Is there Partial Social Security Disability?

Our firm sometimes gets calls relating to Partial Disability Claims.  Sometimes a Claimant may feel they are eligible for this because they are no longer able to perform a previous job, are now working at a much reduced rate of pay, or will be out of work for a few months due to their medical conditions. 

With Social Security there is no Partial Disability, you are either disabled or not disabled, unlike VA (Veterans Administration) and Workers Compensation claims, which have a doctor give a PIR (Permanent Impairment Rating) stating the percentage of disability the person may have.

You are still able to work a part-time job while collecting benefits or while going through the Disability process as long as you do not exceed SGA (Substantial Gainful Employment) which is $1,260 gross a month for 2020 for non blind individuals and $2,110 for blind individuals.  (This amount changes slightly every year)  If you exceed this amount for a period of time your Social Security Claim will be dismissed based on the fact that you are exceeding SGA or you can even end up owing Social Security for the months that you have been overpaid.

Being able to work part-time does not mean that you are not disabled; because Social Security determines if you can work on a full-time continuous basis.  The ability to only work a part-time job does benefit a lot of these Claimants who can still supplement their income while collecting their benefits.  This is especially helpful to those who have low benefit amounts and need the funds to support themselves.

Social Security Disability Lawyer, West Palm Beach 

If you have questions about whether you can qualify for Social Security Disability Benefits or SSI, please do not hesitate to contact us at 877-817-4127.

Lyle Masnikoff & Associates, P.A. 1645 Palm Beach Lakes Blvd #550 West Palm Beach, FL 33401 877-817-4127 www.workerscompfl.net

© Copyright 2020. All Rights Reserved.

Source: https://workerscompfl.net/is-there-partial-social-security-disability/

from Law Offices Of Lyle B Masnikoff Workers Compensation Law Firm https://workerscompflorida.wordpress.com/2020/08/17/is-there-partial-social-security-disability/

Returning to Work During a Pandemic

After being out of the workplace due to businesses closing, furloughs, caring for children whose schools were shuttered, caring for loved ones, or due to working remotely, many Floridians have now returned to the office and are back to work in a traditional sense (although whether or not there is anything traditional during this very trying time is a subject for another discussion).

From teachers to lawyers to restaurant workers and every industry in between, a large majority of Florida’s workforce is back to work. Although, it does not seem like much has changed since we were initially out of work to now. The COVID-19 pandemic is still very much around us and our lives are still very much altered. As we return to work, there are mask requirements, temperature checks, social distancing, only two people allowed in the elevator at a time (which certainly presents unique challenges in our office building), etc… We have been asked to alter our personal and work lives in an effort to do our part to make sure we are doing everything we can to be safe, courteous, and help to stop the spread. A very valid concern that we all have as we return to work is contracting the virus while doing our jobs. Are you covered in this instance? The answer is “maybe.” According to data put out by Chief Judge Langham via his informative blog post and able to be reviewed at http://flojcc.blogspot.com/ approximately half of COVID-19 claims have been accepted as compensable, and benefits being provided. As previously discussed, there are some industries in Florida where there is a presumption that if you contacted COVID-19 it is presumed to be from the job.

In Florida, this presumption applies to state “frontline” employees. What is considered “frontline” may be up for debate, but none the less there is a presumption that the job is the cause of your infection. Other states have started to introduce similar presumption legislation where in if you contract the virus, it is presumed to be from the workplace, with no limitation on the type of work you do. Other presumptions will depend on the type of work you do, such as legislation for first responders. Regardless of the type of work you do, with a virus that is so easily transmissible, all of us are at risk.

Our first layer of defense is of course to be safe and follow the guidelines put in place to help protect ourselves and our co-workers. If you believe that you are sick, stay home. If you unfortunately get infected and believe it was due to an exposure at work, make sure to report it to the appropriate human resources representative. One concern we all have if we get infected, aside from our health concerns which are first and foremost, is financial concern. Our bills certainly do not stop coming when we are out of work.

Luckily, there are some programs set up to help alleviate the financial strain. Some employers are required to pay sick leave if you are out due to COVID-19 and there are unemployment benefits, to name a few. Under workers’ compensation laws, if you are out of work due to the virus and your claim is accepted as compensable you will be entitled to indemnity (missed wage) benefits in addition to medical treatment provided by your employer’s insurance carrier.

Personal Injury Attorney West Palm Beach

Throughout Mr. Masnikoff’s twenty-year career he has worked tirelessly to ensure that Floridians are provided quick and efficient medical and missed wage benefits under the law so that they are able to return to gainful employment. If you or a loved one have questions regarding what to do if you have contracted Coronavirus through your employment, please contact us as we are here to answer any question. The consultation is always free. We practice throughout Florida and you can reach any one of our offices at (877)817-4127. Stay safe, and we will all get through this together!

  Lyle Masnikoff & Associates, P.A. 1645 Palm Beach Lakes Blvd #550 West Palm Beach, FL 33401 877-817-4127 www.workerscompfl.net

© Copyright 2020. All Rights Reserved.

Source: https://workerscompfl.net/returning-to-work-during-a-pandemic/

from Law Offices Of Lyle B Masnikoff Workers Compensation Law Firm https://workerscompflorida.wordpress.com/2020/08/15/returning-to-work-during-a-pandemic/

Are COVID-19 tests reimbursable under PIP?

With the recent COVID-19 pandemic, the everyday lives of many people have changed.  The legal world is no different.  While people grasp with new ways of doing things, the legal world is having a whole host of new issues that come up. One question we have been getting frequently is whether COVID-19 tests are reimbursable under PIP.  Due to the pandemic many chiropractors, orthopedists, diagnostic facilities, and other physicians that treat PIP patients have still been open for business providing medical care for injured patients.

We have clients that have informed us of the extra precautions they are taking.  One of those precautions is having a patient tested at the office for COVID-19 prior to receiving treatment.  As this comes at a cost to the medical facility, clients have asked whether the tests are reimbursable under PIP.  While some PIP insurers have been paying for the tests, others have denied them.

As this is a new issue, there is no caselaw on point.  However, under PIP, treatment needs to be reasonable, related, and necessary in order to be reimbursable.  While there is no certainty on how courts will ultimately rule on the issue, we believe there is quite a strong argument that the COVID-19 tests would be reimbursable under PIP.

COVID-19 has killed over 130,000 people and spreads rather easily.  Medical professionals are in extremely close quarters with their patients and are unable to properly social distance themselves from their patients.  Whether it is an orthopedist checking on a patient’s extremities, diagnostic facilities placing a patient in the proper position for a diagnostic test, or a chiropractor performing an adjustment on a patient, it is often very difficult to properly treat a patient without violating social distance protocols.

Doctors and other medical professionals also have a right and a duty to take proper precautions in their office to insure that COVID-19 does not spread to other patients, their employees, and themselves.  They have a right to make sure that the patient they are treating does not have COVID-19 to keep themselves and their other patients safe.  A very strong, compelling argument can be made that the COVID-19 test is thus reasonable, related, and necessary.  Many doctors would not be safely able to perform the proper treatment on a patient that has COVID-19.

If you have any denials for COVID-19 testing, or any other CPT code denials, please contact us with any questions.  Our goal is to get you paid for treating injured patients. Please call us at (877)817-4127.

Lyle Masnikoff & Associates, P.A. 1645 Palm Beach Lakes Blvd #550 West Palm Beach, FL 33401 877-817-4127 www.workerscompfl.net

  © Copyright 2020. All Rights Reserved.

Source: https://workerscompfl.net/are-covid-19-tests-reimbursable-under-pip/

from Law Offices Of Lyle B Masnikoff Workers Compensation Law Firm https://workerscompflorida.wordpress.com/2020/07/19/are-covid-19-tests-reimbursable-under-pip/

Has the Social Security Judge Denied Your Claim

If a person receives an Unfavorable decision letter after their hearing before the Administrative Law Judge (ALJ), they can appeal their case to the Appeals Council. You are given 60 days to appeal your case and the Appeals Council will decide if the Judge erred and if the decision was made according to the law.

The Appeals council can agree with the Judge’s decision, remand the case back for another hearing before generally the same Administrative Law Judge (ALJ) or reverse the Judges decision. Unfortunately, the Appeals Council generally agrees and upholds the Judges decision, and sends a letter stating the appeal has been denied, and advises of 60 day deadline to file an appeal with the Federal District Court. If the Appeals Council remands the decision it means they are sending it back for another hearing before generally the same Administrative Law Judge with instructions of what was done incorrectly. Generally cases are remanded if the Judge fails to acknowledge severe medical conditions or not giving weight to treating sources opinions.

Less than 1-2 % of cases nationally are reversed by the Appeals Council, which means they overturn the Judges decision approving the case, and agreeing the Judge made a significant error. Fortunately, we just had a case reversed due to the Judge failing to follow the grid rules, and the Appeals Council reversed the denial to a Favorable decision.

If you have been denied by Social Security at any level, we may be able to help you. Please call us at.(877)817-4127.

Lyle Masnikoff & Associates, P.A. 1645 Palm Beach Lakes Blvd #550 West Palm Beach, FL 33401 877-817-4127 www.workerscompfl.net

© Copyright 2020. All Rights Reserved.

Source: https://workerscompfl.net/has-the-social-security-judge-denied-your-claim/

from Law Offices Of Lyle B Masnikoff Workers Compensation Law Firm https://workerscompflorida.wordpress.com/2020/07/14/has-the-social-security-judge-denied-your-claim/

Material Misrepresentation wihout the Misrepresentation

A number of low-budget insurers target segments of South Florida’s population where English is a second language.  The scam by insurance companies works as follows:

First, the individual goes to an insurance agency to obtain PIP insurance for their automobile.  The insured pays their premium and believe they have automobile insurance to cover their medical expenses if and when they are injured in an automobile accident

Upon getting in an automobile accident and seeking medical treatment, the insurance company sets up an Examination Under Oath (EUO), and asks the insured all sorts of questions.  The questions revolve around a number of issues ancillary to the insurer’s purpose for the questioning, such as the medical treatment and what happened to cause the accident.  The real purpose for the EUO is engage in post-loss underwriting.

Post-loss underwriting is a practice in which  the insurer investigates the application for insurance after an insurance claim.  The insurer asks questions about prior accidents and household members.  If they found out that something was not disclosed on the application for insurance, they claim there is a  “material misrepresentation” and rescind the insurance policy.  The insured’s medical bills are never paid for, and it is as if there was no insurance in the first place.

Post-loss underwriting is an illegal practice in many states.  However, this reprehensible practice is still legal in the state of Florida.  What this practice allows insurers to do is to collect premiums, and make money off those premiums.  The insurer, despite having many tools accessible to them, does not verify any of the information obtained by their agents unless and until there is a claim by the insured.  Once there is a claim, the insurer seeks to rescind the policy.

This practice seeks to guarantee that the insurer does not have any risk.  The insurer collects premiums on policies where there are no claims, and does not pay out on policies where there are claims.  This guarantees maximum profits for these predatory insurers.

The majority of the time, the target of these scams are some of the minority communities in South Florida.  These insurers have targeted our Haitian and Hispanic communities predominantly.

Our firm has discovered the prevalence of fraud by these insurers and their agents in procuring applications for insurance and in improperly rescinding insurance policies.  Many times, the insurer is lying about household members they “discover” live with the applicant for insurace.  Other times, none of the questions on the application have ever been asked of the insurance applicant.  Much of the time, the applicant for insurance does not even speak English.

If you have had any claims denied for material misrepresentation, please contact Attorney Lyle Masnikoff or Attorney Kevin Davies at

(877)817-4127, so that we can fight for your rights.

Lyle Masnikoff & Associates, P.A. 1645 Palm Beach Lakes Blvd #550 West Palm Beach, FL 33401 877-817-4127 www.workerscompfl.net

© Copyright 2020. All Rights Reserved.

Source: https://workerscompfl.net/material-misrepresentation-wihout-the-misrepresentation/

from Law Offices Of Lyle B Masnikoff Workers Compensation Law Firm https://workerscompflorida.wordpress.com/2020/06/01/material-misrepresentation-wihout-the-misrepresentation/

Social Security Disability Grid Rules

If a person has a severe impairment, does not meet or equal a disability listing, and is unable to return to any work they performed in the past 15 years, the Grid Rules come into play to determine if they are disabled.  The Grid Rules are basically a series of charts that are set up based on the exertional level of work that SSA believes a person is capable of functioning at, their highest level of education, their age and past work.   

The charts range from sedentary to very heavy work.  Using the Grid Rules a person with physical impairments who is at advanced age, 55 plus, has a much higher chance of being considered disabled then someone aged 18-49 who is considered a younger individual.  Anyone 49 and younger who can speak English is generally considered not disabled under the Grid Rules.  If a person has both  physical and mental impairments, SSA will first determine if they are considered disabled based on the physical conditions per the Grid Rules.

If there is a finding of not disabled based on the physical, exertional limitations, the mental non-exertional limitations are considered to determine how they would further affect your ability to perform work.  Non-exertional limitations include difficulty with concentration and memory and normally come from conditions such as Bipolar Disorder and Depression.  Exertional limitations include ability to walk, sit, bend and stoop and can be caused by back or joint problem.

Keep in mind, the Grid Rules is only one way to qualify for benefits, but age plays a huge role in the results when applying the grid rules to determine disability.

If you have questions about the Grid Rules and any other Social Security Disability topic, please do not hesitate to contact Attorney Lyle Masnikoff at (877)817-4127.

  Lyle Masnikoff & Associates, P.A. 1645 Palm Beach Lakes Blvd #550 West Palm Beach, FL 33401 877-817-4127 www.workerscompfl.net

  © Copyright 2020. All Rights Reserved.

Source: https://workerscompfl.net/social-security-disability-grid-rules/

from Law Offices Of Lyle B Masnikoff Workers Compensation Law Firm https://workerscompflorida.wordpress.com/2020/06/01/social-security-disability-grid-rules/

State Farm’s 9810A Policy Before Supreme Court of Florida

Currently before the Supreme Court of Florida is the case of MRI Associates of Tampa, Inc., Etc. vs. State Farm Mutual Automobile Insurance Company.  At issue is whether the 9810A policy unambiguously elected to reimburse at 80 percent of the schedule of maximum charges. The case is an appeal from the 2nd DCA’s decision in which the appellate court ruled in favor of State Farm.  The 2nd DCA found that State Farm’s policy was properly written to properly elect to pay at fee schedule.  While the 2nd DCA is the only district court of appeal decision on the matter, lower courts have been split on the issue.  The 2nd DCA certified the question to the Florida Supreme Court  as one of great public importance.

If the Florida Supreme Court rules in favor of medical providers, we can expect medical providers who billed at above medicare fee schedule to receive additional payments for their underpaid services.

Oral arguments before the Florida Supreme Court are scheduled for May 6, 2020.   We will update you once the Supreme Court rules on the matter.  If you have questions about this case or any other PIP issues, please do not hesitate to call Attorney Lyle Masnikoff or Attorney Kevin Davies at (877)817-4127.

  Lyle Masnikoff & Associates, P.A. 1645 Palm Beach Lakes Blvd #550 West Palm Beach, FL 33401 877-817-4127 www.workerscompfl.net

  © Copyright 2020. All Rights Reserved.

Source: https://workerscompfl.net/state-farms-9810a-policy-before-supreme-court-of-florida/

from Law Offices Of Lyle B Masnikoff Workers Compensation Law Firm https://workerscompflorida.wordpress.com/2020/03/27/state-farms-9810a-policy-before-supreme-court-of-florida/

Effects of Coronavirus (COVID-19) on Social Security Disability Cases

As we are facing a healthcare pandemic, many people are wondering what will happen with their Social Security Disability case and/or benefits.  The good news is your benefits will not be stopped or suspended nor will upcoming hearings. 

As of March 17, 2020, all Social Security Offices are closed to the public but if you have an upcoming hearing, you will be contacted by the hearings office to offer you a hearing via telephone. 

Telephonic hearings are being offered so that your case is not delayed but if you prefer your hearing to be heard in person, they will rescheduled your hearing for a later time so that you can see the Administrative Law Judge live.  If you elect a telephonic hearing, you will be called on the date and time of your hearing in a conference call with your representative and the Judges office.

Social Security can still be contacted by telephone and they are also being very lenient with time deadlines for submitting documentation and appeals with their good cause policy.  Many documents can be mailed or faxed into their offices or deadlines will be waived until the office re-opens to the public.

Social Security will also be suspending any current continuing medical disability reviews, where possible collections of over payments, any third party requests for information except for Appointed Representatives and Representative Payees, and Freedom of Information Act requests.

Our office remains open.  We are continuing to help our clients get accepted as Disabled by the Social Security Administration.  If you have any questions or need help getting SSDI, please do not hesitate to call Attorney Lyle Masnikoff. We practice throughout Florida and you can reach any one of our offices at (877)817-4127.  Stay safe, and we will go get through this!

  Lyle Masnikoff & Associates, P.A. 1645 Palm Beach Lakes Blvd #550 West Palm Beach, FL 33401 877-817-4127 www.workerscompfl.net

  © Copyright 2020. All Rights Reserved.

Source: https://workerscompfl.net/effects-of-coronavirus-covid-19-on-social-security-disability-cases/

from Law Offices Of Lyle B Masnikoff Workers Compensation Law Firm https://workerscompflorida.wordpress.com/2020/03/26/effects-of-coronavirus-covid-19-on-social-security-disability-cases/

“Coronavirus and Workers’ Compensation”

 As more and more businesses are shuttering their doors due to the Coronavirus pandemic, employees and employers are left with many unanswered questions regarding what is going to happen in terms of  what benefits the employees and employers may be entitled to in an effort to stave off the negative financial impact that this will have on everyone’s lives.

Luckily, the Government is working very hard to try to devise and implement stimulus packages that will  help alleviate the burden on business owners, as well as on employees who are out of work due to their job being forced to close or work within very restrictive, buy important, parameters.

The industry that comes to mind is restaurants.  In Florida, restaurants can still stay open but only for take out purposes.  This means that many servers and bar tenders will not be needed, leaving many Floridians out of a job.  On the other hand, some industries seem to be thriving and even hiring temporary employees.  Company’s such as Publix, Walmart, Domino’s, Amazon, etc… have all stated that they are hiring thousands of workers to keep up with the demand.  This could be a huge blessing to those workers who are displaced due to the Coronavirus, as they now have an opportunity for employment, even if temporary, until this pandemic passes.  Which it will.

A lot of workers, and employers, have questions regarding what to do if you come into contact with someone in the workplace and end up testing positive for Coronavirus.  Does workers’ compensation kick in?  The short answer is that it depends.  It depends on what industry you are working in.   If the employee contracts the virus in the course and scope of their employment because their job requires them to be exposed to persons who are infected, then there could be a potential workers compensation claim where the employee is entitled to benefits, such as medical treatment and indemnity, or missed wages.

The most common industry where one would see this are health care workers who, as part of their duties, have no choice but to be exposed to patients who may have Coronavirus.  On the other hand, if you contract the disease from a co-worker, customer, or someone else who just happens to be at your jobsite or place of business, workers’ compensation benefits would most likely not apply.   If you fall into the ladder and contract the disease, we implore you to use your paid time off as well as the Family Medical Leave Act.  With the stimulus that passed last week, you may be entitled to paid sick leave for up to two weeks as well as some economic benefit while on FMLA, which typically is unpaid.

Throughout Mr. Masnikoff’s twenty-year career he has worked tirelessly to ensure that Floridians are provided quick and efficient medical and missed wage benefits under the law so that they are able to return to gainful employment.   If you or a loved one are in the medical industry and have questions regarding what to do if you have contracted Coronavirus through contact with a patient or have temporarily lost your job due to the pandemic, please contact us as we are here to answer any question.  The consultation is always free.  We practice throughout Florida and you can reach any one of our offices at (877)817-4127.  Stay safe, and we will go get through this!

  Lyle Masnikoff & Associates, P.A. 1645 Palm Beach Lakes Blvd #550 West Palm Beach, FL 33401 877-817-4127 www.workerscompfl.net

  © Copyright 2020. All Rights Reserved.

  Source: https://workerscompfl.net/coronavirus-and-workers-compensation/

from Law Offices Of Lyle B Masnikoff Workers Compensation Law Firm https://workerscompflorida.wordpress.com/2020/03/24/coronavirus-and-workers-compensation/

“Chronic Traumatic Encephalopathy or CTE and Workers Compensation”

As the Big Game has come and went and another football season behind us, most of us outside of Kansas City are left to wonder what changes our team could have made to have been in the hunt and come away with that trophy.  In recent years however, there has been another story permeating away from the lights and glamor and super bowl wins.  A phrase that is unfortunately becoming somewhat of common place.  “CTE” or Chronic Traumatic Encephalopathy has been making head lines in recent years mainly due to ex-football players being diagnosed with same.

According to the Concussion Foundation, CTE is a degenerative brain disease mainly found in athletes, military veterans and others with a history of repetitive brain trauma.   One major issue in the diagnosis is that symptoms do not generally begin until years after the impacts.  The Concussion Foundation states that CTE can currently only be diagnosed after death through brain tissue analysis.  A recent case out of California found Pro Football Hall of Famer Kellen Winslow Sr. filing a workers’ compensation claim for brain and nervous system injures due to repetitive trauma to his head during his football career.  In the workers’ compensation case Winslow Sr. claims that his years of playing football resulted in “cognitive and behavioral disorders.”  According to the Concussion Foundation early symptoms of CTE usually manifest in a patient’s altered mood and behavior and case impulse control problems, aggression, depression, and paranoia.  Mr. Winslow Sr. could be experiencing the onset of CTE.   The claim was denied on the defense that the Statute of Limitations had expired.

In Florida, you have two years to bring your claim.  There are certain exceptions to this two-year Statute of Limitations, one of which you see in repetitive type claims.  Repetitive claims are difficult because essentially every impact or “hit” is arguably either a new injury or a continuation of an injury sustained in an earlier impact.

The major issue with these types of injuries is that you may not begin to feel the effect or even know that you were injured until years later, at a point where you may not even be in the same profession, just as with Mr. Winslow Sr.

Throughout Mr. Masnikoff’s twenty-year career he has worked tirelessly to ensure that Floridians who suffer repetitive injuries on the job receive the proper benefits and receive them timely.  If you or a loved one suffered repetitive trauma to your head, or any injury sustained due to some repetitive impact or action while working, and have concerns and or questions regarding what rights you are entitled to under Florida’s workers compensation law, please contact us as we are here to answer any question.  The consultation is free.  We practice throughout Florida and you can reach any one of our offices at (877)817-4127.

  Lyle Masnikoff & Associates, P.A. 1645 Palm Beach Lakes Blvd #550 West Palm Beach, FL 33401 877-817-4127 www.workerscompfl.net

  © Copyright 2020. All Rights Reserved.

    Source: https://workerscompfl.net/chronic-traumatic-encephalopathy-or-cte-and-workers-compensation/

from Law Offices Of Lyle B Masnikoff Workers Compensation Law Firm https://workerscompflorida.wordpress.com/2020/03/10/chronic-traumatic-encephalopathy-or-cte-and-workers-compensation/

Overpayments  

  Unfortunately overpayments are a pretty common occurrence that may or may not be at any fault of your own.  An overpayment occurs when Social Security pays you more then they should have paid.  This can happen due to changes in your living arrangements, no longer being disabled, beginning to work, receiving a settlement in a lawsuit, providing Social Security with insufficient information or changes in your marital status.

Once Social Security notices the error, they will send you a notice explaining why you have been overpaid, your repayment options, and your appeal and waiver rights.  If you do not believe you have been overpaid or you disagree with the amount of your overpayment, you can file an appeal.  If the overpayment was accurate but you feel you should not have to re-pay the money then you can file a waiver. The waiver must prove that the overpayment was not your fault and that paying back the overpayment would cause financial hardship or be unfair to you. If you file an appeal or waiver, Social Security will not withhold money until they decide if the appeal or waiver will be granted.

Failure to re pay overpayments to Social Security can result in them taking the money from your tax returns, your monthly pay checks, future benefits and even reporting you to the credit agencies.

If you have any questions about Social Security Disability Benefits or Overpayments, please do not hesitate to contact Attorney Lyle B. Masnikoff at 877-817-4127.

  Lyle Masnikoff & Associates, P.A. 1645 Palm Beach Lakes Blvd #550 West Palm Beach, FL 33401 877-817-4127 www.workerscompfl.net

  © Copyright 2020. All Rights Reserved.

Source: https://workerscompfl.net/overpayments/

from Law Offices Of Lyle B Masnikoff Workers Compensation Law Firm https://workerscompflorida.wordpress.com/2020/02/05/overpayments/