One benefit you may be able to obtain without penalty when you are waiting for your workers' compensation case to reach conference is Social Security Disability or SSI. This is a Federal program with its own forms, rules and standards of what is disability and if you are covered for Social Security Disability or Supplemental Security Income, (SSDI or SSI). With regard to Social Security Disability, the employee must be or has been disabled for a period of 12 months, and the employee has to have sufficient quarters of coverage to qualify. That is roughly 5 years.
I usually ask my clients to apply in person with the Social Security Administration and follow up with an appearance letter to Social Security. The Social Security Administration would check the quarters the claimant has in the system whether he or she meets eligibility standards. Requests to the medical providers and the clients treating doctors should then be made. There should be no charge from medical providers for records with regard to Social Security claims. After the client receives denial you have 60 days to file for Reconsideration. After you get that denial you put in a request to have a hearing with an Administrative Judge. Most cases are tried and approved at the hearing level. If you do get your client on benefits remember that there is a set of with workers' compensation so the employee cannot earn more than 80% of the pre-injury average weekly wage.
With regard to compensation benefits, Social Security operates in a different sphere, Benefits under Social Security can be awarded not just for your clients work injury but for any and all other conditions, both physical and mental, which render your client disabled. However, in some circumstances, the Social Security Award may serve as evidence. The administrative judge may determine what significance, if any, attaches to a Social Security decision, Yuksel v. Davidson Chevrolet, 9 Mass. Workers' Comp. Rep. 757(1995). In that case, the Reviewing Board ruled that: "Social Security awards may serve as evidence, even though findings from those proceedings are based on different standards and criteria and have no binding effect in this forum." Id. 758
Often, the reason cited for the employee's disability in the Social Security decision was the same work injury in the workers' compensation matter, the award by the Social Security Administration should be admitted into evidence as a prior administrative decision, and the judge would then be allowed to decide what weight to give it. However, no res judicata attaches to the Social Security decision. Res judicata only applies when the same parties, same claims, and same law as the prior adjudication applies. The award of social security disability benefits has no conclusive effect in a proceeding under the Massachusetts Workers' Compensation.
Law Office Of James K. Brownell
Meet At Your Home Or My Office
875 Massachusetts Avenue
Cambridge, MA 02139
(617) 669-2345 • 24 Hour
(617) 864-8055 • Office
All Regions • All Locations