Find the Answers to Your Pennsylvania Workers’ Compensation and Disability Benefits Questions
Most people navigating the workers’ compensation and disability benefits application processes come to us with questions and confusion. Here, we share some of the questions that we answer most about the disability and workers’ compensation application and appeals processes. If you have a question for us, check out this page to see if we have answered this question for others!
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What should I do if I believe that my injury, illness, or disease was caused, in whole or in part, by my job?
Under some circumstances, the connection between your job and your injury will be obvious. For example, if you fall from a scaffold while installing a window on a building. Under such circumstances, you must simply notify your supervisor.
However, the connection is not always so obvious. For example, you may notice a tingling in your fingers and only later realize that the tingling is worse every time you type on your keyboard at work; or you may have a cough that leads to a diagnosis of tuberculosis and which your treating doctor associates with your work exposure.
If you suspect that your injury or disease was caused by your job, make an appointment with a doctor and discuss it with him. If the doctor believes that the condition is work-related , inform your employer as soon as possible.
What is Workers' Compensation?
Workers' Compensation is insurance paid for by employers to cover on-the-job injuries. Every state in the United States has some law that requires employers to have workers’ compensation insurance or to make other arrangements to pay for on-the-job injuries. However, every state’s workers’ compensation law is different. Under Pennsylvania law, workers suffering from work-related injuries or diseases are entitled to wage-loss benefits until there is evidence that the person can work, and medical expense benefits until they have fully recovered from their injury or disease.
How long will it take to receive my Social Security disability benefits?
One of the most frustrating experiences we have a people in today’s world is the knowledge of an indefinite wait time. Social Security Disability Insurance (SSDI) benefits do not offer the same convenience as say, your local deli counter, which assigns you a number and you have an approximate idea of when your turn has arrived.
There are horror stories circulating of people waiting years to receive SSDI benefits, and the media is flooded with reports on the overwhelming backlog in the disability system. While these stories may hold some truth, many of the tales of multi-year waits are the result of multiple mistakes and appeals on a single claim.
Much of your personal timeline will depend on factors that you can control—factors like making sure you have included the proper paperwork and medical documentation as well as meeting all deadlines and requests promptly. Below is an approximate timeline that you can expect for your own SSDI benefits, from application through success:
- From your first application, you can expect to receive an initial decision from your claims agent in about 3-6 months. If you are asked to return or resend any forms, or attend a consultative exam to gather more information, do this promptly in order to avoid further delay.
- If your initial application is denied—and don’t worry, many people are denied in their first attempt to collect SSDI benefits—you can file an appeal. Once the appeal is filed, you can expect to hear back in another 3-6 months. You may be requested to resend forms or attend another consultative exam, and again, the quicker you act, the sooner you will receive a decision.
- If your initial appeal is denied, you can file a second appeal. This appeal takes place in front of a judge, and can take a year or more even to be scheduled.
You Can Receive Benefits for the Time You Spend Waiting
That’s right: if your application and appeals process takes excessive time, you can collect backlogged benefits once you finally receive approval. In most cases, you will receive a lump-sum settlement for the money you should have received while waiting for a positive decision. That settlement will come shortly after you start collecting monthly SSDI benefits.
One of the best things you can do to speed along the process is to ensure that your application or appeal is error-free and complete. While this sounds simple enough to do on your own, there are veritable mountains of required documents and information that can often be left out if you are not experienced with the Social Security disability system.
If you are considering applying for SSDI benefits, or your application has been denied, our experienced Philadelphia disability attorneys can help you get the results you have worked so hard for. Schedule an appointment to discuss your claim today—just pick up the phone or click on the live chat link to be connected with a firm representative now.
Do I need an attorney in order to apply for long-term disability benefits?
We receive many questions from workers who are suffering from a disability about hiring an attorney for their long-term disability claim. The short answer is: it really depends on your own personal situation.
Let us elaborate a bit. Long-term disability insurance companies are just that—companies. They have a bottom line that must be met in order to make a profit. The fewer claims that they pay out, the more money the company ultimately makes. This is not unique to long-term disability insurers—auto, home, and health insurers do the very same thing.
When a Disability Attorney May Help Your Case
While there are certainly honest companies out there that are not trying to cheat you out of your benefits, even these companies do not want to pay out unnecessary claims. This means that they will be investigating your claim closely to ensure that you have the evidence necessary to back up your application.
In the initial application process, a disability attorney can make sure that your application is complete and that you are in full compliance with your policy. Many long-term disability insurance policies have very strict regulations and deadlines, and an attorney will help you stay on-track throughout the process. While not everyone needs an attorney at this stage, many people enjoy the added security that a disability attorney’s experience can bring to the table.
When You Absolutely Need a Disability Attorney
If your application to receive long-term disability benefits has been denied, you need an attorney right away to assist you with your appeal. The appeal process for long-term disability claims is incredibly complex, and requires much of the same preparation and skill as a legal trial. In an appeal, the burden is on you to prove that you are entitled to these benefits, and it will be an uphill battle—the long-term disability insurance company has already gathered enough evidence against you to deny your claim in the first place.
At The Boles Firm, our experienced, aggressive disability attorneys have spent decades successfully representing injured Pennsylvania workers who have denied long-term disability benefits. If you are filing for long-term disability benefits or have been denied, do not delay—contact our firm today to learn what we can do for you.
If I am receiving Worker’s Compensation benefits, can the Social Security Administration offset those benefits?
Yes. Under the Social Security Act, a disabled person is not entitled to collect Social Security and Worker’s Compensation benefits which together total more than 80% of the person’s pre-injury earnings.
For more detailed information from our document library, click here.
How does Social Security calculate pre-injury earnings?
The Social Security Administration computes the disabled person’s “ACE” which stands for “Average Current Earnings.”
To calculate the Average Current Earnings, the Social Security Administration looks at the disabled person’s earnings year in which he became disabled and the 5 previous years.
In a second method, the Social Security Administration looks at the disabled person’s 5 highest consecutive years of earnings in his lifetime, and divides the 5 years of income by 60 to get a monthly average. Whichever method produces the highest number yields the Average Current Earnings.
Can people with terminal illnesses be approved for Social Security benefits?
Yes. If you have a terminal illness that meets the Social Security Administration’s definition of a disability, you are eligible for Social Security Disability Insurance benefits.
How long after I am approved will I begin receiving SSD benefits?
Your entitlement date for monthly benefits is set after a mandatory waiting period of 5 full months after the Social Security Administration determines the date of your disability. The Social Security Administration also compensates you for the period of time it takes to approve your application. You receive a one-time only lump sum that represents the number of months that you are entitled to benefits.
Are there medical conditions that are pre-approved for Social Security Benefits?
Yes. These conditions are included in the Social Security Administration’s Compassionate Allowance Initiative that quickly identifies applicants who clearly meet the Social Security Administration’s definition of disability. Claims are processed within days instead of months. Confirmation of the medical diagnoses with supporting medical information is often all that is needed to get approved.
How long does the Social Security application process take?
The Social Security Disability Insurance initial application process typically takes 3-5 months. Appeals of denied claims may take significantly longer. Due to the extensive backlog of claimants waiting for appeals with an administrative law judge, it could take a year to get approved.