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Worker’s Compensation Insurance: Can I Choose my Own Doctor?
Q: I was hurt on the job recently and my employer directed me to go to an occupational health clinic and treat with the doctors there. Can they make me treat with these doctors?
A: No. An injured worker is entitled to choose his or her own attending physician. Prior to claim acceptance, you can choose any licensed physician, chiropractor, nurse practitioner, or physician assistant to provide medical services. Certain workers’ compensation insurers have contracted with managed care organizations (MCOs). If so, you will be required to treat with a medical provider within the MCO after your claim is accepted. However, the choice of physician is up to you. You can choose an attending physician who refers you to specialists for additional tests or procedures, such as surgery, while still maintaining attending physician status. An injured worker is also entitled to change attending physicians up to three times. If you have questions or need help, you can contact the Workers’ Compensation Division Ombudsman’s office at 1-800-452-0288. speak with an attorney
Do I Meet Disability Requirements?
Q: I have been diagnosed with chronic fatigue syndrome. Can I qualify for Social Security Disability Insurance even though they cannot test for my disabling condition? I am in a lot of pain and I have no energy to perform work.
A: You can qualify for Social Security Disability Insurance Benefits and/or SSI, if your doctor agrees that you have a disabling medical condition. Social Security law says that the agency is required to find a person “disabled” if he or she is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairments which can be expected to result in death, or which have lasted or can be expected to last for a continuous period of not less than 12 months. Chronic fatigue syndrome is a systemic disorder consisting of a complex of symptoms that may vary in frequency, duration, and severity and is recognized by the Center for Disease Control of the United States government. So, yes, you can qualify for disability based on a chronic fatigue syndrome.
If you have applied for disability benefits and been denied,contact an attorney
Do I Need a Lawyer to Help File my Work Injury Claim?
Q: I had an on-the-job work injury claim which has required surgery and has kept me off work. I have a lot of questions and concerns about my future. Do I need a lawyer to help me with my claim? The insurance representative contacts me periodically and tells me not to get a lawyer because the lawyer will just take some of my money. Is that correct and should I get legal advice?
A: An attorney practicing workers’ compensation law in Oregon will usually offer a free case evaluation to talk to you about your case. In fact, lawyers in Oregon are not allowed to charge an attorney fee except with the approval of a workers’ compensation judge or member of the Workers’ Compensation Board. Attorneys only collect fees if they assist an injured worker obtain compensation or if the insurance company has denied the claim. Most of the time the attorney fees are paid by the workers’ compensation insurance company. You can contact an attorney for a free case evaluation and ask the attorney the questions you have about your workers’ compensation case. Additionally, if you need help with your work injury claim, you can call the Oregon Workers’ Compensation Division directly on their Injured Workers’ Hotline at 800-452-0288. The Workers’ Compensation Division is not allowed to give legal advice. However, they can contact the insurance company on your behalf and find out why a check is late or why something has or has not been done. If you have any questions, you can also call the Oregon State Bar Lawyer Referral Service, at 1-800-452-7636, to get the name of an experienced workers’ compensation attorney.
Contact a legal professional for assistance.
Applying for Social Security Disability Q/A
Q: I am considering applying for Social Security Disability because I can no longer perform my usual work. I have no training or skills to perform lighter duty activities. Can I receive disability Benefits?
A: The Social Security Disability Insurance programs provides benefits, to you and certain members of your family, if you have worked long enough and have a medical condition that prevents you from working for at least 12 consecutive months. Depending on your age, education, and work experience, you may qualify for benefits even if you are not totally disabled. For example, individuals over 55, who have performed physical work activity most of their working lives, can still be considered disabled if they do not have the education or training to perform lighter duty activities. The Social Security Administration will want to see your medical records and test results to see what the doctors are saying about your physical condition and any limitations you have from performing your usual work. You can talk to the Social Security Administration directly by calling 1-877-405-0302, or by looking at the Social Security website at www.ssa.gov. You can also make an appointment to talk to somebody at the local Social Security office. You can also talk with an attorney who represents individuals who have applied for Social Security Disability. The case evaluation is free and attorney or representatives can only get paid if you are successful with your case. If you have been disabled at least 12 months or expected to be disabled for 12 months, you should file your application as soon as possible to ensure that you receive all the benefits to which you are entitled.
Contact a legal professional to get assistance.
What Do I Do If I am Unemployed After a Work Injury
Q: After my work injury, I was “let go” by my employer. Was that legal? If so, is there anything you can do to help me get back to work?
A: The answer to your first question is complicated. The second question is a little easier. The law in Oregon requires an employer to reinstate an injured worker if the worker is either released to return to his or her regular work or another job which is “available and suitable.” That means if you can do your normal work, you must be reinstated. If you can’t do your regular work, and the employer does not have another, physically suitable job available, they are not required to create a permanent job within your physical limitations. You do have other options if you have suffered a work injury, however. The law requires Workers’ Compensation insurers to assist injured workers in returning to the workforce. Therefore, retraining, or Vocational Rehabilitation benefits may be available to help you. Check with an experienced attorney to understand your rights. If you believe you were unfairly terminated from your job, possibly relating to a work injury, you can also contact the Bureau of Labor and Industries for advice. Or, contact a legal professional today!
Worker’s Compensation Claims and Pre-Existing Conditions
Q: I was injured on the job. I received a letter from the insurance company that said they accepted my claim. However, my doctor says I need injections in my back but the insurance company says they will not pay. They say the injections are not related to my injury. I did not have a problem until I got hurt on the job. What can I do?
A: The law says that workers’ compensation insurance companies are responsible to pay for all treatment related to a work injury. Many times an insurance company tries to limit its liability by accepting a lesser condition, such as a lumbar strain, when your doctor says you have a herniated disc, nerve, or similar problem. Consequently, workers’ compensation insurance companies sometimes deny payment for necessary medical treatment. You can appeal the insurance company’s denial with the help of the Workers’ Compensation Department. You can also seek legal assistance at no cost to you. Attorney fees are paid by the insurance company. Recent changes from the Oregon Courts require insurance companies to be responsible for any medical treatment caused by the work injury, whether or not you have “pre existing” conditions. Contact the Oregon Workers’ Compensation Department, Injured Worker’s Hotline or an attorney experienced in handling workers’ compensation cases to help you get your medical treatment.
Contact a legal professional today for assistance.
Am I Too Young to Receive Social Security Disability Insurance Benefits?
Q: I went to apply for Disability benefits and was told I was “too young.” I am 45 years old and have worked in construction most of my life. I have had two back surgeries and my doctor says I will never be able to return to construction work. I don’t have the education or training for other work. I thought Social Security Disability would cover me or anyone who cannot go back to work.
A: Anyone who has worked long enough can apply for Social Security Disability Insurance benefits. If you have applied and been denied, file an appeal and ask that the Social Security Administration (SSA) reconsider its denial. You can get assistance with your appeal if necessary. Appeals have strict deadlines, so act promptly. The Social Security disability insurance program is designed to assist anyone who, because of injury or illness, is unable to return to work. The program is based on Federal Law which requires the SSA to consider medical considerations and opinions, as well as your age, education, and work experience. SSA regulations state that an individual under age 50 who can return to some other kind of work will be found not disabled. That same individual who is over 50 may be considered disabled. It depends on the person’s ability to adapt to other kinds of less demanding work. In addition to filing an appeal, you can contact the Oregon State Employment Department or the Vocational Rehabilitation Division and see if they can provide retraining or return to work help.
Contact a legal professional to evaluate your case at no charge.
Happy Birthday Social Security
This month marks Social Security’s 80th birthday (as well as the 50th anniversary of the Medicare and Medicaid programs). Franklin D. Roosevelt signed the Social Security retirement program into law in 1935. Benefits for dependent survivors were added in 1939. In 1956, disability insurance benefits were added. The Medicare and Medicaid programs were created in 1965.
Today, nearly 65 million American men, women and children receive benefits from the various Social Security programs, including retirement, disability, children’s benefits and SSI. According to the most current data from the SSA, the average retired worker receives about $1,335 per month and the average disabled worker about $1,165 per month. Not much to live on, but life-saving for many beneficiaries.
Social Security benefits play a vital role in reducing poverty. Without Social Security, more than 22 million more Americans would be poor according to the latest Census data. Most of those are elderly but nearly 1/3 are under age 65.
Last month the Social Security Board of Trustees released its annual report on the long-term financial status of the Social Security Trust Funds. The combined assets of the Old-Age and Survivors Insurance and Disability Insurance Trust Funds are projected to become depleted in 2034, with 79 percent of benefits payable at that time. Congress needs to act, and act now, to keep these vital programs intact. Let your Congressional representatives, and candidates for public office, know how important this issue is the country, its elderly and disabled. We want Social Security to continue to celebrate its anniversaries for years to come.
contact a legal professional today!
Social Security Benefits and Worker’s Compensation Benefits Q/A
Q: I am over 60, and disabled from an on-the-job injury. I was just awarded Social Security disability benefits, but those benefits are reduced by more than $1,000 per month because of my workers’ compensation benefits. Is this correct? Is there anything I can do about it?
A: Federal law requires Social Security to reduce your disability benefit if you are also receiving workers’ compensation benefits. However, if you are 62 years or older, you have another option. You can stop your disability benefit and opt to receive your early retirement benefits with no offset because of your workers’ compensation benefit. Once your workers’ compensation claim settles, you can then resume receiving your Social Security Disability Benefits with no offset. The law here is complicated. There are other factors that may influence your decision.
Worker’s Compensation Claim Insurance Question
Q: I filed a workers’ compensation claim for an injury to my hands. The insurance company wants to know every job I have had my entire life and is scheduling me to see one of their doctors. What is going on and do I have to cooperate?
A: Oregon Workers’ Compensation Claim law allows insurers up to 60 days to make a decision about accepting a claim. That means within 60 days after you filed your claim, the insurance company is required to do its investigation, which typically includes taking your statement, getting your medical records, and sometimes scheduling a medical appointment. Insurance companies can choose the doctor they send you to. Unfortunately, most of these doctors have an insurance bias and do not always agree with your doctors regarding the nature of your injury and its relationship to your work activities. By law, the injured worker has a duty to cooperate with the insurer’s investigation which usually means giving truthful and complete answers to the insurer’s questions, provided they are relevant to the claim, and obtaining an evaluation arranged by the insurer. You have the right to be represented, at no charge to you, during this process. The insurance companies are required to pay the injured worker’s attorney fees.
If you have questions, contact an attorney