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Underinsured and Uninsured Motorist Coverage and Why It is Important

Posted on Thursday, August 2nd, 2018 at 1:41 pm    

The following post is part of our Law Student Blog Writing Project, and is authored by Madelyn Stampley, a law clerk at Lawrence and Associates, who is pursuing her Juris Doctorate at NKU Chase College of Law.

UIM and UM Coverage: An Introduction

crashSadly, in today’s economy, a lot of Kentucky and Ohio residents are only able to afford car insurance with minimum coverage, or worse they are unable to afford car insurance at all. When one of these underinsured or uninsured drivers are at-fault for a motor vehicle accident that caused you injuries, underinsured (UIM) and uninsured (UM) motorist coverage allows you to fully recover. Securing an attorney for your UM or UIM claim is crucial to just compensation for your harm and damages.

Can I Still Get Compensation from a Motor Vehicle Accident if the Other Party in the Accident Does Not Have Insurance?

Both Kentucky and Ohio law allow you to get compensation from a motor vehicle accident if the other party in the accident does not have insurance. Uninsured motorist coverage provides protection when you are in a motor vehicle accident and the responsible party does not have auto insurance and this cannot cover repairing your car or covering your medical bills and lost wages. UM is important because it is the only way to know your damages are covered in an accident with an uninsured motorist. An uninsured motorist is more likely than not uninsured due to not having the funds to afford auto insurance. If they do not have the funds to afford insurance, they most likely do not have enough money to cover expensive medical bills, lost wages, and your automobile repairs.

Why Is It Okay to File an Uninsured Motorist Claim?

An uninsured motorist claim can help ensure your medical expenses (medical bills, lost wages, and pain and suffering) are paid for when you are in a motor vehicle accident with an at fault driver that does not have auto insurance. It is not only okay, but it is recommended to have uninsured/underinsured coverage. In some states uninsured motorist coverage is mandatory, although in Ohio and Kentucky it is only optional. Uninsured motorist coverage also covers you if you are the victim of a hit-and-run accident.

What is Underinsured Motorist Coverage and How Can It Protect Me?

Underinsured Motorist Coverage, or UIM, provides you protection when you are in a motor vehicle accident and the at-fault driver does not have enough auto insurance coverage to fully cover repairing your cap or covering your medical bills, pain and suffering, and lost wages.

For example, let’s say you are a Kentucky resident in a motor vehicle accident that accrues $200,000 worth of damages. The at-fault driver has insurance, but it only covers $100,000 of the damages. In this case you can make an underinsured motorist claim against your own insurance policy. If you had $150,000 in underinsured driver coverage, you would settle with the negligent driver for $100,000, and would settle with your insurer for an additional $100,000. Your auto insurance policy is required to cover all the damages you have that exceed the amount covered by the at-fault driver’s policy, up to the limit of the UIM coverage reflected on your auto insurance declarations page.

In contrast, in Ohio your available UIM coverage is based on the difference your UIM limits and the underinsured driver’s liability limits. For example, if the underinsured at-fault driver has $25,000 in liability limits, and you have $100,000 in UIM limits, you would be able to collect up to $75,000 from your own UIM policy ($100,000 – $25,000 = $75,000). This is because Ohio law allows a UIM policy to be offset by the at-fault driver’s liability coverage, instead of requiring that UIM coverage stacks on top of the liability coverage as it does in Kentucky.

How Do I File an Uninsured or Underinsured Motorist Claim?

If you are in a motor vehicle accident, it is important to start taking the proper steps immediately to make sure your claim goes your way. Generally, you will know if the at-fault driver is uninsured once the police are called to the scene after the accident. On the other hand, knowing if the at-fault driver is underinsured tends to be more difficult and time-consuming. It can take a while, sometimes several months, to determine the amount of money needed to cover the damages due to the motor vehicle accident. Once this amount is calculated, the at-fault driver’s insurance will cover as much as their policy allows. After the insurance limits are reached, you should contact your insurance company or attorney to file an underinsured motorist claim.

The key to filing either of these claims is acting swiftly to make sure claim runs smoothly due to a lot of car insurance policies having limits on how many days you have to report the claim. Once you have filed your claim, there will be pretrial investigation, disclosure of medical records, and settlement discussions. Generally, the insurance company and your attorney will discuss and negotiate the best possible settlement for you.

The Importance of Securing an Attorney for your UM/UIM Claim

Due to financial struggles, a lot of Kentucky and Ohio residents decide to purchase auto insurance policies with minimum coverage. A shocking amount of people also decide to forego auto insurance completely. To ensure your insurance covers your medical bills, lost wages, pain and suffering, and vehicle damages during a motor vehicle accident with an uninsured or underinsured driver, it is important to have UM or UIM coverage. If you find yourself post-car accident unsure how to make sure all your damages are covered, securing an attorney is the best way to proceed. Having an attorney during this process will ensure that you will have the best possible result and have your damages covered. If you decide to not obtain uninsured or underinsured motorist coverage, you are driving at the mercy of everyone on the road who does not have insurance or is underinsured. While it may be more expensive, you should view it as a stress taken off your shoulder knowing that you have enough insurance coverage to cover medical bills, lost wages, pain and suffering, and car repairs.

If you have been in a Car Accident in any state, or if you have any other questions about Underinsured or Uninsured Motorist coverage, please call our Fort Mitchell, Kentucky office at 859-371-5997 or our West Chester, Ohio office at 513-351-5997. We successfully resolve hundreds of cases every year for people who are in your shoes. We’re Working Hard for the Working Class, and we want to help you!

How Age, Education, and Residual Functional Capacity Help Cincinnati Residents Get Social Security Disability

Posted on Thursday, July 19th, 2018 at 4:43 pm    

The following post is part of our Law Student Blog Writing Project, and is authored by Dayna Wilson, a law clerk at Lawrence and Associates, who is pursuing her Juris Doctorate at Chase College of Law.

This blog is designed to provide you with an easy understanding on how three important factors – age, education, and residual functional capacity – all work together to determine the amount of Social Security Disability you may receive.

How is Residual Functional Capacity Determined?

There are many factors to be considered when determining if you can collect Social Security benefits. One important factor is called residual functional capacity (RFC). When determining your ability to work, Social Security evaluates your residual functional capacity. Social Security will assess the types of activities and tasks an applicant can still perform on a regular and continued basis. A Social Security disability claim will only be approved if it is established that you cannot perform any work.

The Code of Federal Regulations, defines residual functional capacity as what an individual can do despite limitations. Residual functional capacity will take into account all limitations and medical conditions. In other words, Social Security will evaluate how much you can do and how long it will take to perform the function. A Social Security claim examiner will assess all impairments, including serious and minor impairments when evaluating residual functional capacity. Manipulative or postural activities are assessed such as reaching, handling, and lifting. Environmental conditions are considered such as the ability to tolerate high and low temperatures or wet and dry conditions. The RFC also encompasses mental conditions such as the ability to maintain concentration and attention for extended periods of time. Also, how well you can understand and remember duties throughout the day are considered. When these important factors are not clearly explained in your medical records, Social Security often finds you can perform these functions. It is important your doctor assess your ability to twist, bend, reach, grasp, kneel, and climb. Social Security also takes into account nonexertional factors such ability to follow directions; perform work at a normal rate and persistence throughout the day; and one’s overall reliability.

What happens if one retains Residual Functional Capacity?

If residual functional capacity is obtained to perform any common work in the national economy, an individual will not be found to be disabled. If Social Security examiners determine you can perform light, semi-skilled work, examiners will compare your residual functional capacity with those in the Dictionary of Occupational Titles and will match you with any jobs listed in that publication which call for light, semi-skilled work.

What is the importance of Residual Functional Capacity?

A complete understanding of all the factors that go into residual functional capacity determination is important for you to have a successful Social Security disability claim. In the Cincinnati Social Security office, medical records are an essential component in the determination of residual functional capacity. Often times, many of the factors such as bending, twisting, and kneeling are irrelevant to a doctor’s actual treatment of a medical condition. However, they are important for a Social Security Administration (SSA) examiner in determining benefits because SSA focuses on your functional ability not just your medical history.

How Does Social Security Determine your Social Security Benefits Eligibility?

Social Security uses your “Full Retirement Age” to determine the amount of monthly income you will receive. Full retirement age is based on your year and day of birth. Full Retirement Age determines when you are able to receive your full benefit amount. If you have started claiming benefits before your full retirement age, you become eligible for delayed retirement credits.

What is the difference Between Retirement Age and Stop Work Age?

Retirement age and stop work age must be distinguished in order to get a better understanding of how age can affect Social Security benefits. According to the Social Security Administration, your retirement age is the age at which you begin receiving Social Security retirement benefits. Stop Age is the age at which you leave the labor force and no longer work. This age affects the amount of Social Security benefits you may collect. Retirement benefits are based on your highest 35 years of earnings and your age when you start receiving benefits.

What Happens if you Stop Work Before your Retirement Age?

Social Security Administration will use a zero for each year without earnings, then they complete their calculations to determine the amount of retirement benefits you are due. If you stop working between the age of 62 and full retirement age, you may receive reduced benefits. The earliest you can start receiving retirement benefits is age 62. If you retire when you reach full retirement age, you will receive retirement benefits. In the Greater Cincinnati area, many individuals often work past full retirement age. Here, you are presented with two options: you can work and get full retirement benefits no matter how much you earn; the second option is to delay getting retirement benefits and earn credits that increase your benefit amount.

Are there any consequences of claiming Social Security Early?

There are consequences for receiving Social Security benefits early. If you are married you are reducing the survivor benefit available to your spouse. This will occur if your benefit amount is greater than theirs. Next, if you claim Social Security Benefits before your full retirement age and continue employment and make too much, then benefits will be reduced. It is important to note; investment income does not count toward the annual earnings limit. The only income that counts is income earned by working.

How does Education Affect Social Security Disability?

When applying for Social Security Disability, the Social Security Administration will ask what is the highest level of education you have completed. This information is used to assist with determining what kind of work you are capable of performing given your age and impairments. Education level can be measured to determine one’s ability to adapt to skilled work. The presence of additional education does not necessarily mean you can perform skilled work. A judge may determine the education you have received is outdated that it doesn’t affect your ability to perform present work. If you are over the age of 50, it is important to have your education evaluated. The rules assume that older individuals who cannot perform their past work because of physical and/or mental limitations will have the hardest time adapting to new work given their again. Therefore, it is generally easier for older individuals to be approved.

Age, education, and residual functional capacity all work together to determine the amount of benefits you will receive. It is essential for you to know how these are assessed and we want to make it easier for you to receive benefits. At Lawrence & Associates, we want to help you recover the benefits you have worked hard for. We’re Working Hard for the Working Class; call us today for a free, confidential consultation!

SSDI: What Can Cincinnati and Northern Kentucky Residents Do to Help Their Social Security Disability Cases?

Posted on Tuesday, July 10th, 2018 at 10:51 am    

The following post is part of our Law Student Blog Writing Project, and is authored by Madelyn Stampley, a law clerk at Lawrence and Associates, who is pursuing her Juris Doctorate at NKU Chase College of Law.

In order to receive social security disability, you must go through a five-step sequential evaluation process by the Cincinnati branch of the Social Security Administration. During the fifth and final step of the sequential evaluation, the Social Security Administration must prove that work exists for you in the national economy that you will be able to adjust to considering your impairment(s), age, education, and past work experience. If they cannot prove that work exists for you, then you are found disabled. To have a ruling in your favor, there are a few simple things you can do to help. Attending all of your medical appointments and keeping a log of all of those appointments is very helpful. Making sure to also track your symptoms, your medications, and the side-effects of your medications. Lastly, making sure your doctor is writing detailed medical reports and stating his medical opinion about your impairments and how they limit your abilities in your work life can be extremely helpful to lead to getting disability.

Firstly, making sure that you attend all of your medical appointments is very important to your claim. In Northern Kentucky and Cincinnati, the Social Security Administration uses your medical records to determine if you are disabled or not. If you fail to attend your medical appointments that also means you are failing to obtain medical records, which means the Social Security Administration will have nothing to base their determination off of for your disability. The more medical records you have the more proof you have to show that you are severely and permanently impaired and ultimately unable to work.

Secondly, along with attending your medical appointments, keeping a log of all your appointments helps your case as well. Write down when and where you were treated, who you treated with, and what impairment you were treated for. It makes it easier for your attorney to obtain the proper medical records and have a record of every time you went to the doctor. Along with keeping a log of your appointments, also make sure to track your symptoms. Keeping a daily log of your impairments and how they affect you gives your attorney more information that they can use to win the case. Along with this, also track your medications with their corresponding side effects. Keeping a log of everything speeds along the social security process and helps everything run more smoothly.

When you go to your medical appointments it is also important to ask your doctor to write detailed and clear medical reports. Generally, when doctors write their medical records, they are writing them for themselves. They often times neglect being too detailed and instead write quick and concise notes. Ask your doctor for a medical report that includes a detailed narrative that explains all of your impairments and functional limitations. The Social Security Administration reads through all of your records and a detailed narrative is very helpful to you case.

You should also ask your doctor to include his medical opinion in your medical reports. Have your doctor state whether or not they believe that you are so severely and permanently disabled that you should not and cannot return to work. While the Social Security Administration will not take your doctor’s opinion as their answer, having your doctor’s opinion in your medical records can help prove that you are disabled. It never hurts to have more than one opinion attesting to your disability.

Along with asking your doctor for a more detailed medical report, also ask them to complete a Residual Functional Capacity (RFC) report as early in the process as you can. A Residual Functional Capacity report is an accounting of your capacity for full-time work. It allows your doctor to check off boxes allocating your limitations, like how much you can lift, how far you can walk, and whether you can bend or stoop. It is a great way for the Social Security Administration to get the information they need to make a determination of your disability.

Another thing you can do to help your case is making sure you are seeing the appropriate doctors for your impairments. While it is convenient to see the same doctor for everything, it is important to make sure you are receiving care from doctors that specialize in the area in which you need treatment for. For instance, instead of seeing your primary care physician for your mental health impairments, you should see a doctor who specializes in mental health, like a psychiatrist. This will ensure that you are getting the best possible medical records and opinions from someone who specializes in the disability that you have.

Lastly, strong communication and cooperation with your attorney is very important. It is crucial that you come to all of your meetings with your attorney and are easy to get a hold of. Making sure to fill out the forms we give you correctly and in a timely manner helps the social security process move along quickly. If you have questions about the process or are confused about something asked on one of your forms you have to fill out, it is best to contact your attorney instead of guessing.

The fifth step of the sequential evaluation by the Social Security Administration is the final step in determining if you are considered disabled or not. If they cannot prove that work exists for you, then you are found disabled. There are several ways you can help bring about the result you want in this fifth step along with your case as a whole. Make sure to attend all of your medical appointments so that the Social Security Administration has medical records to base their ruling off of. Obtaining good medical records and opinions by the appropriate doctors as well as having your doctor fill out a Residual Functional Capacity report goes a long way. Keeping a detailed log of your symptoms, your medication and its side effects, and a list of all of your medical appointment dates and your provider is also very helpful.

If you believe you have a Social Security Disability claim, don’t go it alone. Lawrence & Associates has helped many Cincinnati and Northern Kentucky residents just like you get disability benefits. We’re Working Hard for the Working Class, and we want to help you! Call today for a free, confidential consultation.

How Many Work Credits Do I Need to Get Social Security Disability in Ohio and Kentucky?

Posted on Monday, July 2nd, 2018 at 11:27 am    

The following post is part of our Law Student Blog Writing Project, and is authored by Dayna Wilson, a law clerk at Lawrence and Associates, who is pursuing her Juris Doctorate at Chase College of Law.

Today, many people are unfamiliar with work credits requirements. Further, some people have not even heard of the term. This blog is designed to make you to have a simple understanding of social security work credits and the importance of them. Here at Lawrence & Associates, we encourage you to call us for a free consultation! We are qualified representatives who can help determine whether you qualify for Social Security Disability.

What are Social Security Work Credits?

Let’s jump into Social Security benefits and what you should know about them. The Social Security Administration refers to these work credits as the “building blocks” which Social Security uses to determine whether you have worked long enough to qualify for benefits. Work credits are earned throughout your employment history.

You qualify for Social Security benefits by earning Social Security credits when you work in a job and pay Social Security taxes. Credits are based on your income during the year, no matter when you did the actual work. When an individual works they can earn up to 4 credits in a year. It is important to keep in mind that it does not matter if you earn $5,000 or $500,000 in a given year, you can only earn up to four credits in a given year. Currently, a worker must earn $1,320 to earn one work credit. This figure gets adjusted based on inflation every year. Your average earnings during your working years determine how much your monthly payment will be.

How Many Credits Do You Need to Be Eligible in the Cincinnati area?

The number of work credits needed for disability benefits depends on your age when you become disabled. In general, you need 40 credits, with 20 earned in the last 10 years ending with the year you become disabled. However, younger workers can qualify with fewer credits. For example, if you are 24 or younger, you may qualify if you have six credits earned in the three-year period ending when your disability starts. If you are between the age of 24 to 31, you may qualify if you have credit for working half the time between age 21 and the time you become disabled. For example, if you become disabled at age 27, you would need credit for 3 years of work (12 credits) out of the past 6 years (between ages 21 and 27). For individuals 31 through 42, the number of credits needed for disability benefits is 20.

In this video, Social Security Attorney Danielle Lawrence, explains to be considered for Social Security Disability at the age of 46, you will need 24 work credits in the last 10 years. On the other hand, if an individual is 58, 36 work credits are needed in the last 10 years in order to qualify. Social Security will use those work credits from the 10 years prior to disability to determine whether an individual may receive Social Security disability benefits.

A common misconception among many people is that Social Security Disability is the same as Social Security Retirement. People may think if they are working hard and paying into their retirement, then they can easily qualify for Social Security benefits. However, it is important to know that is not the case.

Special Rules for Some Jobs

Are you an individual who is self-employed? If so, then you earn Social Security credits the same way employees do (one credit for each $1,320 in net earnings, and no more than four credits per year). There are special rules that apply if you earn less than $400. It is important to note, if you are in the military then you also earn credits the same way civilian employees do. Additional earnings may also be considered based on certain conditions.

How You Can Ensure Accurate Work Credits

Each year, your employer sends a copy of your W-2 (Wage and Tax Statement) to Social Security. Social Security Administration compares your name and Social Security number on the W-2 with their records. Your earnings shown on the W-2 are recorded on your lifelong earnings record. Your lifelong earnings record is what Social Security uses to determine your future benefits and the benefits amount.

Your name and Social Security number on your Social Security card must agree with the information on your employer’s payroll records and W-2. It is important to protect your benefits by ensuring that your employer has the correct social security number and name.

Why Are Work Credits Important to Social Security Disability Determinations in the Cincinnati Area?

According to the Social Security Administration, in 2017, about 173 million people worked and paid Social Security taxes about 62 million people received monthly Social Security benefits. Social Security reaches almost every family, and at some point, impacts the lives of nearly all Americans.

Social Security Attorney Kelsey Westermeyer explains the importance of work credits. She states, “If you do not have enough credits, you cannot get disability.” If you do not have enough credits, then Social Security Administration does not have to pay you monthly checks. A statement from your doctor saying you are disabled is not enough to qualify for Social Security disability benefits.

In sum, The Social Security Administration uses work credits to determine whether an individual qualifies for Social Security Disability benefits. An individual may earn a maximum of four work credits a year. Today, a worker must earn $1,320 to earn one work credit. As an individual gets older the more work credits are needed to qualify for benefits.

If you are unsure about the amount of credits you have earned then it is important to contact a qualified representative. Here at Lawrence & Associates, we are strong advocates for your rights in the Social Security system. We recognize your hard work and efforts and we are here to help you recover your benefits you have worked so hard for.

We offer a free, confidential consultation in order to determine whether you qualify for Social Security Disability. Call today! We’re Working Hard for the Working Class, and we want to help you.

How Can a Local, Cincinnati Attorney Help Get Social Security Disability Approved?

Posted on Thursday, June 28th, 2018 at 11:53 am    

The following post is part of our Law Student Blog Writing Project, and is authored by Jennifer Tressler, who is pursuing her Juris Doctorate at The Ohio State University Moritz College of Law.

Social security disability attorneys can help make an overwhelming process seem much more manageable. While hiring a lawyer specializing in social security disability cases is not required, it will likely be extremely beneficial during a difficult time when your health is suffering. Social security disability attorneys have experience dealing with the Social Security Administration (SSA) and, as such, will be able to handle any of the various issues that could arise during the application process. You can expect your social security disability benefits attorney to review your case with you and ask you a variety of questions, both to gather information on your case and to prepare you for questions you may be asked should a hearing be necessary in the future. Your social security disability attorney will function as the liaison and communicator between you and the SSA. This is just one of the duties that you can expect your social security disability attorney to carry out on your behalf. But it is an important one, as the language and application process of social security disability is complex and often foreign to the average person. At Lawrence & Associates, Kelsey Westermeyer  handles the vast majority of social security claims and consistently achieves high approval ratings.

How Can My Attorney Help Get Approval for SSDI Through the Cincinnati, Ohio or Florence, Kentucky Social Security Offices?

Another one of the duties of your social security disability attorney is to complete an initial review of your case. This will happen no matter at which stage of the application process you are. After this initial review, your social security disability attorney will determine the best strategy for you moving forward. He or she will assist you in crafting a compelling story around your case and develop some strategies for how your case will be won.

One of the most common (and significant!) mistakes made by individuals applying for social security disability benefits is filing with an incomplete claim. The majority of applicants for social security disability benefits are denied during the initial stages, mostly due to incomplete applications. Having your social security disability attorney review your application and ensure its completeness is one of the best ways to ensure your application will go undo review in the proper channels.

Your social security disability attorney will collect and sort medical evidence on your behalf. Many social security disability cases are won and lost on medical evidence. After obtaining proper medical release forms, your social security disability attorney will help you gather the relevant medical evidence needed for your application. He or she will review your medical records and work alongside you to collect any missing medical information or tests. Most importantly, he or she will sort through the hundreds of pages of medical documents to determine which information is the most important. Many social security disability attorneys will work directly with your medical provider, physician, or other healthcare provider to gather supportive opinion statements and letters. Having this evidence strengthens your case and makes it more likely that you will be granted social security disability benefits. Additionally, if your social security disability attorney determines that additional testing is necessary to bolster your application, he or she can request a consultative examination from the Social Security Administration doctors or ask that you get the additional testing completed on your own.

Your social security disability attorney is responsible for staying in communication with the Social Security Administration. The Social Security office is enormous and has an immense volume of claims pass through it. The application process of social security disability benefits is complex, filled with multiple deadlines and various formalities that must be adhered to. Your social security disability attorney will communicate directly with the SSA on your behalf, so that you have less to worry about regarding your application and more time to work on your health. Having a middleman communicate with the SSA on your behalf protects your best interests during this already stressful time. Your social security disability attorney will work to push your social security disability benefits application through the system with minimum effort and work from you.

How Can My Attorney Help Represent Me in Front of a Social Security Administrative Law Judge at a Hearing?

If needed, your social security disability attorney will file the necessary appeals for you. According to the Social Security Administration, less than forty percent of social security disability applications are approved at the initial application level. If your case is one that receives an initial denial, you are entitled to appeal the decision. The appeals process contains several specific and distinct steps that much each be completed within a certain amount of time. Hiring and retaining a social security disability attorney can help you navigate the appeals process, should your initial application be denied. To that end, your social security disability attorney will represent you at disability hearings, if necessary. The majority of successful disability claims are won at the hearing level. If you are originally denied disability benefits and you and your attorney appeal the decision, you are offered a hearing in front of an administrative law judge.

The hearing process is stressful, and having adequate preparation is critical to your success. Having a social security disability attorney will ensure that you are adequately prepared for your hearing. Though you will still need to speak for yourself, your social security disability attorney will represent you during the process and prepare you to testify. Your social security disability attorney will ask questions of your witnesses and address any expert witnesses, such as medical or vocational experts. If you have already been granted social security disability benefits but feel that you are not receiving adequate compensation, your social security disability attorney can help you request additional financial aid in the form of SSI benefits.

Your chances of success when applying for social security disability benefits dramatically improve if you are working with a social security disability attorney. Even if you are struggling financially due to your illness, hiring and working with a social security disability benefits attorney is well worth your time, energy, and money when you consider that without their help, winning your case can be exponentially more difficult. If you are overwhelmed by the social security disability benefits application process and would like some assistance from qualified, experienced individuals, contact Lawrence & Associates today. We can help you obtain that fresh start that you deserve! Call today for a free consultation at (859) 371.5997. We’re Working Hard for the Working Class, and we want to help you!

Social Security Disability: Five FAQs and Facts

Posted on Tuesday, June 19th, 2018 at 2:59 pm    

Enduring the process of applying for Social Security Benefits can be extremely stressful to any person. Fortunately, we are here to help ease your mind and speed up the process. In this blog, we are going to cover five frequently asked questions and other facts about Social Security Disability Income.

ONE: What Conditions Qualify for Disability Benefits?

One of the most common questions we hear when talking to social security disability candidates is this: “What disabilities qualify for benefits?” One way that the Social Security Administration answers that question is by using a Listing of Impairments (Part A) also known as the “Blue Book.” The Blue Book has several categories and is then broken down to sub categories.

The main categories for adults are listed below:

  • Musculoskeletal System
  • Special Senses and Speech
  • Respiratory Disorders
  • Cardiovascular System
  • Digestive System
  • Genitourinary Disorders
  • Hematological Disorders
  • Skin Disorders
  • Endocrine Disorders
  • Congenital Disorders that Affect Multiple Body Systems
  • Neurological Disorders
  • Mental Disorders
  • Cancer (Malignant Neoplastic Diseases)
  • Immune System Disorders

The Blue Book also has a Listing of Impairments for Children (Part B). The children’s Listing of Impairments is broken down into main categories and sub categories as well.

The main categories for children are listed below:

  • Low Birth Weight and Failure to Thrive
  • Musculoskeletal System
  • Special Senses and Speech
  • Respiratory Disorders
  • Cardiovascular System
  • Digestive System
  • Genitourinary Disorders
  • Hematological Disorders
  • Skin Disorders
  • Endocrine Disorders
  • Congenital Disorders that Affect Multiple Body Systems
  • Neurological Disorders
  • Mental Disorders
  • Cancer (Malignant Neoplastic Diseases)
  • Immune System Disorders

The Social Security Administration describes the Listing of Impairments as: “Impairments considered severe enough to prevent an individual from doing any gainful activity (or in the case of children under age 18 applying for SSI, severe enough to cause marked and severe functional limitations).”

TWO: My Disability is listed in the Blue Book. Do I Still Need an Attorney?

You may have a disability that is displayed on the Listing of Impairments, but may not be seen as “severe enough” by the SSA to fulfill eligibility requirements. Your disability must then be proved “severe enough” to qualify.

Even if your disability is listed, your benefits are not automatic. By hiring an experienced Social Security Attorney, you are letting go of the reins and letting a professional take over. So many people have had applications denied because of mistakes on their applications. Don’t let this happen to you.

THREE: My Doctor Says I am Disabled. Why do I Keep Getting Denied by the SSA?

The SSA may have denied you for medical reasons. In order to prove you have an impairment that is found in the Blue Book, you will need to obtain proper medical evidence that supports what you have claimed to be disabled for. Your attorney can obtain this medical evidence by requesting medical records, reports and more from your doctor(s).

FOUR: What is the Importance of My Attorney Getting Medical Records for My Case?

Claims for Disability benefits are approved or denied based on medical evidence. Medical records establish the severity of your impairment and helps the SSA understand your disability.

According to The Code of Federal Regulations, medical evidence that can be used or submitted with your claim include:

    • Objective Medical Evidence
      • Medical Signs
      • Laboratory Findings
    • Medical Opinion
      • This can be a report from your doctor stating things that you CAN do, despite your impairment.
    • Other Medical Evidence
      • Medical History
      • Clinical Findings
      • Diagnosis and more

If your application lacks these key evidence types, your claim could be denied. An attorney can request these medical records for your claim and help your claim get approved.

FIVE: Can I Work While Getting Disability Benefits?

SSDI recipients generally can’t do Substantial Gainful Activity (SGA) while receiving full benefits. The SSA describes SGA as “A term used to describe a level of work activity and earnings. Work is “substantial” if it involves doing significant physical or mental activities or a combination of both.” They describe “Gainful” Work activity as “Work performed for pay or profit, work of a nature generally performed for pay or profit, or work intended for profit, whether or not a profit is realized.” Your eligibility for SSDI benefits depends on whether or not you are able to do SGA.

SGA has two parts. Hours worked and income earned. If you work more than 20 hours per week that is SGA and will cause you to be ineligible to received benefits. According to the SSA the income portion of SGA for 2018 “for statutorily blind individuals for 2018 is $1970. For non-blind individuals, the monthly SGA amount for 2018 is $1180. SGA for the blind does not apply to Supplemental Security Income (SSI) benefits, while SGA for the non-blind disabled applies to Social Security and SSI benefits.” In other words, if you are a non-blind individual, you can make up to $1,180 per month while receiving benefits and for blind individuals, you can receive up to $1,970 per month while receiving benefits. According to the history of SGA amounts, they have slightly increased almost every year since 1975. This is because the amounts change based on the National Average Wage Index.

If you are concerned about your application to the Social Security Administration for SSI or SSDI, call Lawrence & Associates to talk to one of our trained intake specialists about setting up a completely free consultation to talk to one of our Social Security Attorneys. Lawrence & Associates will be with you every step of the way and will help you fight for your benefits. We practice Social Security in the states of Ohio and Kentucky.

Call us today to find out how we can help you now!

Warnings to Injured Workers in the Ohio Workers’ Compensation System

Posted on Monday, June 11th, 2018 at 11:31 am    

Compensation: When most people hear the word “compensation” they think of monetary recovery. While there is monetary recovery involved in Ohio Worker’s Compensation, it is only one of several benefits available to injured workers. In fact, Ohio Workers’ Compensation provides many forms of recovery that are valuable, but do not come in the form of a check or monetary award. These valuable benefits are unique to Workers’ Compensation and are often times not available in civil lawsuits. However, these added benefits do come as somewhat of a “tradeoff” as some of the monetary recovery received via the Ohio Bureau of Worker’s Compensation is smaller in amount or may seem less significant at first glance when compared to the monetary recovery that can be common in civil litigation. This blog discusses some of the unique aspects of the Ohio Worker’s Compensation system; pointing out both the positives and the negatives for injured workers as compared to more typical civil litigation lawsuits.

In order to receive any Ohio Workers’ Compensation benefits, monetary or otherwise, a claim must first be allowed by the Ohio Bureau of Workers’ Compensation. Before wasting your time, energy, and resources spinning your wheels to see if your claim is allowed you will want to consult with an attorney who specializes in Ohio Workers’ Compensation. What they tell you may surprise you. For example – did you know that Ohio is a “no fault” state? This means that no showing of breach of duty on the part of the employer is required for the allowance of a claim. Unlike commonplace civil litigation the defendant need not do anything wrong, careless, or negligent. If an employee is hurt in the course of, and arising out of, the injured employee’s employment they are covered! The actions the employer took, or failed to take to prevent such an accident are most times irrelevant.

While this no fault system may lead an injured worker to believe it is easy to get their claim allowed and compensation awarded, there are many other hurtles the injured worker may be unaware of that will cause their claim to be denied if not handled correctly. For example, if an employee legitimately gets hurt at work, but hurts a part of their body that has been hurt previously, or may not be perfect to begin with due to the natural aging process, the allowance of such claim may be fought by several other parties at several levels on the basis that it was a preexisting condition. Another situation in which it is nearly impossible to get a claim allowed is for a psychological condition. While Ohio does recognize psychological conditions in certain situations, there are particular procedures and requirements which must be met to receive benefits for psychological injuries. Another quite common scenario is for a claim to be initially allowed for a very minor injury, such as a sprain or strain, but then to not be recognized for the true, but more expensive condition suffered such as radiculopathy or torn muscles and ligaments which will require surgery. Only an experienced Ohio Worker’s Compensation attorney can help overcome these common obstacles in receiving the benefits an Injured Worker may be entitled to.

Where’s the money?

Generally speaking there is a lot less monetary compensation paid to plaintiffs in Ohio Workers’ Compensation than would be recovered for the exact same injury in a Personal Injury lawsuit. The reason for this is twofold: First, there are benefits for plaintiffs hurt at the work place that are not available to plaintiffs in Personal Injury lawsuits; these benefits will be spelled out later on in this blog article. Secondly, as a counter balance to some of those benefits to the injured worker, there are no punitive damages (in other words no pain and suffering) imposed on the employers of a Workers’ Compensation claim, unless there is a special circumstance known as a VSSR.

So, now that we’ve established that plaintiffs tend to recover significantly less money through Workers’ Compensation as compared to other civil litigation, let’s talk about how much money is involved and when an injured worker can expect to receive it. There are usually two situations in which an injured worker can expect to receive monetary compensation in a typical Ohio Workers’ Compensation Claim. The first is known as Temporary Total Disability, or TTD for short. An Injured Worker becomes eligible for TTD when they miss eight or more consecutive days of work and a Doctor has taken them off of work via a form called a MEDCO14. Therefore, plaintiffs who have missed less than eight consecutive days or do not have a MEDCO14 completely filled out and clearly stating that they have work restrictions that prevent them from returning to work will not be eligible for TTD. This is one reason why it pays to have an attorney in your corner. Oftentimes Doctors who are unfamiliar with such required forms will fail to fill them out or fill these forms out riddled with errors. These mistakes can cost injured workers thousands of dollars in TTD, so you will want someone who is familiar with these requirements to advocate on your behalf to your doctor.

The next question you may have is, “how much TTD can I expect to get?”

This number is calculated by statute and is dependent on the wage you were earning prior to your workplace injury. This calculation is set out by the Ohio Revised Code and can be complex and confusing to understand. Therefore it is important to consult with an attorney to ensure you are not being shortchanged on the TTD you receive. One aspect of this type of wage loss recovery that differs from its civil litigation counterparts is that TTD is capped every year by state statute. For example, injured workers receiving TTD in 2018, can receive no more than 902 dollars per week, regardless of what they were earning prior to their injury.

The second major situation an injured worker is typically eligible for monetary compensation is much later on in their claim when they have been determined by a doctor to have reached Maximum Medical Improvement, or MMI. MMI is defined by Ohio statute as “a treatment plateau (static or well-stabilized) at which no fundamental functional or physiological change can be expected within reasonable medical probability in spite of continuing medical or rehabilitative procedures.” However, reaching MMI does not necessarily mean the injured worker is %100 recovered. Again the monetary compensation is set out by the Ohio Revised Code, which provides a calculation that is based on the Permanent Partial Disability the injured worker has sustained. By way of example, if an injured worker reaches MMI, but is determined to only be 90% recovered, their compensation will be based on the remaining 10% Permanent Partial Disability. Much like TTD, this calculation is confusing and the process for obtaining this award is complex. This is another component of Workers’ Compensation in which an attorney who specializes in Ohio Workers’ Compensation will add tremendous value to your claim.

Other possible, but far less common Workers’ Compensation monetary benefits can include: working wage loss, VSSR, death benefits, and living maintenance. Only an attorney with experience in Ohio Workers’ Compensation will be able to identify if these special benefits are entitled to a particular injury or claim.

Other than monetary compensation, Ohio Workers’ Compensation provides injured workers with medical treatment and rehabilitation that can often times far outweigh the value of compensation paid via TTD and Permanent Partial Disability. The Ohio Workers’ Compensation system is designed to enable Injured Workers to be treated and get back to work as soon as possible. Therefore if an injury or disease is determined to be work related, treatment for such aliment is covered through the Workers’ Compensation System. Such treatment can include, but is not limited to surgeries, diagnostic tests such as MRIs and x-rays, physical therapy, chiropractic treatment, and pain management. However, for this valuable treatment to be covered through your Workers’ Compensation claim, the treatment must be deemed reasonable and necessary to treat a condition that has been formally allowed in the claim. Again, getting both conditions and treatments allowed is confusing and time consuming. If a condition or treatment is denied an injured worker may only have a short amount of time to figure out how to appeal it. This is when an attorney with Ohio Workers’ Compensation experience can make a remarkable difference in your claim.

Due to the fact that so many of these benefits are received by the injured worker before the end of their claim, the payout at the end in the form of Permanent Partial Disability, is much less than what would be recovered for the same injury in civil litigation. In other words, if a person were to recover for an accident through a personal injury lawsuit, that person would have to front all of their own medical treatment, and come up with income during time missed from work, then at the end of their treatment they would recover all of the money spent on medical bills, lost on missed wages, and even be compensated for their pain and suffering. In Ohio Workers’ Compensation however, the Injured Worker will be receiving most of these benefits as they work through the claim, and because the Ohio Workers’ Compensation system is set up to get workers back to work rather than to punish employers the monetary sum at the end will almost always be quite less than the same injury would result in through a Personal Injury claim.

Many injured workers are surprised to find out that even after reaching MMI and getting a Permanent Partial Disability award, there may be further benefits an injured worker is entitled to, that only an attorney with Ohio Workers’ Compensation experience will be able to identify. These can include maintenance treatment, vocational rehabilitation, and even future increases in Permanent Partial Disability.

So the next question you might be asking yourself is, “Yes I can see that having an attorney who understands the complexities of the Ohio Workers’ Compensation system is important. But I am out of work and how am I supposed to pay an attorney?”

The good news is that most Workers’ Compensation Attorneys work on a contingency basis. Meaning, the attorney only gets paid a percentage of money they recover for you. Therefore, just as most injured workers are eligible for monetary awards twice during their claim, so also attorneys get paid for their work most commonly at these two junctures as well: when back due TTD is awarded, and at the resolution of the case upon reaching MMI. “What about when my attorney wins additional conditions, diagnostic tests, or treatment for me?” You might ask. Most attorneys will only charge a very small and nominal fee for this type of service if that attorney feels that the Injured Worker is not likely eligible for any of the monetary compensation to which they would collect a typical fee for. If the attorney is certain that there is lost time at issue in the claim, or a Permanent Partial Disability has been suffered by the injured worker, any work done to get treatment allowed will be done at no additional charge.

Last, but certainly not least are some time frames that injured workers should be well aware of. The first is that of a short 14 day appeal deadline. Oftentimes when an aspect of a claim, or a claim in its entirety is not allowed an Injured Worker may have only 14 days to appeal such a decision. Additionally, disputes over the allowance of benefits necessitate Injured Workers to appear at various hearings and medical exams on quite little notice. Thus, an injured worker does not want to delay in getting an attorney. In order to make sure you have representation at such hearings, and to ensure you do not miss appeal deadlines, it is in your own best interest to retain an attorney as early as possible.

In sum, Ohio Workers’ Compensation is a complex area of the law. Attorneys and non-attorneys alike may has some understanding of what to expect in a run of the mill civil lawsuit, but these understandings and expectations cannot be applied in the same way to Ohio Workers’ Compensation claims. Before you find yourself in over your head, or facing a deadline that you do not understand come in for a free consultation with one of our attorneys who specializes in Ohio Workers’ Compensation.

The Personal Injury of Never Playing Again: Damages for Athletes in Southern Ohio and Northern Kentucky

Posted on Tuesday, June 5th, 2018 at 8:32 am    

The following article was written by William Doering, a former law clerk at Lawrence and Associates. Doering is currently a student at Chase Law and pursuing a Juris Doctorate.

Personal injury cases happen all the time. Most are run-of-the-mill in terms liability and damages. However, there are always extraneous circumstances where damages can be more complex. Each individual plaintiff will require a different amount and type of damages depending on the facts of the accident and the plaintiff’s life circumstances. After accidents, plaintiffs are concerned with being able to do the activities that they were able to do before the accident. Plaintiffs who are no longer able to do certain activities following a personal injury accident may be compensated for that loss. For many, playing sports is an activity that plaintiffs lose the ability to do after an accident.

Suppose for instance that you are an athlete who has just been in a motor vehicle accident. The injury caused by the negligent third party has left you unable to play your respective sport. Damages are proper to help pay for the value of your damaged vehicle, your medical bills, and future treatment. However, you also have the ability to claim damages for being unable to play sports in the form of loss of enjoyment of life. We’ve previously written about damages on several occasions. This blog will describe the basics of personal injury damages, explain the purpose and function of loss of enjoyment of life damages, then describe damages for pro and semi-pro sports players, and discuss how to claim these damages in a tort lawsuit in both Kentucky and Ohio.

What Kinds of Damages Are Allowed in Kentucky and Ohio?

In all successful tort claims, plaintiffs will be able to claim compensatory damages. These can be either general damages or special damages. The American Jurisprudence defines general damages as “those that are the natural and necessary result of the wrongful act or omission asserted” in the complaint. These damages compensate the plaintiff for any loss, injury, or damage such as property damage or medical bills resulting from an accident. Special damages, sometimes called hedonic damages, are another form of compensatory damages. These damages encompass “damages for a harm other than one for which general damages were given.” Special damages can include expenses like loss of enjoyment of life, loss of consortium, pain and suffering, lost wages, mileage, or lost profits.

When claiming special damages, plaintiff must show that they received a great deal of bodily harm; past what general damages can cover. Special damages are calculated separately from one another depending on the jurisdiction; i.e. loss of enjoyment of life will be judged as a separate and distinct category of damages from pain and suffering. Kentucky does not recognize loss of enjoyment damages as a separate claim. However, loss of enjoyment damages may be considered as evidence in determining the severity of injuries, general damages, or pain and suffering. In limited circumstances, Ohio does see loss of enjoyment damages as a separate claim. The reasoning is that Ohio courts see loss of enjoyment damages as a loss of positive experiences rather than an infliction of negative experiences. In calculating loss of enjoyment damages, Ohio limits recovery to circumstances of the injury that were not already addressed in the general damages. This ensures that there are no excess damages awarded to the plaintiff.

What Special Damages Do Kentucky and Ohio Allow Professional Athletes to Claim?

Claiming damages for inability to enjoy sports requires a showing that the harm suffered resulted in a “loss of ability to engage in sports or recreational activities, … loss of a desired vocation or avocation, loss of use of a limb, … or miscellaneous losses” as the court deems fit. A plaintiff must have “developed the ability to perform a pleasurable activity or hobby specifically identified to his or her lifestyle.” There must be an adequate showing that the plaintiff regularly participated in and enjoyed the activities which they can no longer do because of the injury suffered.

If the plaintiff is an athlete with potential to play college, semi-professional, or professional sports, that factor is taken into consideration. However, this type of predictive futures damage is harder to prove. Courts err on the side of caution before awarding these damages because they must be a precise as possible. Not every person injured in a car accident will make it to the pros. Thus, not all plaintiffs should be able to claim these extra damages for potential lost financial damages. Courts will only rule in favor of extra damages in this manner if an athlete was already playing sports at a higher level or if they were certain to play them and have some form of monetary gain from playing them in the near future.

Loss of enjoyment damages are real damages that can be claimed from a personal injury accident. Courts in Kentucky and Ohio allow for them to be claimed following an injury; they are just argued differently. If you have been injured due to someone else’s negligence and can no longer enjoy playing sports, you can be compensated for this loss of enjoyment. Make sure to talk to a legal professional about your options if you think you can claim these damages. The legal system may not get you back to playing sports again but it can fairly compensate you for the loss of those positive experiences in life.

Are you a pro or semi-pro athlete that has been injured in an automobile accident or as a result of someone else’s negligence? Don’t go it alone! Lawrence & Associates has helped thousands of people recover for their injuries, and we know how to fully recover for your damages. We’re Working Hard for the Working Class, and we want to help you!

Why You Shouldn’t Feel Bad for Filing a Personal Injury Lawsuit

Posted on Thursday, May 31st, 2018 at 8:28 am    

At the time I’m writing this, I’ve been in practice for over 13 years, and I’ve filed thousands of personal injury lawsuits in Ohio and Kentucky for everything from car accidents and slip-and-falls to products liability and boating accidents. I’m proud of what I do. I get a lot of injured people medical treatment that they’d never have gotten otherwise. I help widows keep their homes. I help hard working men and women get the money to pay back the debts they incur while they’re off work and recuperating from surgeries. But no matter whether I’m in Kentucky or Ohio, no matter who is across the desk from me at a consultation, there is one comment I hear more than any other: “I’m not the kind of person that normally sues people.”

This comment never fails to amaze me. There isn’t a kind of person that sues people. Personal injury lawyers don’t get repeat customers. On the rare occasion that I have seen the same person back in my office, I don’t think I’ve ever seen more than two lawsuits. But more than that, “I’m not the kind of person that normally sues people” speaks to a kind of shame associated with the civil justice system. 
“I’m not the kind of person that normally sues people” means that nearly everyone who walks into my office thinks only bad people sue other people. We all know that doesn’t hold water. We’ve all driven past accidents where the ambulance is already removing a driver that was rear ended or t-boned; do we really believe the guy in the ambulance is a bad person for suing the one who put him there?

But really, the ridiculousness of “I’m not the kind of person that normally sues people” goes deeper than that. There are a lot of reasons that lawsuits are good things, so long as they are handled by good lawyers. That so many people don’t understand that speaks to a long history of disinformation about the civil justice system, including things like the myth of the McDonald’s Hot Coffee and a series of widely believed email forwards from the early 1990s. When you set aside falsehoods and think about it, there are many reasons you should file a personal injury lawsuit if someone else hurts you.

It’s Your Constitutional Right, and It’s Better Than Any Alternatives

Today, many politically minded people swear by the founding fathers. The original meaning behind the Constitution, both federal and state, is the cornerstone of Libertarian and most Conservative political theories, and in the Greater Cincinnati area where I practice, a large percentage of registered voters identify as Libertarian, Republican, or Conservative. On top of that, in this area it is typically Democratic elected representatives that are the staunchest defenders of the jury trial system. With that in mind, it is worth remembering that the Seventh Amendment in the Bill of Rights to our federal Constitution states:

“In Suits at common law, where the value in controversy shall exceed twenty dollars, the right of trial by jury shall be preserved, and no fact tried by a jury, shall be otherwise re-examined in any Court of the United States, than according to the rules of the common law.”

Section Seven of Kentucky’s Constitution goes further, saying:

“The ancient mode of trial by jury shall be held sacred, and the right thereof remain inviolate, subject to such modifications as may be authorized by this Constitution.”

Section Five of the Ohio Constitution states:

“The right of trial by jury shall be inviolate, except that, in civil cases, laws may be passed to authorize the rendering of a verdict by the concurrence of not less than three-fourths of the jury.”

There is a reason the founding fathers of every state, and of the federal government, made sure to enshrine the jury trial system: it provides for a peaceful resolution of conflicts while making sure the wrongdoer – the one that hurts, the one that takes, the one that breaks – is brought to justice. Prior to the jury trial system, it was common for people to fight duels, or for might to make right. Today, lawsuits are common and duels don’t exist. No one dies over defamation, or for being an inattentive driver. And no one should get away with it either. The beauty of the lawsuit is that it brings peaceful justice for men and women that have been wronged. Without it, we’d be back to the kind of 18th century justice our forefathers fought to prevent.

Everyone Is Insured (and If They Aren’t They’re Breaking the Law)

That was all well and good for the 1700s, you might say, but does it really apply today? Yes, and even more so than it did when the Constitution was written. Back then, a defendant losing a lawsuit might have to pay a princely sum of money; maybe enough to have to mortgage the family farm, or lose a business. Today, that fear doesn’t apply because almost everyone and everything is insured.

The most familiar form of insurance is auto insurance, which all Americans are required by law to get, but it isn’t the only kind. There is property insurance, general liability insurance, homeowner’s policies, farmowner’s policies, malpractice insurance, umbrella policies; you name it, and the insurance industry already thought of it thirty years ago. All those insurance policies not only mean that no one has to sell their house because they lost a lawsuit, but they also change the very nature of filing a lawsuit.

Let’s take automobile insurance as an example. An insurance policy is a contract. The insurance company says they will cover a driver for a specific amount of money if he or she causes an accident, and in exchange they want a certain amount each month as a premium. Let’s say that driver pays the premiums, and a few months down the line, rear ends you while you’re driving your car. You’re taken away by ambulance, and later file a lawsuit to cover your medical bills and the wages you missed while being off work.

When you file that lawsuit, you aren’t saying you want the other driver to pay you. You’re saying you want the insurance company to honor its contract. The money doesn’t come from the other driver’s pocket. It comes from the insurance company. The insurance company took the premiums, and they are supposed to pay for the damages. The lawsuit only happens if they don’t honor their contractual obligations. Feeling guilty for forcing an automobile insurance company to honor its contractual obligations makes no more sense that feeling guiling for forcing your health insurance company to pay for medical bills.

Lawsuits Help Your Doctor and Health Insurance Company Get Paid, Too

It’s worth bringing up another common myth about lawsuits: the money doesn’t really all go to the injured person. Yes, they take some home and yes, the attorney gets paid. But most people don’t realize that doctors often receive money as a result of a successful Workers’ Compensation lawsuit by an injured person against an insurance company. Also, every successful lawsuit against an automobile insurance company like Statefarm means a health insurance company like Humana gets reimbursed for the bills they paid. The logic is simple: one person or company caused the harm, and that person or company should pay for the harm. A doctor should not bear the burden of medical bills that cannot be paid, any more than the injured man or woman should bear the burden of being unable to put food on the table while they recover from surgery. A lawsuit against someone that is liable for negligence helps many people, not just the person hurt by the negligence.

Lawsuits Make Everyone Safer

We’ve all seen warnings that you can’t believe had to be printed, like a ridiculous commercial that tells you not try some obviously stupid act at home. It’s all the lawsuits, people think, that made that dumb warning appear. This is a part of the myth of the lawsuit too – do a little research and you’ll usually find that no one ever tried to sue over whatever dumb warning you saw. Generally, they are a part of an overabundance of caution on the part of companies that never bothered to ask a lawyer if they could be sued in the first place.

But some warnings do appear because of lawsuits. Like the warning that cigarettes can cause cancer, or that taking too much Tylenol can be fatal. Lawsuits also brought us the fire escape, the seatbelt, and the safety stop on saw blades. When used properly, the lawsuit is a force for good and drives the creation of new technology and new processes that make all Americans safer for decades to come.

It isn’t that there aren’t bad lawsuits. There are. Sometimes unhappy people file lawsuits on their own without a lawyer, which is generally a recipe for disaster. Sometimes bad lawyers with bad goals file bad lawsuits. But those lawsuits are the rare headline grabbers that cast a shadow on the good lawsuits, good lawyers, and good people who have been hurt through no fault of their own. If you have been hurt, and know someone else is at fault, don’t let the myth of the bad lawsuit cause you to deny yourself your right of recovery. If you’re a good person, get a good lawyer and get the justice you deserve.

If you have any other questions about Personal Injury or Workers’ Compensation lawsuits, please call our Fort Mitchell, Kentucky office at 859-371-5997 or our West Chester, Ohio office at 513-351-5997. We have helped over 3,000 clients and help a new, deserving person every day. We’re Working Hard for the Working Class, and we want to help you!

Why Is a Treating Doctor an Important Part of a Worker’s Compensation Case?

Posted on Tuesday, May 22nd, 2018 at 12:39 pm    

When a worker gets injured at work, they aren’t thinking about which doctor to go to. They are hurt and want medical attention and that’s about as far as the thought process goes. In contrast, the insurance company has already given the subject a lot of thought. Often insurance companies have pre-selected the doctor’s office they want an injured worker to treat with. While their medical treatment is not controlled by the insurance company directly, these offices are in long-standing relationships with the workers’ compensation carrier.

Under Kentucky workers’ compensation law, medical treatment is controlled by a “designated physician” this is a doctor the injured worker selects on what is known as a “Form 113”. Sometimes an insurance company will fill in the Form 113 with a physician’s office of their choosing. However, the injured worker has the right to pick their own doctor.

The selection of a Form 113 doctor is crucially important. This doctor is the “quarterback” of the injured worker’s medical team. They are the physician who calls the medical plays, so to speak. This doctor determines whether a referral to a specialist is necessary, and they often make a recommendation as to which specialist to see. This in turn determines whether an injured worker gets diagnostic testing such as MRIs and whether the injured worker gets surgical care.

For the selected doctor, the decision on medical care is actually twofold, not only are they determining whether they think there is a medical need for treatment, they are deciding whether or not the treatment is work-related. For example, let’s say you twisted your knee at work. If your doctor is of the mindset that you need surgery now but consider that part of that surgery is to treat an arthritic condition, they might determine that you cannot have the surgery under workers’ compensation coverage. This might be the case even though you 1) got hurt at work, 2) there were witnesses 3) you had never once received any kind of medical care for arthritis or for your knees in your entire life!

When a doctor makes this decision they are not necessarily following the law. In Kentucky it is well-established that if a worker has some kind of condition that pre-existed the work injury, but was dormant i.e. it never bothered them before the work injury so they weren’t under medical care for it and then the condition becomes problematic after the work injury then both the work injury itself AND the prior dormant condition can be treated under the workers compensation carrier coverage. If the injured worker is off work while this treatment is undertaken, they may qualify for income benefits.

This makes the doctor’s decision very important. If a doctor does not agree with the law, say, due to their political stance, or if the doctor simply is unaware of the law, the treatment and income benefits the injured worker is entitled to may get denied. As you can see, it is extremely important that an injured worker gets a treating physician that either already has an understanding of the legal ramifications of the decisions they make or is at least willing to listen and learn. Sadly, not all doctors are.

An understanding of the workers’ compensation system is not the only requirement for the right treating physician. An insurance company is in business to make money. They do not make money by paying for medical care or paying an injured worker income benefits. Therefore, they will do things to try and minimize the amount they pay out. One of the things the insurance company will do is challenge the medical treatment through a process called utilization review, or peer review. In these scenarios the insurance company has hired a doctor, or often a nurse, to review the records to see if they believe the injured worker should get the medical care their doctor asked for. The reviewer will not see the patient, not even once, they will often refer to what are called the Official Disability Guidelines, and commonly they will determine that the treatment is not compensable. In the denial they will often state that they attempted to call the treating doctor but could not get through. The treating doctor has the right to appeal the decision of the reviewer, but they have a limited amount of time. It is very important that the injured worker has a doctor who is willing to answer the call and to respond to the denial when it comes. If the doctor simply doesn’t bother, the injured worker may have to litigate just to get their medical care, and this can take months. If the injured worker gives up, then the insurance company saves a bunch of money.

The treating doctor has an important role to play in the amount of income benefits an injured worker receives. This is because these benefits are calculated using an impairment rating provided by the physician. Many times, a hired expert will give an opinion on the percentage of impairment, and a good attorney will know which experts to use. However, the Administrative Law Judges often consider the view of the treating physician to be very significant. If your treating doctor is unwilling to figure out your impairment, or if they are unfamiliar with the process, they will not be assisting your case.

The treating doctor will be the one who assesses work restrictions, in other words they determine whether an injured worker can go back to work. Often the insurance company will employ a nurse case manager who will question the doctor on this issue. The injured worker will want a physician that is willing and able to justify their decision on work restrictions under this kind of challenge.

At Lawrence & Associates we describe the physicians that do these things as “patient advocates”. While proper medical care is essential, patient advocacy is always very important too.

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