Saturday, September 19, 2015
That Guy in the Bushes With the Video Camera? He's From your Employer's Insurance Company!
Top 5 insurance company moves when conducting surveillance on people claiming workers compensation benefits.Recently there was a woman caught on the Price is Right while collecting workers compensation benefits. She did not look very disabled while jumping up and down with excitement.
This story has gotten much attention and caused outrage. It feeds into the false perception that everyone on workers compensation is just scamming the system.
Insurance companies are not innocent victims and go to extremes to show a claim is fraudulent. Here are five examples that we have personally witnessed.
1. We represented several clients who were losing their jobs after a plant closure. These individuals had been given restricted duties instead of being paid wage loss benefits. A surveillance van actually sat in our parking lot during a group consultation. Was this a legitimate activity check or just harassment?
2. Another client has been in a wheelchair since the 1980s due to a spinal cord injury. The only dispute was regarding current home modifications. The insurance company hired a private investigator to see if he would secretly get out of his wheelchair after 25+ years. This shows the depths of insurance company paranoia.
3. One client lost her arm in an industrial machine. An investigator showed up at the hospital within hours of amputation trying to get a sample for a drug test. Emergency care was still being administered and she was appropriately unavailable.
4. An insurance company lawyer made a big deal about surveillance video showing our client working on a vehicle in his garage. This was a concern because he was disabled from being an auto mechanic. Turns out the vehicle was a model car and our client was hunched over a workbench in pain.
5. A private investigator lied to a doctor’s office to obtain confidential medical information. This individual claimed to be our client’s relative and wanted to know about treatment including the next appointment date.
Carey & Associates never charges a fee to evaluate a case. We have represented injured and disabled workers exclusively for more than 45 years. Call (207) 364-7826 or message us for a free consultation.
Tuesday, February 17, 2015
Residual Functional Capacity
In order to know whether you can work, the Social Security Administration (SSA) needs to know what you are still able to do, after considering the effects of your disability. For instance, if you can still sit and type, but you can’t walk or stand for three hours, the SSA will use this information to show you can probably do some kinds of work but not others.
What Is Your Residual Functional Capacity (RFC)?
To learn what your capabilities are, a disability claims examiner works with a medical consultant at DDS (Disability Determination Services, a state agency that works for the SSA) to perform an RFC (residual functional capacity) assessment on your claim. The consultant will determine what level of exertion you are capable of, and what restrictions limit the jobs you can do. The medical consultant will rely on your medical record and your doctor’s notes about your functional abilities and restrictions to come up with your RFC.
What Level of Activity Are You Capable Of?
Your physical RFC determines whether you can be expected to do sedentary work, light work, or medium work. For instance, if your doctor has restricted you to walking and standing no more than two hours per day, your RFC will be for sedentary work. Here are the various exertional levels that could appear in your RFC.
- Sedentary work. This means you have the ability to lift no more than ten pounds at a time, and occasionally lift or carry things like files or small tools. A sedentary job is mostly sitting, but you must be able to walk and stand occasionally.
- Light work. This means you can lift up to 20 pounds occasionally, and frequently lift or carry up to ten pounds. Light work requires frequent walking and standing and the ability to push and pull with your arms or legs. If you can do light work, you can do sedentary work.
- Medium work. This means you can lift up to 50 pounds at a time, and frequently lift or carry up to 25 pounds. If you can do medium work, you can also do light and sedentary work.
- Heavy work. This means you can lift up to 100 pounds at a time, and that you can frequently lift or carry up to 50 pounds. If you can do heavy work, you can do medium, light, or sedentary work.
- Very heavy work. This means you can lift objects that weigh more than 100 pounds, and frequently lift or carry 50 pounds or more. If you can do very heavy work, you can do all other levels as well.
Your RFC will also include any non-exertional restrictions, such as not being able to stoop, use your fingers, or remember instructions.
How Your RFC Is Used
The disability claims examiner at DDS will first use your RFC to determine if you can be expected to do your prior job. The examiner will look at your work history for the past 15 years to see what type of work you know how to do. If your prior job was sedentary and your RFC is for sedentary work (or higher), the claims examiner will probably find you should be able to return to your job, unless your RFC has further non-exertional restrictions. (If you have mental or emotional limitations, such as memory problems from a psychiatric or neurological disorder, or you are unable to concentrate, DDS should create a mental RFC for you as well.)
Note that to be considered able to work, you must be able to work full time, attend work regularly, be productive at work, and not need to take frequent rest breaks.If the disability examiner determines you can’t do your prior job, the examiner will then use the SSA’s medical-vocational rules grid to determine whether, given your RFC, your age, your education, and your skills, you should be able to learn another job.
If you do not think you can work anymore and want me to help you apply for SSDI, or have already applied and been denied, please contact me and let me help you get the compensation you have earned through your years of hard work.