OHIO BWC Changes it’s Premium Collection Period

October, 2014 By: Mark L Newman, Cincinnati Workers’ Compensation Lawyer

Ohio BWCProspective Payment Timeline Announced for 2015!

Currently, Ohio employers pay their workers’ compensation premium for the previous six months of coverage (Example: Private employers paid in February 2013 for the July 1, 2012 to December 31, 2012 coverage period.)

This will soon change, as the BWC is transitioning to a prospective billing system that will provide more flexibility for employers while reducing overall system costs. Prospective billing is a national industry standard and builds upon ongoing efforts by BWC to modernize its operation. Under prospective billing, BWC will, like most insurance companies, collect employer premiums at the beginning of and throughout the policy period.

According to BWC the benefits of changing to the prospective payment process for Ohio employers will include:

  • More flexible payment options (e.g., monthly, quarterly, semi-annually and annually) with possible discounts for those who pay in advance.
  • Better ability to anticipate budgetary impacts of workers’ compensation program cost changes.
  • Better opportunities for BWC to provide quotes online or via phone.
  • Lower mutualized costs from employers who don’t pay premiums timely or have workers injured without coverage for employers in good standing.
  • Increases BWC’s ability to detect employer non-compliance and fraud.

The biggest benefit will be the savings. The BWC is providing Ohio employees a one-time transition credit of nearly $1.2 billion. The credit is being issued so the switch from the retrospective billing system to the prospective system will not cost the Ohio employers additional funds.

The transition is expected to become effective July 1, 2015 for private employers and January 1, 2016 for public employers.

For more information about Ohio Workers’ Compensation, contact Mark Newman, Ohio Certified Specialist Workers’ Compensation Lawyer.

 

The Social Security Disability Claims Process Stage 4: The Appeals Council

By Mark L. Newman, Cincinnati Social Security Disability Attorney

SSD Chart ProcessOf the millions of applications received by the Social Security Administration (SSA) each year, only 30% are approved at the initial stage of the application process. What happens to the remaining 70%? If you choose to move forward in order to receive Social Security Disability benefits, you must appeal the decision that was made during this initial stage. This is why understanding the application and appeal process can make this process of applying for benefits clearer and less stressful.

If you have been going through the long and tedious process of appealing your denied claim and you have also been denied at the hearing stage (Stage 3) of the appeal process, you still have a chance. The next stage of the appeal process is to go before the Appeals Council in hopes of having your Social Security Disability claim approved or at least looked at one more time.

Let’s look at how we arrived at this stage, Appeals Council, Appeal #3:

  • Your initial application request was denied, which happens to about 70% of the applications.
  • You asked for a reconsideration, 1st Appeal, and it was denied, which is usually the case (about 85 -90% get rejected at this stage).
  • You then asked for and received a hearing before an administrative law judge (ALJ) – the 2nd appeal in the process. The ALJ hearing results in approval for benefits for about 2/3rds of all disability claimants who follow the appeal process to the hearing level.
  • If you were in the 1/3rd group at the 2nd appeal stage that did not get approved, you will now find yourself at Stage 4, the 3rd appeal and Appeals Council. This is the last level of appeal before you have exhausted the appeals process through the SSA.

A few facts about this stage, The Appeals Council, of the disability claims process:

  • When denied at the hearing stage, you have 60 days to ask for a review by the Social Security Appeals Council.
  • The average time it takes to process an appeal with the Social Security Disability Appeals Council can be anywhere from six months to one year.
  • There is no guarantee that your appeal will even be heard for review. The Appeals Council does not review every case brought before it.
  • Only about 3% of the cases at this level are approved. So based on the low odds of having your case even reviewed, the odds are just as low to have your case approved.
  • The council does not review your actual disability claim. It only reviews the legality of the decision by the administrative law judge. In most cases, the Appeals Council will simply send you a letter stating that the appeal has been denied and will uphold the decision made by the administrative law judge.
  • The Appeals Council can decide to send your case back for another hearing or overturn the decision made by the administrative law judge and approve your SSD claim, if the Appeals Council finds:

o   The judge had made a technical error when reviewing your case, or

o   The judge failed to consider valid medical evidence during your Social Security Disability hearing, or

o   The decision made by the administrative law judge was made completely in error.

  • An appeal at this stage can be handled by you alone but claimants who request an appeal at this level without a lawyer’s help are most often denied.

After the long wait and your case gets denied at this stage, you will need to go on to file another appeal with the Federal District Court. This entails filing a lawsuit at the Federal Court level. If you do not yet have an attorney representing you in your disability claim, you should retain one for this portion of your Social Security Disability appeals process.

By Mark L. Newman | Twitter  | LinkedIn

If you have any questions about any of the information contained in this blog, contact Mark Newman via phone: 513-533-2009  or by email at mln@bpbslaw.com.  Advertisement Only

The Social Security Disability Claims Process Stage 3: Hearing

SSD Claims AppBy Mark L. Newman, Cincinnati Social Security Disability Attorney

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If you are thinking about filing for social security disability benefits it is important to understand the process. The cycle of an SSD claim can be quite lengthy so having a basic understanding of each step will be helpful. Last week I reviewed the second step. This article will review the third step. This stage is referred to as the Hearing or 2nd Appeal.

SDD Process Stage 3

If you receive a notice that your request for reconsideration of your Social Security disability claim has been denied (Stage 2) and you want to appeal again, you must request a hearing before an administrative law judge (ALJ). You have 60 days from the date of your denied reconsideration to request this hearing. You can see why this is a long process – appeals, 60 day deadlines, and more appeals.

How to Request a Disability Hearing in Front of an ALJ

There are three ways that you can apply to request a hearing in front of a judge:

  • Online
  • Sending in forms, or
  • Writing a letter to your local Social Security office

You must request a hearing in writing in one of the above ways.  Click here for more information.

When you request a hearing, your case will be reviewed by an ALJ, who are attorneys that work for the SSA’s Office of Hearings and Appeals. They can do one of three things:

  1. Approve your claim,
  2. Send your case back for review, or
  3. Deny your claim.

First, the good news. At this stage, about 67% of the claims are approved. However, the average length of time to go through this Stage 3 appeal is almost 12 months. Stage 3 can take a large amount of time to get to, but if you have the time, desire and assistance it also provides the highest chance of having your Social Security disability claim approved.

The Hearing

At the hearing, you appear in person and can argue why you deserve a medical-vocational allowance. The primary goal at this stage is to deny the claim or issue a favorable/partially favorable determination and award Social Security disability benefits to the claimant.

There are several items to note that are unique at a Level 3 hearing and why you should have a qualified disability attorney present with you at this level. This is a legal hearing and while less formal, there is still protocol to follow.

  1. You can and should be present, along with your attorney or representative, and you will testify regarding your condition. Your attorney can assist you in answering questions from the judge.
  2. Witnesses can be present, such as a doctor or other vocational experts, whom the judge will also question regarding your conditions. An attorney can cross-examine these witnesses.
  3. You can submit additional evidence, which should have been submitted within ten days of the date that you filed the request for a hearing. If you are not able to submit your new medical evidence within that time frame, you may request an extension from the ALJ to submit the new evidence.

After the hearing, the Administrative Law Judge will consider all the evidence and testimony presented and he or she will render an independent written decision, of which you will receive a copy within one to two months following the hearing date.If your claim is approved you will receive both a Notice of Decision and a Notice of Award. If your claim is denied, you can move to the next Stage – Appeal #3, the Appeals Council.

Are you starting to see why this process is so lengthy?

For more information, click here. Remember, working with a lawyer can help keep this process on track so you can get the disability coverage you deserve.

By Mark L. Newman | Twitter  | LinkedIn

Understanding the social security disability benefit claim process : Step 1

SSD Claims App

By Mark L. Newman, Cincinnati Social Security Disability Attorney

If you are thinking about filing for social security disability benefits it is important to understand the process. The Social Security Administration has divided this process into 5 basic steps or stages. The cycle of an SSD claim can be lengthy so having a basic understanding of each step will be helpful. This article will review the first stage.

SSD 5 Step Process

SSD 5 Step Process

Stage 1: Initial Application

This step is the most important because it lays the foundation for  the initial decision regarding your claim and any subsequent decisions or appeals will be based on the information provided in this step. So being thorough and accurate are necessary. There is a large amount of detailed information that you will be required to provide on forms from the Social Security Administration, including, but not limited to:

  • Personal and family information
  • If you served in the military, you will need to supply service records
  • Work history with names of employers, dates worked, salary and maybe even job duties
  • Detailed medical records (details of your disabling condition, doctors and/or hospital visits and exams, diagnosis, treatments, medications, etc.)Financial information such as your tax records (W-2s, and tax filings)
    • If you do not have these, the SSA will pay for and collect all your relevant medical records at this stage.
  • Federal tax filings and copies of W2s

At this stage, it can take up to four months before a decision is made on your claim. The key here is to be patient and if contacted to supply additional information, do not delay in responding to the request. Being slow to respond may delay any decision on your disability claim, and if you do not answer their requests for information, your claim may be completely denied.

Be accurate when completing the sections on this application. Any false information could result in quick denial of your claim.  If you get a notice from the Social Security Administration stating that your application has been “disapproved”, don’t feel rejected. 65% of all initial applicants are denied for many different reasons. In fact, that denial letter you receive will contain information about your rights to appeal the initial decision, which will take us to explaining how stage 2 works.

Next blog post will be about stage 2 of the SSD claim process – filing your first appeal.

By Mark L. Newman | Twitter  | LinkedIn

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Thinking about filing for social security disability?

Social Security AdminBy Mark L. Newman, Cincinnati Lawyer Social Security Disability

Filing for and receiving Social Security disability is a long process, made more so by the fact that you have medical problems and may not be not working. Although some cases are approved at the initial level, many claims end up at hearing, and the time from the initial application to hearing can extend over two years.

In this recent article there were some interesting and current statistics about the Social Security Disability program. The article focuses on the Social Security’s disability program as it edges toward the brink of insolvency. The trust fund that supports the disability program is projected to run out of money in 2016.

So if you are thinking about filing for social security disability, here are a few facts:

  1. The amount you receive each month will be based on your average lifetime earnings before your disability began. It is not based on how severe your disability is or how much income you have.
  2. In 2007, the average processing time for a hearing was 512 days. It was reduced to less than 365 days in 2012 but has since crept back up above 400 days.
  3. There are 937,600 cases pending before administrative law judges, according agency statistics.
  4. Social Security employs a little more than 1,400 administrative law judges.
  5. By the time disability cases reach an administrative law judge, the claims have been rejected at least once and often twice by workers in state offices.
  6. Nearly 11 million disabled workers, spouses and children get Social Security disability benefits. That’s a 45 percent increase from a decade ago. The average monthly benefit for a disabled worker is $1,146.
  7. Nationwide, approval rates among judges have declined in recent years. In 2013, judges approved 56 percent of the cases they decided, down from 72 percent in 2005.

Contact Mark Newman for any questions you may have regarding social security disability. (513) 533-2009 | mln@bpbslaw.com | @MarkLNewmanAtty

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I have known Mark for over 25 years. Mark is always a good friend, intelligent, insightful. Rest easy when Mark takes your case. He will do a fine job, keep you well informed, and, be a caring human being too boot.

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