Workers’ Compensation, Social Security Disability & SSI

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.