Podcast Episode 1 – Social Security Law Overview

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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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There has been an increase in motor vehicle accidents in Shiawassee County, including Owosso, in the past year or two.  Ever since the recession of 2008 no-fault insurance has become more and more expensive and a larger portion of an individual’s income.

Because of the increase in cost for car insurance there has also been an increase of uninsured drivers.  If a person is driving their own vehicle and it is uninsured they cannot make a claim against another driver even though that driver may be at fault.  For example, if a drunk driver crosses the center line and hits you causing serious injury normally you would have a claim for PIP benefits (medical expenses and wage loss), through your no-fault insurance and a separate claim against the drunk driver for pain and suffering.  In the past if your vehicle was uninsured and you were driving you lost the claim for medical bills and wages but could still sue the drunk driver.  Now, you not only lose that claim but you also lose the claim against the drunk driver.

Though the cost of no-fault benefits in Shiawassee County has steadily increased making it more difficult to insure your vehicle it is more critical now than ever to make sure you have insurance on your car.  If you are seriously injured and you do not have coverage you could lose a claim for lifetime medical coverage.  You could also lose a claim against the other driver for yourself and your family if the accident causes death.  Most people that cannot afford the insurance are willing to take the risk thinking that ‘this will never happen to me’.  Though chances are when you get in an uninsured vehicle you will not be in an accident, it only takes ones mistake by someone else to change your and your family’s life forever.  It simply is not worth the risk to drive a vehicle if you know it is uninsured.

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Shortly after the Supreme Court ruled same sex marriages were constitutional in Windsor v United States, the Social Security Administration began recognizing same sex marriages.

This change had had a positive effect for some people including those who could not obtain retirement benefits on a spouse’s record and those who could claim survivor benefits when a spouse passed away.  However, for many SSI beneficiaries these newly recognized marriages posed the risk of overpayments because a spouse’s income factors into how benefits are determined.  There appears to be little question that the recognition of same sex marriage will result in more benefits for couples now that one spouse or their children may be able to draw off the other spouse.  A smaller group of people may be penalized though concerning SSI benefits.

The Social Security Administration, at the request of over 100 members of congress, is processing any overpayments regarding same sex couples in a favorable manor to the claimant.  In other words, the Social Security Administration are to presume if there is an overpayment that the recipient of the overpayment requests a waiver.  This policy should help couples who were receiving the appropriate amount of SSI for perhaps sometime but found themselves facing an overpayment going back years now that the county recognized such marriages.  This presumption of a request for a waiver is beneficial to the couples that this applies to.  This is another example of how recognizing same sex marriages means an overhaul of many other regulations and statutes due to the fact that these couples are now legally married.

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               It is difficult to understand why a Social Security disability case can take so long.  An initial application averages four months for a determination, but there are times where it takes nine months.  70% of the initial applications are denied.

Once an application is denied, an appeal can be filed requesting a hearing in front of a judge.  This is anybody’s best chance to qualify for benefits.  The majority of cases at this level though are denied as well.  Only 45% of cases that go to hearing are allowed.

To get in front of a judge for a hearing it can easily take a year and a half to two years from the time you filed your initial application.  First you go through the initial denial and then appeal it to the court.  Once it is appealed, the Lansing hearing office, on average, takes 418 days to schedule a hearing.  This is nearly fifteen months.  The Flint and Grand Rapids offices average eighteen months.  Fortunately, cases in Shiawassee County are heard in Lansing and though this is a long wait it is quicker than other districts.

Why does it take so long?  There are many reasons including the fact that applications for disability benefits has been increasing ever since the recession in 2008.  Though it does not justify the wait now, back in 2008 the average wait was over two years.  The system is improving but the improvements have been slow and it has a long way to go.  It is also frustrating because there are times and exceptions when someone may have to wait even longer and other people get a determination within a matter of a few months.  Unfortunately, this is the system we have to deal with and hopefully improvements will be made.

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Be careful when you research Social Security disability on the internet.  There are many websites which offer assistance in helping you determine if you might qualify for disability benefits, but some are not even sponsored by attorneys.  These groups also use Facebook, and their links pop up deceptively.  You can easily be redirected to these websites without even knowing it.  Even when you think you are researching Social Security disability on a government website this can happen.

I constantly have clients tell me they are unrepresented, and it turns out they unknowingly supplied enough information on one of these websites for an organization to become their representative.  The clients are surprised to find out they have an out-of-state attorney or non-attorney representing them.

It makes sense to do research to see if you qualify for benefits, but if you do, make sure you are on a government sanctioned website unless you wish to be represented by someone you may never even meet.  Many of these organizations do not even go to hearings with the client but rather send an “advocate” they hire at the last minute to accompany the client—someone who doesn’t know the case, someone the client has never even met before, and sometimes someone who is not even any attorney.

Always be cognizant of the source of the website you are on when you are doing research.  It’s perfectly legal for firms to solicit clients via the internet.  Just beware that some websites are deliberately misleading.  Go by the old adage:  Buyer Beware.

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Currently if you are in a motor vehicle accident you have lifetime medical coverage for any injury related to the car accident.  This was one of the benchmarks of no-fault law when it was enacted in 1972.

Legislatures are considering limiting medical coverage for auto accidents.  The Insurance Companies are promising cheaper rates if the law is changed and they ‘guarantee’ these lower rates for two years.  Can they be believed?  Doubtful.  This is why they only guarantee two years.

Serious automobile accidents happen.  You never know if it could happen to you.  The reason we have no-fault law is to provide protection from catastrophic cost if someone is seriously injured.  The insurance companies’ proposal to limit this coverage is nothing more than a rouse to allow them more profit.  Do not believe everything you hear about the cost of medical coverage in car accidents.  Do some research on your own.  Insurance companies for motor vehicles are not losing any money.  In fact, they have had record profits.  Periodically their efforts to change the law is nothing more than an effort to maximize profits without any guarantees to us that our rates will be cheaper.

No-fault law has been in effect and worked for more than forty years.  Make sure you let you congress person know they should not limit the benefits we are paying for.

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Changes in Medical Coverage – Work Injuries

The political climate has affected work related injuries as well.  The Michigan Department of Licensing and Regulatory Affairs (LARA) has instituted new rules effective this year.  In order to receive pain medication (opiates, such as Vicodin, OxyContin, etc.) a workers’ compensation carrier has to pay for them only for 90 days.  In order for pain medications to be paid longer than 90 days new rules have been instituted where they will not be allowed unless a doctor complies with onerous regulations regarding paperwork and qualifications.

With the institution of these new regulations it is doubtful many physicians will even try to see a patient past 90 days if it is for pain treatment only.  How this will affect people with severe injuries remains to be seen but it is definitely not going to be easy or beneficial to those who are seriously hurt.  This is another example of the current government pandering to the insurance companies but saying they are doing it for the benefit of the worker.  They say they are concerned about people becoming addicted to medications and are trying to prevent that.  They are only targeting work related injuries in their endeavor.  Of course, this does not take into consideration the legitimate serious injuries that require long term care.

If you need long term pain management care you will want to get advice on how this may affect your case.  How these new regulations will be applied will be better known as time goes on but one thing is certain:  Insurance companies for employers are making it harder for workers to treat their injuries.

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Social Security Disablity – Political Climate

New statistics show that disability awards are the lowest they have been in 30 years.  Some have the perception that disability allowances have never been higher.  This is not the case.  The national allowance rate at the hearing level has fallen dramatically since 2007.

In 2007 the Administrative Law Judges’ awarded benefits 62% of the time on average.  The last year for analysis, 2013, has shown that this rate has dramatically fallen.  The current rate for allowance is 48%.  This is the lowest rate in more than 30 years.

Has there been a sudden change in the nature of people applying?  Doubtful.  What has changed is the political climate.  Pressure is being put on the Administration to bring costs under control and this has made a difference in how claims are being viewed.  It is more important now than ever to properly present a claim given these statistics.

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Having the Right Type of Car Insurance – Michigan No Fault Law

Michigan law requires an individual to have no-fault insurance before the car can go on the road.  As we all know, insurance is getting more and more costly.  Too often people base their decision on insurance by whatever is the cheapest.

Did you know you can have extra coverage that will pay for your injuries if you are hit by a person who is uninsured or underinsured?  Uninsured is someone who is on the road illegally without insurance.  If you have uninsured motorist coverage, your company will pay for your pain and suffering because the other individual did not have insurance.

Underinsurance Insurance Coverage

Underinsurance means your company will pay if the other driver’s insurance isn’t enough.  Let’s say you get hit by a drunk driver who has PLPD insurance and you end up having back surgery as a result of the accident and will be off work for months if not years.  That individual only has $20,000 worth of insurance to pay for your injuries.  Under this example it is easy to know that your injuries are going to be far in excess of $20,000.  If you have underinsurance coverage, your company will make up the difference.

I have $1 million of underinsured coverage on my policy.  This means if I am seriously injured or even killed by another driver my family will at least get up to $1 million no matter how much or how little insurance the other driver has.  This type of coverage costs me $30 per year!

For as little as $30 a year you can protect yourself and your family by having underinsured motor vehicle coverage.  Even if you cannot afford that amount, for less you can at least get coverage for $100,000 or a half million dollars.  Every car owner should have underinsured motor vehicle coverage.  Your agent will not necessarily offer this coverage to you.  In fact, most agents will not even mention this.  Make sure when you get your insurance to inquire into the cost of underinsured and uninsured motor vehicle coverage.

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Workers’ Compensation – Changes In Michigan Law

There have been drastic changes in the Workers’ Disability Compensation law over the past 10 years.  No longer is a worker entitled to wages if their doctor has them off for a work injury.  Now they have to prove they are vocationally unable to perform virtually any job in order to get their full benefits.

In 2013 out of all the cases tried before the Workers’ Compensation Agency, only 17 percent resulted in an open ward for benefits.  17 percent!  You know when the statistics are this low the deck is stacked against you.

If you are hurt on the job, you must now show that you are unable to perform any potential job you are capable of doing based on your limitations, education, and training.  This “phantom” job can reduce or eliminate a person’s wage loss.  Take the case of an individual in his 20’s who hurt his back working for Bell Tire.  His injury required surgery and created a permanent condition where he was unable to perform the heavy physical labor he did in the past.  In fact he is now limited to lifting only 10 pounds.  His workers’ compensation benefits should have paid him $318 per week.  The court reduced his benefits to $22.90 per week on the theory that he was able to perform a sedentary job at $8 an hour.  Not only is this individual not working but this assumes that someone would hire him with this back injury and he would be able to perform it full time.

In order to avoid this, an employee must now establish through vocational testimony that he is unable to perform any jobs within his physical ability.  This usually necessitates the cost of several thousand dollars to hire vocational experts and the worker must actively seek employment to prove he/she cannot find any jobs.

Tip To A Successful Workers Compensation Claim

The best way to protect yourself if you are in this situation is to look for work on a weekly basis—even 10-20 jobs per week.  By keeping meticulous records of applications you submit, you can prove there are no “phantom” jobs available.  This may seem ludicrous when your doctor has you off work, but it is the only way to protect your benefits.  The courts have even reduced a person’s wages while they were recuperating in the hospital saying they could have looked for work.  Talk about ludicrous!

The best way to protect your rights is to seek advice from an attorney who specializes in workers’ compensation law.  The Law Office of Patrick Marutiak has been handling these types of cases for 28 years.  If you have any questions, feel free to call us at 989-725-8118 or send an email to pmarutiak@tds.net.

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