Social Security benefits that are available to people with disabilities are Supplemental Security Income (SSI) and Social Security Disability Income (SSDI).  SSDI applies to those people that have sufficient quarters of coverage, based upon their past earnings, to qualify for disability insurance through Social Security.  This generally means that someone who has earnings in five out of the last 10 years before the onset of their disability would qualify for SSDI benefits. These rules are different for people who are age 31 or younger.  The five years do not have to be continuous in order to qualify.  A person's assets or family income does not matter in terms of qualifying for SSDI benefits.  SSI benefits are for those people who do not have enough quarters of coverage.  A person's assets or other family income will be a factor in determining whether a person will qualify for SSI benefits.  SSI is meant for people who can show a financial need.  Therefore, there are limits on assets and family income for SSI.

Under either program, a person must also demonstrate a disability.  Social Security defines disability as, "the inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment(s) which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months."  Children may also qualify for Social Security benefits if they have a significant impairment that affects various aspects of their life.  There are different guidelines for disabled adult children and disabled widows or widowers.

Do I need an attorney to apply for or  receive benefits?

 You are not required to have an attorney represent you in the Social Security process.  Statistically, however, it is more likely that you will be able to win benefits if you have an attorney represent you than if you pursue the benefits on your own.  There are a number of rules and regulations, including medical/vocational guidelines, listings, and the Social Security Act that may apply to a given case.  An attorney who is experienced in the Social Security field and understands these rules and regulations can be helpful in getting benefits awarded.  An attorney will also be able to present your case to an Administrative Law Judge who hears Social Security claims, or to a court if an appeal is necessary.

How much does it cost to hire an attorney?

The Social Security Act controls and limits what attorneys may charge.  Generally, attorneys charge a fee based upon the amount of the Social Security Award.  This usually amounts to 25 percent of the past due benefits up to a maximum of $6,000, whichever is less. This may increase based upon Social Security Rules.   There may some out-of-pocket expenses that must be paid as well.  At Midwest Disability, we will explain our fees up front and you will owe no attorney fees unless we recover benefits for you.  Contact us for your free consultation and case evaluation today.

STD/LTD

My benefits have been denied what happens now?

It is important to remember that STD/LTD policies are based on contracts between the employer, their insurer and the insured. Most of these contracts contain provisions allowing for at least one level of appeal. It is also important to remember that the appeal has to be in to the insurance company within 180 days from the date you receive your appeal letter UNLESS the contract provides for a different time period.

What information do I need to send in for my appeal?

You need to submit all information that explains why you are disabled. It is imperative that you have your doctors explain in detail what your diagnosis is, what your specific restriction are and what medical evidence exists to support your claim for benefits.

How long does the insurance company have to decide my appeal?

Generally they have 45 days to decide whether to approve your benefits or uphold their denial. They may have an additional 45 day extension to decide if they send your files out for a medical review.

My doctor says I'm disabled why isn't that good enough?

It has been held that insurers can use independent doctors to support their denials. That is why it is extremely important to have you doctor be as specific and detailed as possible when filling out any form or writing any letter in support of your disability.

When do I need a lawyer?

While you can certainly handle the appeal process on your own but, we have found that it is extremely important to get not only as much information to the insurer as possible but that information needs to, presented in the right way. Because these cases fall under the Employee Retirement Income Security Act (ERISA), and have specific rules governing legal proceedings, you have a much better chance of getting your denial overturned on appeal than in the courtroom. Getting a lawyer involved early in the appeals process can help you establish a complete administrative record helping your chances of success.

I am receiving Social Security benefits why am I still being denied?

Most STD/LTD contracts have different definitions of "disabled" and those definitions may not be the same as used by the Social Security Oepartment. It is important to read and understand those definitions so that you can understand just what they need to approve your claim.

The denial has been upheld on appeal, know what?

You have the right to bring suit against the insurer for recovery of your benefits.