Wednesday, May 30, 2012

Workers Compensation & SSD

I represent a 55 year old trucker with back problems whose application for Social Security Disability (“SSD”) benefits was approved today without a hearing based on a request for a fully favorable decision on the record (“OTR”) that I filed. The claimant had also applied for workers compensation (“WC”) benefits, and that affected his SSD claim in two ways.

The State agency had denied the claimant’s SSD application based on the one time consultative exam by a WC doctor named John Waller. The OTR discussed how the case law holds that where the WC insurer paid a doctor, like Waller, to examine the claimant, and it had a vested interest in minimizing the claimant’s impairments. The OTR also pointed out that even some of Waller's own patients do not approve of his services:

terrible doctor. didn't pay attention to my condition.
didn't send a diagnosis to my primary doctor, no
improvement in my condition. somewhat condescending.

More importantly, I highlighted that even the WC Board had rejected Waller’s report, and continues to pay benefits to the claimant. Social security agreed with the arguments in the OTR, and gave greater weight to the opinion of the claimant’s orthopedist.

The other way that the WC application may affect the claimant’s SSD benefits is that it could result in an offset. The Social Security regulations provide that a claimant’s SSD benefits might be reduced if other disability benefits are received, including WC. In general, SSD and WC benefits together cannot exceed 80% of the claimant’s predisability income.

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