Workers’ Compensation & Disability

Workers’ Compensation and SSDI & SSI: Social Security Disability

Binghamton Area Workers’ Compensation and SSDI & SSI Disability Attorneys

Coughlin & Gerhart is a dedicated legal ally for workers throughout New York’s Southern Tier and Northern Pennsylvania. With a team of highly experienced attorneys, paralegals, and administrative staff, we have the resources – and compassion – to make a disability or the time following a workplace accident as manageable as possible for you or a loved one. Our firm’s attorneys are highly experienced in these following areas:

  • Workers’ Compensation
  • SSDI (Social Security Disability Insurance)
  • SSI (Supplemental Security Income)
  • Long-Term Disability
  • Related Applications & Appeals

Guiding You to the Benefits You Deserve

By ensuring that our clients have comprehensive documentation of their injuries – including incident reports, medical examinations & records, and other evidence – our attorneys work diligently to help them obtain or maintain their benefits for lost wages and temporary or permanent disability. As experienced trial lawyers, our attorneys also have significant experience representing clients whose claims must be appealed.

Workers’ Compensation

At Coughlin & Gerhart, we believe that workers deserve to do their jobs in safety. When people in New York State and Pennsylvania are injured on the job -regardless of the cause- they should not have to face undue difficulty to receive the workers’ compensation benefits designed to shield them from financial hardship.

Our attorneys are experienced helping people navigate both the New York State Workers’ Compensation Board (WCB) and the Pennsylvania Bureau of Workers’ Compensation. Although workers’ compensation systems are “no-fault” programs (meaning workers can generally receive benefits regardless of what caused an accident), obtaining benefits can often require the assistance of a lawyer.

Whether you were just injured at work, are wondering how to get reimbursement for your medical expenses, or have been notified that you will no longer receive wage-loss benefits, our firm can help you. Feel free to call our main office in Binghamton at (607) 722-6423, toll free 800-646-3420, or send an email.

SSDI & SSI: Social Security Disability Insurance & Supplemental Security Income

Learn if You or a Loved One May Be Eligible

Our attorneys also assist clients in applying for and obtaining federal Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). These benefits are administered by the federal Social Security Administration (SSA), which maintains a separate application and appeals process. Our attorneys are highly experienced in all aspects of Social Security disability claims, including representing claimants before the Office of Disability Adjudication and Review (ODAR), which is responsible for holding hearings before Administrative Law Judges and issuing decisions on behalf of the Social Security Administration in determining whether or not a person may receive benefits.

SSDI benefits are for certain people who are restricted in their ability to hold a job because of a physical or mental disability. You and certain members of your family may be eligible for SSDI benefits if you are “insured,” which means that in the past, you have worked long enough and paid Social Security taxes.

SSI benefits are paid to certain people based on financial need, and are designed to help aged, blind, and disabled people (as defined by the SSA), who have little or no income. SSI benefits are granted to such people to provide them with cash to meet basic needs for food, clothing, and shelter.

In addition, we also assist clients in obtaining and maintaining Long-Term Disability Benefits.

Our attorneys can determine whether you or a loved one may be able to receive these benefits for a disability that hinders the ability to work, or whether you may be able to appeal a previous denial.

Social Security Disability FAQ

Why should I find a Social Security disability lawyer near me?

The Social Security hearing offices we most often deal with are Syracuse, Albany and Wilkes-Barre. We also regularly appear before other Social Security hearing offices including the National Hearing Centers. The lawyers at Coughlin & Gerhart know how to effectively navigate the local offices and are experienced in working with the Administrative Law Judges (ALJs) who handle disability cases in this area.

Hiring a Social Security disability lawyer near you also allows for more personalized guidance and communication. Face-to-face meetings and direct contact with your lawyer enable you to discuss your case in detail, ask questions, and receive personalized advice tailored to your specific circumstances. At Coughlin & Gerhart, we have detailed meetings with our clients either in person, by Zoom, or over the telephone in the weeks leading up to your hearing with an ALJ.  This level of personalized attention can help alleviate any concerns or confusion you may have throughout the process.

When it comes to representing you at a hearing before an administrative law judge, having a local lawyer is advantageous. We are familiar with the local administrative hearing processes, can present your case effectively, and are skilled in cross-examining witnesses if necessary. Our experience and knowledge in handling hearings in your jurisdiction can significantly enhance your chances of success.

How can a Social Security disability lawyer help with my claim?

Expertise in Social Security Disability Law: the Social Security disability lawyers at Coughlin & Gerhart have in-depth knowledge of the rules, regulations, and criteria set forth by the Social Security Administration (SSA). We understand the requirements for proving disability and can guide you through the entire claims process.

Building a Strong Case: The lawyers and support personnel at Coughlin & Gerhart will work closely with you to gather all the necessary medical evidence and documentation to support your disability claim. We know what types of evidence are crucial for establishing a strong case, such as medical records, diagnostic tests, physician statements, and vocational assessments.

Completing and Submitting the Application: The initial application for Social Security disability benefits can be complex and requires accurate and detailed information. Coughlin & Gerhart will help you complete the application accurately, ensuring that all necessary sections are properly filled out. At Coughlin & Gerhart, we review every form that you complete for accuracy before submitting it to the SSA. This helps eliminate problems at your Social Security hearing with an ALJ.

How much does it cost to hire a Social Security disability lawyer?

The Social Security disability lawyers at Coughlin & Gerhart work on a contingency fee basis, which means they only get paid if they successfully win your case. The fee is 25% of the backpay you receive, up to a maximum limit set by the Social Security Administration (SSA). This arrangement allows individuals to obtain legal representation without upfront costs or fees, making it accessible to those who may be facing financial challenges due to their disability.

What happens at a Social Security disability or SSI hearing?

A Social Security disability or Supplemental Security Income (SSI) hearing is a crucial stage in the process of pursuing your disability benefits. It is an administrative hearing where your case is reviewed by an administrative law judge (ALJ) to determine whether you qualify for disability benefits. While the process may seem complex and intimidating, having a skilled lawyer by your side can provide significant advantages and increase your chances of success.

During the hearing, you will be required to appear before the ALJ in a formal setting. Hearings are often held using Microsoft Teams or by telephone. The ALJ will preside over the proceedings and ask you questions about your medical condition, limitations, and how your disability affects your ability to work. The purpose of the hearing is to provide you with an opportunity to present your case and provide additional evidence to support your claim.

The process of presenting your case at a hearing can be complex and daunting, especially if you are unfamiliar with the legal proceedings and the specific rules and regulations governing Social Security disability. This is where having a lawyer becomes crucial. A skilled Social Security disability lawyer will have extensive experience in representing clients at these hearings and will guide you through every step of the process.

The lawyers at Coughlin & Gerhart will prepare you for the hearing by conducting a thorough review of your case, collecting additional evidence, and formulating a strong legal strategy. We will help you gather the necessary medical records, obtain expert opinions, and ensure that all relevant evidence is presented to the ALJ. When we meet in advance of the hearing, we will also help you anticipate the types of questions you may be asked.

During the hearing, we will advocate on your behalf, cross-examine the vocational expert presented by the SSA (this occurs in most cases), and present compelling arguments to support your claim. We will use our knowledge of Social Security disability law and familiarity with the hearing process to effectively present your case and address any legal issues that may arise.

Can a Social Security disability lawyer increase my chances of winning my case?

Yes, hiring a Social Security disability lawyer can significantly increase your chances of winning your case. Numerous studies and statistics support this conclusion, demonstrating the positive impact of legal representation on the outcome of Social Security disability claims.

For example, a study conducted by the Government Accountability Office (GAO) in 2015 found that claimants who had representation at their hearing substantially increased the likelihood of a favorable decision.

Should a Social Security disability lawyer assist with filing the initial application?

When applying for Social Security Disability (SSD) benefits, having an attorney from Coughlin & Gerhart assist you with the initial application is not only a good idea but can be crucial to your chances of success. Navigating the SSD system can be complex, overwhelming, and even intimidating. Here are several reasons why you should consider retaining Coughlin & Gerhart, and understanding these factors may help you make an informed decision that can potentially have a significant impact on your claim.

Complex Application Process: The SSD application process involves a multitude of forms, documentation requirements, and legal terminology. Without proper guidance, it’s easy to make mistakes or omit critical information that can jeopardize your claim. The attorneys and support staff at Coughlin & Gerhart are well-versed in the application process and can ensure that your paperwork is complete, accurate, and submitted within deadlines.

Avoiding Costly Mistakes and Delays: Errors or omissions in your application can lead to unnecessary delays or even denials. We can help you avoid common pitfalls that could result in a denied claim. By carefully reviewing your application and ensuring its accuracy, we can minimize the risk of unnecessary delays and setbacks.

Appeal Readiness: If your initial application is denied, the next step is filing an appeal. Having an attorney already involved in your case from the beginning means that we will be familiar with your circumstances and have a comprehensive understanding of your claim. Also, Social Security sometimes denies a claim without even mailing the denial, due to commonplace failures at the local offices. Having Coughlin & Gerhart involved from the beginning reduces the chances of missing a critical appeal deadline.

What is the appeal process for a denial of SSD or SSI benefits?

The appeal process for a denial of Social Security Disability (SSD) or Supplemental Security Income (SSI) benefits involves multiple stages, starting with the initial appeal within the Social Security Administration (SSA) and potentially reaching the federal court system. Coughlin & Gerhart, unlike many law firms or “disability advocates,” handles the entire appeal process, including federal court appeals:

Reconsideration: If your initial SSD or SSI application is denied, the first step is to request reconsideration. This involves submitting a written (typically online) request to the SSA within 60 days of receiving the denial letter. During reconsideration, a different examiner will review your case and any new evidence you provide.

Administrative Law Judge (ALJ) Hearing: If your claim is denied during reconsideration, you can request a hearing before an Administrative Law Judge. You must file the request within 60 days of receiving the reconsideration denial. The ALJ hearing provides an opportunity to present your case in person and explain why you believe you qualify for benefits. It may involve presenting evidence, calling witnesses, and testifying about your condition and its impact on your ability to work.

Appeals Council Review: If the ALJ denies your claim, you can appeal to the Social Security Appeals Council. The Appeals Council reviews requests for review but may deny your request if it agrees with the ALJ’s decision. In 2020, the Appeals Council reversed the ALJ in under 15% of cases. Thus, it is critical to be represented by a firm, such as Coughlin & Gerhart, that is willing to appeal your case to federal court if warranted.

Federal Court Review: If your claim is denied by the Appeals Council, you have the option to file a lawsuit in federal district court. This involves submitting a civil action against the SSA, and your case will be reviewed by a federal judge. The judge will consider the evidence, legal arguments, and whether the SSA’s decision was supported by substantial evidence. The federal court has the authority to uphold the denial, overturn it, or remand the case back to the SSA for further review. Coughlin & Gerhart regularly handles appeals of Social Security disability cases in federal court.

What is the difference between Social Security disability (SSDI) and SSI?

Social Security Disability (SSD) and Supplemental Security Income (SSI) are two programs administered by the Social Security Administration (SSA). While both programs provide support to individuals with disabilities, there are important differences between them.

SSD: To qualify for SSD benefits, you must have a work history and have paid Social Security taxes over a certain period. Your disability must meet the SSA’s definition of a severe and long-term impairment that prevents you from engaging in substantial gainful activity.

SSI: SSI is a needs-based program that provides benefits to disabled individuals with limited income and resources, regardless of work history. To be eligible, you must meet the SSA’s definition of disability and have limited income and resources.

Can I receive both workers’ compensation and Social Security disability benefits in New York?

Yes, it is possible to receive both workers’ compensation and Social Security Disability (SSD) benefits in New York. However, the amount of SSD benefits you receive may be affected by your workers’ compensation payments. Here’s a brief explanation:

When you receive both workers’ compensation and SSD benefits, there is a limit on the combined amount you can receive from both sources. This limit is known as the “offset” amount. The purpose of the offset is to prevent individuals from receiving total benefits exceeding a certain percentage of their average pre-disability earnings.

The SSA uses a formula to calculate the offset amount. They calculate 80% of your average current earnings (80% ACE which is usually determined by your highest year of earnings in the last 5 years) and your workers’ compensation payments. If the combined amount exceeds the limit, your SSD benefits will be reduced accordingly. It’s important to note that workers’ compensation benefits themselves are not reduced, but rather your SSD benefits are adjusted to account for the workers’ compensation payments.

The specific calculation of the offset can be complex, and it is based on various factors including your 80% ACE, your disability onset date, and your workers’ compensation payments. The attorneys at Coughlin & Gerhart can provide guidance on your specific situation and help you understand how the offset may affect your SSD benefits.

Worker’s Compensation FAQ

Should I find a lawyer near me to handle my workers’ compensation claim in New York?

Yes, finding a lawyer near you, such as Coughlin & Gerhart, for your workers’ compensation claim in New York can be advantageous. We have experience with the local Workers’ Compensation Board office. Meetings can be scheduled in person, by Zoom, or by telephone depending on your preference. Being familiar with local attorneys, judges and medical providers is beneficial as it allows us to strategize effectively, make referrals to appropriate medical providers, and often resolve claims without the need for extensive litigation.

How do I file a workers’ compensation claim in New York?

Report the injury or illness to your employer immediately.

Seek medical attention from an authorized healthcare provider.

Your employer should provide you with Form C-3, Employee’s Claim for Compensation, or you can download it from the New York Workers’ Compensation Board website at https://www.wcb.ny.gov/

Complete the form, including details about the incident and your injuries, and submit it to the Workers’ Compensation Board. Keep a copy of the completed form for your records.

The Workers’ Compensation Board will review your claim, and take appropriate action based on the information and the response from the insurance carrier.

Coughlin & Gerhart is available to assist with this process to ensure accuracy and timely claim filing.

What types of injuries and illnesses are covered by workers’ compensation in New York?

In New York, workers’ compensation generally covers a wide range of work-related injuries and illnesses. Some of the typical injuries include those resulting from accidents, such as slips, falls, or lifting heavy objects. Heart attacks and cardiac events can also be covered by workers’ compensation. The workers’ compensation law also covers injuries caused by repetitive motions or overuse, like carpal tunnel syndrome or back strains. Illnesses related to occupational exposure, such as respiratory conditions due to hazardous substances, may also be covered. Work-related mental health conditions, like stress or anxiety, may be eligible for coverage under certain circumstances.

However, it’s important to note that not all injuries or illnesses may be automatically covered. For a condition to be eligible for workers’ compensation, it must arise out of and be in the course of employment.

Each case is unique, and the specific circumstances surrounding an injury or illness will determine its eligibility for workers’ compensation benefits in New York. Coughlin & Gerhart offers free consultations, and can advise you as to the merits of your case.

What benefits can I receive through workers’ compensation in New York?

Medical Care: Coverage for all necessary medical treatments, surgeries, medications, and rehabilitation related to the work-related injury or illness.

Wage Replacement: A portion of your lost wages if you are unable to work or earn less money due to the work-related injury.

Permanent Partial Disability (PPD): Compensation for a partial loss of bodily function or permanent impairment resulting from the work-related injury. These benefits are usually for a limited amount of time.

Permanent Total Disability (PTD): If the injury leads to a total and permanent disability, you may receive ongoing wage replacement on a permanent basis.

Death Benefits: If a worker dies due to a work-related injury or illness, their spouse and/or dependents may be eligible for death benefits.

Can I receive workers’ compensation benefits in New York if I have a pre-existing condition?

Yes, you can be eligible for workers’ compensation benefits in New York even if you have a pre-existing condition. The key factor is whether your work-related injury aggravated or worsened your pre-existing condition. If your job duties or a workplace incident aggravated your pre-existing condition, you may still qualify for benefits. Consulting with an experienced workers’ compensation firm like Coughlin & Gerhart can help assess your situation, gather the necessary evidence, and guide you through the process of seeking benefits for a work-related aggravation of a pre-existing condition.

Do I need to search for work to remain eligible for New York workers’ compensation payments? And what is “labor market attachment” in the NY workers’ compensation system?

In New York, you may need to search for work to remain eligible for workers’ compensation payments, but the requirement can vary based on your specific situation. If your injury prevents you from returning to your previous job, you may need to demonstrate that you are actively seeking suitable employment within your physical limitations in order to continue receiving benefits.

Labor market attachment is a concept in the New York workers’ compensation system that refers to your ability and willingness to seek suitable work within your medical restrictions. It means you are actively trying to find a job that aligns with your current physical capabilities, despite the limitations imposed by your work-related injury.

To maintain eligibility for workers’ compensation payments and demonstrate labor market attachment, you may need to take the following steps:

Medical Evaluation: Obtain a medical evaluation that clearly outlines your physical limitations and work restrictions.

Job Search: Engage in a reasonable job search within your medical restrictions, which might involve submitting applications, attending interviews, and making genuine efforts to secure employment.

Documentation: Keep detailed records of your job search activities, including applications submitted, interviews attended, and any communications with potential employers.

How are attorneys paid in a workers’ compensation claim in New York?

In a workers’ compensation claim in New York, attorneys work on a contingency fee basis. This means that the attorney’s fee is contingent upon the successful outcome of your case, and they receive a percentage of the benefits or settlement you ultimately receive.

In workers’ compensation cases, attorneys receive fees in accordance with Workers’ Compensation Law Section 24.  This generally provides for a fee of 15% of the money that you are awarded, along with other set fees for appearing at hearings and obtaining a finding of permanency. Attorney fees are paid by the insurance carrier out of your benefits, but only if your case is successful and you receive compensation.

Should I settle my workers’ compensation claim in New York?

Deciding whether to settle your workers’ compensation claim in New York is a complex consideration influenced by various factors. Settlement offers typically involve a lump-sum payment in exchange for releasing your rights to future benefits. A settlement can involve indemnity benefits, medical benefits, or both. It is important to consider ongoing medical needs and the impact of the injury on your ability to work both now and in the future. Consultation with a workers’ compensation attorney is crucial at this stage. Coughlin & Gerhart can help you navigate the complex process of settling your workers’ compensation case.

Can I receive both workers’ compensation and Social Security disability benefits in New York?

Yes, it is possible to receive both workers’ compensation and Social Security Disability (SSD) benefits in New York. However, the amount of SSD benefits you receive may be affected by your workers’ compensation payments. Here’s a brief explanation:

When you receive both workers’ compensation and SSD benefits, there is a limit on the combined amount you can receive from both sources. This limit is known as the “offset” amount. The purpose of the offset is to prevent individuals from receiving total benefits exceeding a certain percentage of their average pre-disability earnings.

The SSA uses a formula to calculate the offset amount. They calculate 80% of your average current earnings (80% ACE which is usually determined by your highest year of earnings in the last 5 years) and your workers’ compensation payments. If the combined amount exceeds the limit, your SSD benefits will be reduced accordingly. It’s important to note that workers’ compensation benefits themselves are not reduced, but rather your SSD benefits are adjusted to account for the workers’ compensation payments.

The specific calculation of the offset can be complex, and it is based on various factors including your 80% ACE, your disability onset date, and your workers’ compensation payments. The attorneys at Coughlin & Gerhart can provide guidance on your specific situation and help you understand how the offset may affect your SSD benefits.

Contact Coughlin & Gerhart

Our Workers’ Compensation and Social Security Disability attorneys offer a free consultation, so you can discuss your work injury or potential disability and learn which benefits you may be entitled to receive. Call our main office in Binghamton at 607-722-6423, toll free 800-646-3420, or send an email.