When employees suffer permanent total disability from work-related injuries, they deal with more than just physical consequences. The Social Security Administration (SSA) refers to the financial devastation following the permanent and total disability of a worker as a “major economic hazard.”
Not only are families forced to contend with the loss of a permanently disabled worker’s income, but personal resources are also often quickly depleted by unrelenting medical expenses as well.
If you were permanently and totally disabled due to an Oklahoma workplace injury or occupational illness, you may be entitled to lifetime permanent disability benefits through the workers’ compensation system. As long as you have a qualifying permanent total disability and can prove that it is work-related, you could be eligible for regular weekly payments and certain medical benefits from the workers’ compensation program.
It’s important to keep in mind that permanent total disability (PTD) benefits obtained through workers’ compensation are separate from Social Security disability (SSD) benefits. Workers’ compensation programs are administered by individual states, while the SSA is a federal program. It’s possible to qualify for either workers’ compensation PTD or Social Security disability, neither, or both at the same time.
Making this determination can sometimes be confusing. The benefits received through one program may have an effect on benefit payments from the other. To learn more about qualifying for various permanent disability benefits, contact us now to schedule a free consultation with the permanent disability lawyers at Ryan Bisher Ryan & Simons.
How Do You Get Permanent Total Disability Benefits?
To begin receiving permanent total disability benefits through the Oklahoma Workers’ Compensation Commission, your first step will be to prove that you meet the basic eligibility criteria for worker’s compensation in the first place.
The requirements for workers’ comp eligibility include:
- You must be an eligible employee.
- Your employer must carry workers’ compensation insurance.
- Your illness or injury must be work-related.
- You must follow Oklahoma’s workers’ comp claim procedures.
After you have filed a workers’ compensation claim, you will likely also have to follow regulations imposed by the state or your employer’s insurance carrier regarding the choice of a treating physician. To maintain continuing eligibility, you will also need to follow any doctor’s orders for the treatment of your illness or injury.
Most workers’ comp patients do not qualify for lifetime PTD benefits until doctors determine that their medical conditions have stabilized. If an approved workers’ comp doctor decides that your condition has rendered you permanently and totally disabled, you will be considered eligible for benefits.
In Oklahoma, PTD benefits are paid for 15 years or until an employee is old enough to qualify for maximum Social Security benefits, whichever period is longer. PTD benefits are typically 70 percent of a worker’s prior average weekly income, up to a maximum equal to the average weekly wage in Oklahoma.
What Is Considered a Permanent Disability?
A disability is generally not considered permanent until a treating doctor determines that a patient has reached a plateau in their recovery. This plateau is commonly referred to as a state of “maximum medical improvement” (MMI) in workers’ comp cases.
Workers must undergo certain medical and legal processes to prove that their medical conditions prevent them from earning an income and are unlikely to improve.
Sometimes, it may be obvious within weeks that a disabling injury or illness will not improve. Other times, reaching MMI may take years following an initial workplace injury or occupational illness. This depends partially on the nature of your injury, illness, or disability. It can also be affected by the medical treatments available to you and the speed with which your employer’s insurance provider approves certain procedures.
In some cases, an insurance company may decide that they want an independent medical examination (IME) to review your medical condition. Oklahoma also allows disabled workers to request IMEs themselves if they disagree with the opinion of a chosen physician.
What to Do If I Am Denied Permanent Disability Benefits
If you have suffered a permanent work-related injury, impairment, or disease, and your claim for PTD benefits has been denied, you have the right to appeal the denial decision. When a workers’ comp claim is closed, the employee in question should receive a notice to alert them of the determination. If benefits were not awarded, or payments are significantly less than fair, there should be a description of the procedures available to dispute or appeal the decision.
The first stage of an appeal typically involves a preliminary hearing with an administrative law judge (ALJ). If your preliminary appeal is unsuccessful, you’ll have the option to file a secondary appeal before the Oklahoma Workers’ Comp Commission within 10 days of the ALJ’s decision. If you still do not receive a satisfactory determination from the Commission, you have 20 days to file an appeal with the Oklahoma Supreme Court.
It’s important to keep in mind that these appeal periods are particularly short. Taking quick action is critical to your chances of a successful outcome if your claim is initially denied. To protect your rights, it’s a good idea to consult with an experienced workers’ comp disability lawyer. A skilled attorney in your corner can act as your personal advocate and help you navigate the often confusing appeals system.
Can You Receive Disability Benefits From Social Security and Workers’ Comp?
Not only is the SSA a completely separate entity from state workers’ compensation programs, the eligibility requirements for Social Security Disability Insurance (SSDI) benefits are also very different from workers’ comp eligibility requirements.
It’s possible to qualify for both, either, or neither types of benefits. Because each benefit is administered by a different entity, receiving benefits from one program does not disqualify you or negatively affect your chances of receiving benefits from the other.
Generally speaking, workers’ comp benefits are intended to be temporary. You may not be required to be totally unable to work in order to receive PTD benefits from the workers’ compensation system. Workers are usually considered disabled for the purposes of workers’ comp if they are rendered unable to perform the job they previously held. To qualify for SSDI benefits, however, workers must prove that they are disabled to a degree that completely prevents them from performing any meaningful work in any capacity.
One important thing to note is that while qualifying for either workers’ comp permanent and total disability benefits or SSDI benefits will not disqualify you from collecting the other, the money you receive from one program may affect the amount you could receive from the other. The total amount of income received by a permanently disabled worker cannot exceed more than 80 percent of their previous earnings. If you happen to receive payments from both workers’ compensation and SSDI, the SSA will reduce the amount of your entitlement until your total income is less than that 80 percent threshold.
Do I Need a Disability Lawyer for a Work-Related Injury?
You’re not required to work with a disability lawyer for your work-related injury claim. However, if your physician or an IME determines that you have suffered a permanent and total disability, it’s likely a good idea to consult with an attorney. It’s very expensive for insurance providers and state programs to pay lifetime benefits, so your burden of proof in demonstrating your disability will probably be quite high.
If you do not receive a favorable initial determination from the Oklahoma Workers’ Compensation Commission, the assistance of an attorney can be especially helpful. Negotiating the appeals process can be a time-consuming headache. That is the last thing you need as you attempt to recover and support your family. A skilled disability lawyer can help you gather compelling evidence, build a strong case, and navigate the complex administrative systems that decide your ability to recover compensation.
Talk to Our Lawyers to Find Out More About Your Right to Disability Benefits
At Ryan Bisher Ryan & Simons, our firm’s partners have been exclusively devoted to personal injury law for more than 30 years. We understand the toll a permanent total disability can take. Our personal injury law firm in Oklahoma City is dedicated to aggressively pursuing justice for injured workers and their families. We have built a reputation for success because every year, we win millions of dollars in compensation for our clients.
If you suffered a permanent disability due to a work-related accident, our attorneys can help you understand your legal options and begin taking real action in your case. We offer free, no-obligation case reviews. We look forward to hearing from you. Call us or contact us online now.Get Started