Episode 10 – Medicare and Medicaid

 

There are two types of government benefits for health insurance: Medicare and Medicaid. Medicare is for the elderly and the disabled. Medicaid generally is for the poor.

What Is Medicare?

You’re entitled to Medicare if you’re over sixty-five or if you are disabled and drawing Social Security disability benefits. Medicare begins two years after you start receiving Social Security disability benefits why they have a two-year wait for the Medicare. I cannot tell you why, but if you become disabled today, you will not get Medicare until two years after your benefits start.

What Is Medicaid?

Medicaid, as most people are familiar with, are benefits of health insurance, either through the state or federal programs if you meet certain poverty levels or income levels. That’s changed a lot over the years, especially with the Affordable Care Act (ACA) and other changes under Michigan law.

A few years ago, not many people at all received Medicaid, then they changed the rules under the ACA and many people qualified for it. (Thank goodness, because most of my clients were without insurance until then). Now, however, they’ve changed the rules again, and they’ve implemented a rule that if you have no dependent children, even if you qualify for Medicaid income-wise, you have to either work twenty hours a week, do volunteer work, or be in school in order to continue your Medicaid coverage.

This is going to jeopardize a lot of benefits for people, especially people that can’t commit to twenty hours a week. If you have concerns about this, I strongly recommend you contact your congressman about it.

The Difference Between Medicare and Medicaid

Medicaid coverage actually is generally better than Medicare. Medicare is an eighty-twenty plan. Medicaid covers most any and all treatment. With few exceptions. The problem is sometimes is finding a doctor that’s willing to take on another Medicaid or Medicare patient.

You May Be Able To Qualify For Both Medicare And Medicaid

Some people qualify for both benefits, both Medicaid and Medicare. If you qualify for both, you pretty much have one hundred percent coverage.

Exceptions to Medicare Rules

There’s a couple of exceptions. In Medicare, for example, one is dialysis. If you have kidney failure and you’re on dialysis. You get Medicare automatically, even if you’re working. There’s no two-year wait. There’s, no need to show disability and there’s no need to analyze income.

See An Attorney If You Think You Qualify For Medicare Or Medicaid

There are different rules for both federal and state programs. It’s very tricky. If you think you may qualify, you can always check with DHS for any Medicaid benefits, but if you have questions on it, always talk to an attorney that’s familiar with the health insurance laws. Have any questions? Call me at (989) 725-8118.

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Episode 9 – Workers’ Comp Wage Calculations In Michigan

 

How are workers compensation wages determined? If you’re injured on the job and off work you’re entitled to wages but it isn’t full pay. Most people tell me is that as far as they’re concerned, their understanding is they get 80% of their pay. 

How Workman’s Comp Wages Are Calculated In Michigan

How it really works is this: They go by a formula – if you work someplace for over a year. You take the highest 39 weeks of the last 52 weeks you worked and average it out. We then plug that into a formula based on whether or not you’re married or single, or have dependent children. That is what we call your average weekly wage and your benefits are based on that.

The Maximum Worker’s Comp Benefit In Michigan Is $900

Currently, in Michigan, the highest you can be paid in workers compensation benefits is $900 a week. Every year they change the average weekly wage and increase typically the rate. How it works out for most people is generally 80% – but its 80% of your take-home pay – or 60% of your gross. This is not a rule. This is just a guideline. The formula determines how much you’re entitled to. 

How Much Am I Entitled To If I Worked Less Than A Year?  

If you worked in a place that you’re injured at for less than a year, they just add up the number of weeks you worked and divide that out by how much you made in those weeks. So if you were 10 weeks made $2,000 your average pay is $200.

Exceptions To The Michigan Workers’ Comp Rule

There are always exceptions to that. For example, if you get hurt the first week at work and or even the first day you worked, in those cases, it depends what you were hired for. Even in those cases, the average pay generally comes out to 60% of your gross. There are other factors as well – whether or not you’re entitled to fringe benefits such as health insurance, sick pay, disability pay things of this nature, that may or may not change your rate. As it currently stands though, no matter how much you made the most you can get from workers compensation is $900.

How Can I Figure What My Workers’ Comp Benefits Are?

The best way to determine this is to have it reviewed by someone that knows how to calculate this mathematically.  I can guarantee you any workers compensation attorney knows how to do that. If you ever have any questions on your rate whether or not you’re being paid correctly. Give me a call. 989-725-8118

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Episode 8 – Rules on Shop Doctors (“Shop Docs”) in Michigan

Shop Docs Law In Michigan

What is a “shop doc”?

I would like to talk about work injuries and in particular doctors who are referred to you by your employer after an injury on the job. Many of us are familiar with the term “shop docs” or shop doctors. That’s the doctor a lot of companies will send you to if you get hurt on the job factories, in particular, have a doctor that they always send somebody to.

Michigan Law: Have to see the Shop Doc for the Frist 28 Days

Now as you can imagine these facilities are paid by the employer and they’re looking out for the employer’s interest so they don’t always look out for the workers’ interest.  Unfortunately, under Michigan worker’s compensation law, you must treat with the employer’s doctor the shop doctor for the first twenty-eight days after you are hurt.

You Can Treat With Your Own Doctor, But Your Employer Doesn’t Have to Pay For It.

You can treat with your own doctor if you want. Unfortunately, your employer or their insurance does not have to pay for it in the first twenty-eight days after the injury. This leaves many people having to see the shop doc for a while.

You Are Entitled to Treat With Your Own Doctor After 28 Days In Michigan

What you need to remember is after twenty-eight days you are entitled to treat with a doctor of your own choice. Many, if not all, worker’s compensation insurance carriers and employers will tell you that’s not true. Don’t believe them!  You have the right to treat with your own doctor after twenty-eight days.

It’s important for this reason: You want to get better. Therefore, you want to treat with a doctor that you trust. The doctor that will look out for your interest not necessarily how to get you back to work.

You want someone who’s placing your interests first and you need to see a doctor that you can follow up with and trust.

Getting Authorization for Your Doctor to Treat After 28 Days

The big issue that usually arises when it comes to treating with your own doctor is getting authorizations. I can pretty much guarantee I can get a bill paid if you see your doctor and your employer refused to pay it after 28 days,  but some doctors will not see you unless you have an authorization from the worker’s compensation carrier to treat.

Many workers compensation carriers will not authorize the treatment to go to your own doctor. They may have to pay the bill but unless there’s a court order there’s nothing that requires them to pre-authorized the treatment.

Contact Me If You Are Having Trouble Seeing Your Doctor After A Work-Related Injury

There are things you can do it to get around this and still get the treatment you need with the doctor you trust so after twenty-eight days get into your own doctor. If you have a problem and getting a bill paid or getting authorization to see the doctor, you need to contact worker’s compensation lawyer immediately even before the twenty eight days if you can’t. So if you have a question about your injury and who can treat you, contact me at (989) 725-8118

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Work Injuries and Back to Work Law In Michigan

Back to Work, Light Duty and Favored Duty Law In Michigan

Today, I’d like to talk about work injuries and going back to work law in Michigan. We’ll talk about going back to work, light duty or what we call favored work in this article. If you’re hurt on the job and your doctor has you on restrictions or light duty, the employer has two choices. Let you stay home and heal or take you back to work and offer you a legitimate job within the doctor’s restrictions and recommendations. 

 

If You’re Off More Than Fourteen Days – You’re Entitled To Lost Wages

Now, if your employer sends you home, you have to be off work for more than seven days in order to be entitled to wage loss. If you are off work for more than fourteen days, they have to pay you back to day one. A lot of employers will try to get you back to work, certainly within the fourteen days, but even within the seven, so they don’t have to pay wage loss. They’ll offer you a job and say it’s within the restrictions, and sometimes it isn’t.

 

You Should Try Light Work If It’s Offered By Your Employer

If they offer you a legitimate job that is within your doctor’s restrictions, you are required to take the job or at least try it. If the job does turn out to be too painful, what you want to do is go back and report to your doctor and get your restrictions amended, or have the doctor take you off entirely, but at least try the job. Otherwise, if you don’t even try the job, the employer is going to be in a position better than you to argue that you didn’t even try, it was within the doctor’s restrictions, and you don’t get any wage loss. The most important thing to do is clarify the restrictions with your physician – just what they are and are not. 

Consult Your Doctor If Your Employer Asks You To Do Too Much

Obviously, if the employer wants you to lift fifty pounds and your restriction is five, you have the right to refuse that. But if it’s five-point-five pounds, your doctor has you on five-pound restrictions, well, you may want to at least see if you can do it or not – as long as you don’t jeopardize further injury, according to the doctor’s opinions.

So anytime you get hurt, be aware that a lot of employer’s primary goal is to get you back to work – favored work, light duty work – it has many terms. But they’ll do anything they can to avoid having you off more than two weeks, so they don’t have to pay wage loss. 

If you need time off to heal, just have the doctor take you off entirely and that’s the first and best way to protect yourself. If you have any questions on this, call me at (989) 725-8118.

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Episode 6 – Michigan Dog Bite Law Overview

Dog Bites Are Strict Liability Claims in Michigan

There are not many areas in the law that have strict liability, meaning that you have an automatic claim against someone for your injury. Dog bites are one of these areas. If you are bitten by someone else’s dog, you automatically have a case against the owner of that animal.

The Exception to Liability of Dog Owners

There’s only one exception to this that exception is if you provoked the dog or animal. In other words, you get them to bite you by playing aggressively with him, kicking him something along those lines. Otherwise, even if you’re just trying to pet the dog or walk by a dog and you get bit, the owner is responsibleWhat this means is they have to pay for any damages that you incur because of the bite.  This would include medical bills, pain and suffering, wage loss and more.

What You Need to do if You Suffer A Dog Bite in Michigan

The first thing you want to do if you are a bit by an animal is investigate what the animals owner’s insurance covers. That is what it comes down to in most cases, whether or not the owner has the proper insurance. Many dog owners do not. Many dog owners do not have a license for their animal, let alone insurance. There may be other types of insurance you can tap into. For example, if a dog owner is living with someone else who has insurance, it’s possible you may be able to tap into that.

So the key is investigating the claim immediately and getting medical treatment immediately. Then the issue is really just one of damages and how much it would take to make you whole.

If you’re bitten by a dog or really any animal that’s owned by another individual, have it investigated immediately. The owner of that animal has a strict liability against you for the entry, investigate the claim immediately for insurance coverage and damages.

Contact Me if You Have a Dog Bite Injury

I’ve had over 30 years experience in the Owosso and Shiawassee County Michigan area and am here to help! Please call me at (989) 725-8118 for a free consultation.

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Podcast Episode 5 – Michigan Automobile Uninsured and Under-Insured Law

 

Michigan Automobile Drivers May Be Uninsured or Under-Insured!

We all know that if you get hurt by someone else in an automobile accident, you may have a claim for damages for things like pain and suffering. What most people don’t realize is often times there are drivers on the road who either have no insurance or did not have sufficient insurance.

What Michigan Law Requires

Michigan law only requires a person to have $20,000/ $40,000 coverage on a motor vehicle. Most people know this as PLPD. PLPD means that that person can be sued and insurance will only pay up to $20,000 per injury and $40,000 total per accident. So, for example, if 3 people get hurt there’s only $40,000 to be divided up from the insurance company. Now what most people don’t have and should have is both what is called under and uninsured motor vehicle coverage.

Ask Your Insurance Agent For Uninsured Motor Vehicle Coverage

Be aware, this is something that a lot of insurance agents will not bring up. There’s not enough money in it for them to make it worth their while, and it is surprisingly cheap.  Here’s the difference: If you have uninsured motor vehicle coverage and you get hurt by someone else’s negligence in a car accident, your insurance company will pay what their insurance company should have paid, except they didn’t have insurance.

Why You Should Have Automobile Under-Insurance Coverage In Michigan

For example, if you have $100,000 uninsured policy, it turns out the drunk driver had nothing, you can still make a claim for $100,000 with your insurance company for their negligence. The other portion of the policyunder-insured, simply means if they don’t have enough insurance, you could make a claim against your company for over and above what their insurance provided.

So I’ll give you another example, let’s say a drunk driver severely injured you and they have PLPD, that is $20,000 in limits, and you have $100,000 injury. Well, if you have $100,000 policy, your insurance will make up the difference between that $20,000 limit and $100,000, Which means they’ll pay 80 plus the 20, for a total of 100. The whole idea is to make you whole. 

A Typical Michigan Underinsured Policy Is Surprisingly Cheap

Now, you have to purchase this policy on your own. You’d be surprised how cheap it is. I currently have $1,000,000 for both under and uninsuredand the last time I looked, it cost me $16 every six months. Some companies don’t even sell this, so you do need to shop around. But it’s, easy to find one that does, and it’s the cheapest part of a policy by far.

So if you ever look into reviewing your auto insurance policy, always ask your agent about, and make sure you include, uninsured and under-insured coverage.

Call Patrick Maruiak If You Have A Question About Michigan Automobile Accident Law

Any questions on this? Contact me at (989) 725-8118. I have 30 years experience representing people in Shiawassee County and surrounding areas who have been harmed in automobile accidents.

 

 

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Podcast Episode 4 – Slip and Fall Injuries in Michigan

Welcome to the Patrick Marutiak Podcast. I’d like to talk to you today about slip and fall cases. It is probably the biggest misconception there is in the law.

What you have to prove to recover damages in a slip and fall case in Michigan

People assume if you get hurt on someone else’s property you can sue them for your injuries. nothing could be further from the truth. In Michigan, in our state, in order to make a claim if you fall on someone else’s property, you have to prove not only was the landowner negligent but there was a latent or hidden defect.

No damages if the defect is open and obvious in Michigan

There are two words to remember concerning slip and falls: open and obvious. The law currently states if there is a defect on property that is open and obvious, even if the landowner was negligent, you cannot make a claim for damages. This can result in very egregious than unfair standards.

I’ll give you an example: There was one case where a blind lady was walking up some stairs and she fell because one of stairs was missing. They were doing construction on the stairs.

The court threw the case out because to a reasonable person, the fact that half the stair was missing should have been open and obvious- It didn’t even matter that she was blind – If a reasonable person could have seen that defect, there’s no case.

The exception to the open and obvious rule in Michigan

There’s one exception to this and that concerns landlords. If for example, you’re living in an apartment complex, you may be able to get around the open and obvious defense, but if you’re hurt on commercial property or someone else’s home, these cases are very difficult to make.

It is important, therefore, to contact a lawyer immediately after you get hurt. An investigation needs to be done right away to determine if there was a hidden or latent defect, and whether or not the open and obvious defense applies.

Contact an attorney immediately after getting hurt on a commercial property

One thing you should always know is, if you get hurt, you may be able to make a claim for medical bills. I would like to talk to you about medical payment coverage if you are hurt and someone else’s property.

Even if you cannot make a claim for damages, that is pain, suffering, wages and the like, you may be able to make a claim for what we call “med pay” or payment of medical bills.

What insurance typically pays for in slip and fall cases in Michigan

If you’re hurt on a commercial property or even someone’s home or private property, most any homeowners insurance or commercial insurance policy contains a “med pay” provision. What this means is they will pay your medical bills, regardless of who’s at fault – your fault, the homeowner’s fault, or nobody’s fault. They’ll still pay the medical bills.

Limits to “med pay” provisions in Michigan

Now the “med pay” has certain limits. Most homeowner policies only have a thousand dollar limit. Many commercial policies have more: some five, some ten. A good one would have twenty-five thousand. What this means is they’ll pay any of your co-pays and out of pocket expenses up to that limit, as long as you make the claim within a year of when you were hurt. Depending on how you were hurt, you may not be able to make a claim for your pain and suffering, but as long as there’s insurance coverage, you can always make a claim for medical bills.

Call me if you’re in the Owosso or Shiawassee County Region!

You want to talk to an attorney immediately. If you’re hurt on someone else’s property, even getting your medical bills could go a long way to help to make you whole. Give any questions on this. Always contact a lawyer. You can contact me at (989) 725-8118.

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Welcome to the podcast of Patrick Marutiak. This month, I’d like to talk about automobile accidents and auto law. Now, just so you know, I’ve been doing this kind of work for 30 years, and that means automobile accidents as well. I’ve always represented injured persons, never insurance companies.

Michigan No-Fault Law

Michigan has no-fault law, as we all know. What no-fault covers if you are hurt in an automobile accident are several things. Most important is medical coverage. Except for deductibles, you’re 100% covered. You may have to bill your own personal insurance first but the car insurance will pick up anything they don’t pay. If you are off work because of the injury, wage loss is covered as well. Wages are paid at 85% of what you were earning and the reason it’s 85% is because it’s tax-free, so you’re virtually getting everything you were paid for or working for before. In addition to that, you’re entitled to what we call attendant care but most people would call “nursing care.” If you need help bathing, dressing, feeding, things like that, a nurse can be paid for that or even family members could do it, and they get reimbursed as if they were nursing you.

Rules on Service Care

Lastly, service care. Service care is for those things you used to do around the house that no longer can do because of the injury. This would be things like mowing the lawn, taking out the garbage, perhaps changing the oil in the car. You can be reimbursed for that, too. The only problem with this is that it has a $20 a day limit, so even doing an hour or two of work a day or someone else doing for you will hit that $20 a day cap. In that regard, you may want to space it over a couple of days to get $40 instead of $20.

 

Now, medical coverage and the nursing care is lifetime. The wages and the service care has a three-year maximum limit on it. These are all important benefits that you’re entitled to if you have an injury involving a motor vehicle. Now, you need to have coverage on your vehicle in order to qualify for this, at least if you’re in that vehicle. Currently, under Michigan law, if you’re driving your own motor vehicle and you do not have no-fault coverage, you’re not entitled to any benefits, and that would be for damage to the vehicle as well as to yourself.

You must have auto insurance in Michigan!

I once had a guy who bought a $40,000 truck and he said he was a safe driver so he wasn’t worried about insurance. A drunk driver totaled that truck. Well, unfortunately for him, he didn’t get paid for that truck because he didn’t have any insurance on it, and if you’re hurt by a drunk driver, even if you’re seriously hurt, if you’re driving your own vehicle without insurance, you can’t even sue that driver for pain and suffering. That’s why it’s important to make sure you always have insurance. Michigan has one of the highest rates of non-insured drivers around and that’s because, of course, the coverage is so high, but don’t drive your vehicle if it’s uninsured.

“If you’re driving your own vehicle without insurance, you can’t even sue that driver for pain and suffering. That’s why it’s important to make sure you always have insurance.”

Now, if you’re hurt in an auto accident, you can also make a claim against the driver at fault. That would be for pain and suffering. The wages and the medical bills would generally go through your insurance company but you can go through their insurance company for pain and suffering if you meet what we call “threshold.” Threshold basically means you have to have a serious injury. The legal terminology is “a serious impairment of a body function.” Now, we could spend hours talking about what that means but it generally means it has to affect your day-to-day life and it has to be long-term, but bear in mind “long-term” could be a matter of a month or more or a lifetime. So it’s important to always get an evaluation from an attorney as to whether or not you have a claim against the at-fault driver.

Proposed changes in Michigan No-Fault Law

Currently, Lansing is proposing many changes in the no-fault law. A lot of these changes are quite controversial. Regardless of the stance you take on it, you should pay attention to these changes and contact your congressman about them because one of the main changes they’re proposing is eliminating lifetime medical coverage. Now, if some people are hurt seriously, even maimed, or they’re paraplegic, that lifetime medical coverage gives them a lot of benefits even to the extent of modifying their homes if they’re hurt in a car accident. So these are important benefits. Be aware of that. Try to keep up to date on that especially if you hear of any changes or proposed changes in the law.

 

Things you can do before calling me that would be helpful in evaluating your claim would be such things as, one, knowing what your official diagnosis is from the doctor, having a list of all the doctors you’ve seen or treated with for your condition, and having what is called your “dec sheet.” Dec sheets are the type of coverage you have on your vehicle. Most people don’t have their policy but almost everybody has the first page, which is the declaration sheet that shows if you have full coverage or PLPD, things like that.

 

If you have any questions at any time, feel free to contact me for either in-person consultation or by phone at 989-725-8118.

Podcast Episode 2 – Workers Comp Law Overview

Listen to the podcast:

 

Hi! I’m Pat Marutiak. Welcome to my podcast. I’d like you to know I’ve been doing work-related injury cases for 30 years, workers’ compensation. If at any time you have any questions about a work injury, always feel free to call me for a free consultation, 989-725-8118.

Workers Comp: What is and what is not covered

The first topic I’d like to cover is what is covered and what is not under a work injury. If you are hurt on the job, you are entitled to 100% medical coverage. This means they have to pay all medical bills, and that includes even mileage to and from the doctor’s. So keep track of that. You are entitled to wage loss if you are off work more than a week. It’s paid a percentage, though. It isn’t full pay but it is tax-free. If the injury is severe enough, you’re also entitled to nursing care, which is help around the house for such things as bathing, dressing, feeding, things like that. Finally, you may be entitled to retraining as well if you cannot go back to your former type of work.

The one thing you are not entitled to for a work injury though is pain and suffering. People ask this all the time. Even if your employer is negligent, in general you cannot sue your employer for pain and suffering, but there are still important benefits you can get from workers’ compensation especially lifetime medical coverage.

Who can you see for medical treatment?

The next thing I’d like to talk about is medical treatment, who to treat with. Under the new rules, if you are hurt on the job for the first 28 days, you must see your employer’s doctor. If they send you to a doctor, you have to go to that doctor to have medical coverage. If you choose to go to your own doctor, you’re going to pay for it out of your pocket. The important thing is though after 28 days, you are entitled to treat with a doctor of your choice.

Now, the insurance company will tell you that they’re not responsible for it if you don’t see their doctor. This is not true after 28 days so don’t believe them.

Now, the insurance company will tell you that they’re not responsible for it if you don’t see their doctor. This is not true after 28 days so don’t believe them. The problem usually comes up where the doctor wants an authorization in order to treat. Now, the insurance company isn’t required to give an authorization but they are required to pay the bill, so you do want to treat with a doctor you trust so you can get better and go back to work. Always treat with your own doctor or whomever your doctor refers you to.

Recent changes in workers comp law in Michigan

Now, there’s been a lot of changes in the workers’ compensation law in the last ten to 15 years, a lot of changes. None of them had been in favor of the worker either. Things have been getting harder and harder to get benefits and the insurance companies have been having more and more excuses to try to dodge payment of what they should pay. Some of the biggest changes have to do with wage loss. It used to be if you couldn’t do your work that you were doing when you were hurt, you were automatically entitled to benefits. Now, you have to practically show you’re a hundred percent disabled, and if you’re not, you’re required to look for work within your limitations. As long as you show you can’t find that work, you’re entitled to full workers’ compensation benefits, but the insurance companies will use this to their advantage trying to tell you that you’re not looking for work. If they ever bring up the subject of looking for work, this is a red flag and you should contact a lawyer immediately.

That brings me to the next thing: looking for work. Insurance companies will tell you you have to look for jobs and put in applications ten, 15, even 20 times a week in order to qualify for benefits, and unfortunately with the changes in the law, a lot of judges tend to agree with this. But this can vary a lot, especially depending on what your restrictions are, your limitations, and what area of the state you live in, but if you do have to look for work, the important thing is to document it. Keep track of any place you put an application in, not only where you put it in, when you put it in, and if you receive any response, document that as well. They will try to reduce your wages by saying, “You could find a job at minimum wage,” for example, and so they’re going to reduce your pay accordingly or at least try. There are ways around this to protect you, too many to discuss just on a podcast, but if this issue comes up, make sure you get legal advice on the wage issue.

What do you do if you are injured?

And what to do if you’re injured? If a person is injured on the job, the first thing they need to do is to contact their employer and notify them about the injury. You should always contact your foreman, manager, or someone higher up that you were hurt. Make sure it’s documented. If you need to go to the doctor or the hospital, ask the employer to take you there. If they opt not to, then and only then can you see your own doctor and they would have to pay the bill.

Things that would be helpful to know and do before you contact me if you need legal advice, one thing that’s always helpful is bring in anything you have, whether it’s from the insurance company or the employer. Workers’ compensation insurance companies always send paperwork. Keep anything and everything they send you. Never throw it away. If the doctor gives you restrictions or a slip for being off work, always keep copies of it. Don’t just give the original to your boss. Make sure you keep copies of anything, be it from the doctor or the employer or the insurance company. Those are the main things to maintain. Lastly, again I can’t emphasize enough, make sure you treat with a doctor that you know and trust, especially after the 28-day waiting period.

Thanks for listening to the podcast of Patrick Marutiak. Again, if you have any questions whatsoever, always feel free to call for free consultation either by phone or in person. I can be contacted at 989-725-8118.

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Podcast Episode 1 – Social Security Law Overview

Listen to the podcast:

 

Welcome to the podcast of Patrick Marutiak. I’d like to do this podcast for all the people I represent, which is basically injured workers and disabled people. I’ve been a lawyer for 30 years specializing in representing injured workers and disabled people only. I’ve never represented insurance companies, just individuals. The purpose of the podcast is to give you a general outline of the law and what you can do to protect yourself. If at any time you have questions on that, just call me at the office.

Social Security Disability

This month, I’d like to cover the area of Social Security disability. Now, there’s a lot of areas to cover, a lot of groundwork, but first I’d like to start with the definition of “disability.” In order to qualify for Social Security disability, you have to show that you cannot do substantial gainful activity for a period of one year or more. Substantial gainful activity essentially means that you can’t work full-time. We call it SGA. No matter how disabled you are, if the disability doesn’t last for more than a year, you do not qualify for benefits. So you have to show both components: cannot do full-time work and can’t do it for more than a year. If you do think you qualify, you should also be aware that they look at several things: your medical condition, your age, education, training, and background. So there are several things they focus on but the primary is always your medical condition and what you can and cannot do.

One of the other areas they look at as well is your age category. For anyone between 18 and 49 years old, the definition of disability is the same. If you are 50 and over, the definition of disability changes, fortunately to the worker’s advantage. For example, if you are 55 and older, you only have to show that you cannot perform your past relevant work or similar-type work to qualify for benefits. This is as opposed to anybody under 49 who has to show they can’t do any job full-time. It’s a critical difference and one that has to be looked at carefully if you are 50 and over.

Meaning of “Listings”

Social Security disability also goes by what’s called the “listings.” Listings are for certain medical conditions that can qualify you for benefits. For example, if you are on dialysis because of a kidney condition, that person automatically qualifies for benefits. They don’t have to show anything more. If you’re blind, you automatically qualify for benefits. In fact, you’re even allowed to work up to a certain limit if you’re blind. These are part of the listings. Anytime you have a medical condition with a specific diagnosis, an analysis should be done to see if you can meet the listings. Now, you should be aware probably only five percent of the people meet the listings. The rest of them have to show they can’t work full-time under a different evaluation, but you should always look at the listings to see if you can qualify. It speeds up the process tremendously.

“If you’re denied at the initial level, you can appeal it and have a hearing in front of a judge. That is your best chance to qualify for benefits.”

If you’re denied at the initial level, you can appeal it and have a hearing in front of a judge. That is your best chance to qualify for benefits. Most people have to apply for a hearing and have that hearing in order to get benefits. The unfortunate thing is how long it takes. It can take upwards of 18 and 20 months to get a hearing in front of a judge. It’s a tremendous weight and I wish there was something that could be done about it. It actually used to take up to three years, previously. So they have improved, but it’s still a tremendous hardship on anybody. I don’t have an easy answer to this and no attorney does. It varies from state to state on how long it can take, but in the Michigan area, it’s usually around 20 months typically.

Medicare Benefits

Now, if you’re on disability or qualify for disability, you’re also going to qualify for Medicare benefits, but the Medicare benefits are not automatic. Medicare kicks in 24 months after benefits begin. Another way to look at it is Medicare kicks in 30 months after you are found disabled. The reason you hear both numbers is because there is a five-month waiting period for benefits to begin, so if you’re found disabled, say, January 1, you’re going to wait 30 months from that time before Medicare kicks in. If your benefits begin June 1, then it will be 24 months or two years. Why do they make you wait two years for the Medicare? This I can’t tell you. It’s just under the statute. My own personal opinion is to save money, but again there’s nothing that can be done to change this other than contacting your congressman. Fortunately, most people still qualify for some other type of insurance, be it Medicaid, COBRA, or the Affordable Care Act.

Steps you should take before contacting me

Steps you should take before contacting me for Social Security disability, first off, if you have any questions, you can contact me anytime. However, just so you know, you cannot even file for Social Security disability until you go off work. A lot of people wonder if they can apply while they’re working. You can’t if you’re working full-time. What is always helpful for me before you come in the office is having a good idea of what your medical conditions are, how it affects your day-to-day life, as well as a list of all your physicians, especially your current physicians. If you have dates and times that you saw the doctors, that is helpful too, but you don’t need your license, you don’t need a birth certificate, you don’t need information like that.

“It is a good idea though to have your work history, either an outline of the work you’ve done in the last ten years or even your information from the Social Security office.”

It is a good idea though to have your work history, either an outline of the work you’ve done in the last ten years or even your information from the Social Security office. Those are the forms they used to mail us but now you have to go online to get them.  All you have to do is go to SSA.gov and pull up your income information. If you have that, that’s helpful, too. Other than that, that’s all you really need to come in and get some advice. The rest can be done just by talking.

Thanks for listening. If you ever have any questions regarding Social Security disability, always feel free to contact me, 989-725-8118. This can be whether you’re working, not working, wondering if benefits are available or not. Call anytime. The consultations are always free.

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