How Workers’ Comp Interacts With Other Benefits の全文書き起こし

on the definitions in those policies. [2:54] In those policies, this to the amounts of benefits and how those benefits would be paid. In STD and LTD benefits, most of the time, in work comp claims, we look at who funds those premiums. [3:08] So if the employer is actually providing those benefits and pays the premiums for those benefits, when an individual is on work comp and they get those benefits, the STD and LTD are a credit against the work comp. [3:22] So if the work comp rate is $600 and the short-term disability benefit is $500, but the employer paid for the individual's work comp is going to be reduced. [3:33] If the claimant, the injured worker, that's what a claimant is, if the claimant funds those benefits typically, there is no credit and you can get both of them. [3:44] One of the things I make sure I tell clients when they're applying for these benefits that I think is important to mention at this point is you've got to make sure when you apply for STD, LTD, or any other benefits, frankly, that you make sure that if there is a question on that form that asks whether this is a work injury that you check, yes. [4:02] And you let them know it's a work injury. Sometimes, unfortunately, that results, there's at least one I won't use the name, but there's at least one of the popular policies that if you check, yes, you're not going to get LTD. [4:14] There's others that'll pay knowing that they'll get paid back or something like that's going to happen. [4:19] And I've said this in a prior podcast, at least one, maybe two other times. [4:24] And these benefits now are becoming more and more available, aflack out there, and these other benefit programs. We have them here at my firm. [4:35] And so we make them available to employees, but the employees pay premiums for some of these things. The impremiums are typically very, very reasonable, but there are short term and long term disability benefits. [4:46] And I can't say this strongly enough. This is what I've said in other podcasts. If you have these available, if you have the ability to get short term, long term disability benefits, get them. [5:00] Take advantage of those. I understand it's money out of your pocket. It's typically not a huge amount of money. [5:07] But what I have seen over three decades of practicing in the field of work is calm. It takes time. And if a claim is denied, and you have no income, and we are fighting. [5:20] I think there was the podcast we just did. We talked about the fact that a comp claim can take a year of litigation. Imagine being without income for over a year. [5:30] That's a significant problem for just about anybody. How do you pay your bills? [5:34] Or mortgage or electricity? That's a big problem. And so personally, I have said this in the prior podcast. As I started to do this back in the early 90s, I saw what was happening to my clients where I was having clients who were losing everything their house was in foreclosure. [5:52] Their car was

repot. People selling things of great sentimental and family value watch collections that have been passed down from great, great, great grandfather's years passed. [6:02] And they're selling that because they don't have a choice. So my biggest piece of advice or an important piece of advice here today. [6:09] If you have the ability to get short-term and disability and a long-term disability benefit through AFLAC, recolonial life, or through one of these other employees benefit programs, take advantage of that. [6:21] Get it because once you have your injuries too late, you can't run out and hurry up and apply because you're already off. [6:26] Get those benefits in place. You won't regret that. Unfortunately, if you have an injury, you're going to want those benefits in place so that you can continue to function and not be homeless. [6:38] That's simple. If someone uses their employer's health insurance for treatment related to a work injury, can that create problems with the worker's compensation claim life? [6:48] Problems no. And there is a requirement if we are aware of a lien from the health insurance to get it paid back. [6:56] But I don't consider those problems, frankly, having the ability to submit bills and get treatment is critical. [7:10] Okay. As we've talked about in a number of our podcasts already. [7:16] If comp denies the claim and we have to prove our case, we have to have treatment. And if comp denies the claim or comp denies the claim, guess what, they're not paying. [7:24] If you have no other health insurance in place with your employer, how do you get treatment? [7:30] How do we end up fighting to file a comp claim when you don't have any treatment because it's constantly not paying and you go, aww, so we want that health insurance in place and in the Commonwealth, the insurance carriers for health insurance will pay for medical treatment related to a work injury. [7:46] related to a work injury, if that injury is not compensable. [7:51] In other words, if we haven't litigated the case in one [7:55] or the work comp carrier hasn't accepted that injury. [7:58] So under the law here in the Commonwealth, [8:03] if you have a denied work comp claim for your back [8:05] and you need to go get treatment [8:06] and you have health insurance through high mark [8:09] or blue cross or whatever, those carriers are going [8:12] to pay for your treatment, which then allows us [8:15] to be able to fight for your work comp. [8:17] So yeah, there is an issue of trying to get them paid back [8:20] in certain circumstances, but that is far outweighed [8:23] by the need to be able to get treatment for the injury [8:26] and use your health insurance to get that treatment [8:29] so we can litigate and win your work comp claim. [8:33] Mike, can an injured worker qualify [8:35] for unemployment benefits while they have [8:37] that active worker's compensation claim? [8:39] There are some complexities in the unemployment system [8:44] that will

determine whether or not an individual [8:47] can get worker's compensation or unemployment benefits. [8:50] I'm sorry, unemployment requires that you be available [8:53] for some capacity work, even if it's not your full capability. [8:58] So if you have a serious work injury and you've had surgery [9:02] and you can't even work in a light duty job, [9:05] you cannot get unemployment. [9:07] You have to be available for some sort of work, [9:09] which is 50% probably of the time. [9:13] My clients are not totally disabled. [9:15] They can do some work, they just can't go back [9:17] and do their regular job as an electrician. [9:20] They could do some light duty work, [9:21] but the employer oftentimes doesn't have that light duty work [9:24] in those circumstances a client can apply for unemployment. [9:27] Caution here though, however Evan is, [9:30] if you get unemployment benefits, [9:32] that comes off the top of your work comp. [9:34] Your work comp is reduced because you get unemployment benefits. [9:37] So again, there's a timing issue. [9:40] If my client's injury is accepted and he's on workers comp, [9:43] there's absolutely no reason for him to apply for unemployment. [9:46] In fact, in my opinion, it's a mistake for him to do that. [9:49] If he applies for the unemployment, [9:51] it's going to reduce his work comp. [9:53] He's going to end up with the same amount of money in the end. [9:56] And the problem with that for that injured worker [10:00] is there's a limited amount of unemployment. [10:03] So we've seen clients who are off for six months, [10:07] they go back to work, and then they get laid off. [10:10] Well, if they've used six months of unemployment benefits [10:13] while they were off for a work injury, [10:15] and they go back to work regular duty, [10:17] and six months later they get laid off, [10:20] they can't get unemployment. [10:22] Or they might get a limited amount [10:24] because they've used their 26 weeks [10:26] or there's all these different machinations [10:28] that unemployment goes through. [10:29] So typically, I recommend to my clients [10:33] not to apply for unemployment benefits. [10:35] There are times where they have to. [10:37] It goes back to what we said a moment ago. [10:39] People lose everything. [10:40] So if you get injured and comptonize your injury, [10:44] you can do light duty, but they don't want to bring you back [10:46] like duty, so you're kind of catch 22. [10:49] You call me, we go ahead and file for work comp, [10:52] but you can't wait because your mortgage is due. [10:55] So those individuals can go ahead [10:57] and apply for unemployment. [10:59] They'll get their unemployment for 26 weeks. [11:01] That'll tide them over while I'm trying to fight their comp claim. [11:05] They may still have a period of time [11:06] where they don't have income [11:07] because the comp claim might take longer to litigate [11:10] than the unemployment. [11:11] But at least they've got that

initial six months, 26 weeks [11:15] where they can have some income coming back [11:17] when we can kind of get through the initial stages [11:20] of the work comp claim. [11:22] Maybe we wouldn't quickly get a favorable eye on me. [11:25] And that unemployment ends up helping them. [11:28] And then when they win their comp claim, [11:29] it just gets subtracted off of the back money that they do. [11:33] Reduces my fee, but that's okay. [11:35] I want my client not to be having a house in foreclosure [11:38] or someone has watch collection. [11:40] I want them to be taken care of. [11:41] So in those cases we do, but once you're on a work comp, [11:44] you don't need to apply for unemployment, that's a mistake. [11:46] But my client is the FMLA leave fit in [11:50] when someone is already out of work [11:52] because of that work injury. [11:53] FMLA, to be honest with you, has little to no benefit [11:58] for us in a work comp claim. [12:01] FMLA is the family medical evac. [12:04] That requires employers to maintain [12:09] an individual's status as an employee. [12:13] Now I am no FMLA lawyer. [12:15] So we're just doing my basic understanding here. [12:17] But FMLA requires them to maintain the employment relationship. [12:21] I know about FMLA because of my involvement in work comp. [12:25] I'm a fan of that. [12:27] I tell my clients all the time to continue their relationship [12:30] with their employer, continue that relationship [12:34] so that you can go back to work. [12:36] My hope is always that an individual with an injury [12:39] is going to get back to work. [12:41] Working is important. [12:42] I don't want clients on work comp for 30 years [12:44] unless they need it. [12:45] I don't want them on comp for two years [12:47] unless they need to be. [12:48] I want to maintain that relationship. [12:50] So my clients often have to apply for FMLA [12:53] and that gives them a period of time [12:56] where if they're released and go back to work, [12:58] the employer is going to take them back. [13:00] The reality, however, of workers comp [13:02] is workers comp insurance is just like your auto insurance. [13:06] And so those employers, when somebody's injured on work comp, [13:10] they want to bring them back to work anyway. [13:11] So whether they've applied for FMLA, [13:15] usually isn't going to make a difference [13:16] because if nine months down the road, FMLA's long over, [13:20] my client gets the release to return to work. [13:22] The employer wants to bring them back [13:24] because they want to pay them wages rather than work comp. [13:27] So FMLA, we deal with it. [13:30] We file applications. [13:31] Again, I would say make sure if you're asked questions [13:34] about why you're off work, whether it's a work injury, [13:37] you need to make sure you answer those forms of head clients. [13:39] Say no, it's not work related [13:41] because they want to be approved [13:43] for whatever benefit they're applying for. [13:45] And I understand that goes to the fact [13:47] that they need money. [13:49] But again, that can come back to bite you on the comp. [13:51] I've had many cases where the defense council's going, [13:53] wait a minute, you fell out this form [13:55] and you said it wasn't work related. [13:58] We know why they did, [13:58] but it just creates an issue [14:00] that can come back to bite people. [14:02] What about receiving workers compensation? [14:03] And that affects someone's eligibility for that Medicaid. [14:06] Potentially. [14:08] But I can tell you, Evan, that this is one of the things [14:11] that I use very, very often in workers' compensation claim. [14:16] Going back to what we talked about earlier, [14:18] having the ability to treat medically [14:20] is really, really critical. [14:22] It's critical for a whole bunch of reasons, [14:24] the biggest reason my client needs a treatment. [14:26] Let's just face it. [14:27] But also in terms of the legal aspect, [14:29] I need to have the ability to file a comp claim. [14:33] And in order to file a comp claim, [14:34] go back and listen to our prior podcasts, [14:37] you have to have medical evidence. [14:38] And to get that medical evidence, you have to treat. [14:40] So if you have no health insurance, [14:43] and we've talked a little bit ago about health insurance, [14:45] the unfortunate reality, [14:47] I understand the business aspect of it, [14:49] but most people that get hurt at work [14:51] lose their health insurance as soon as they go off work. [14:54] And employers not can continue paying $1,000 a month [14:57] or whatever for your health benefits [14:59] when you're not working, [15:00] even though it's a work convendory. [15:02] And unfortunately, there's nothing in the law [15:04] that says they have to. [15:06] There might be a union collect the bargaining agreement [15:08] that allows those benefits to continue, [15:10] but I would say in 85% or 90% of every case, [15:14] the minute my client has an injury and goes off work, [15:16] their health insurance ends, [15:18] or they get a notice from the employer saying, [15:20] we'll continue to pay your health insurance, [15:21] but UOS $1,200 a month. [15:24] Well, somebody off on work comp [15:25] doesn't have the money to pay for that, [15:27] so they end up losing it. [15:28] So I can tell you, Evan, I don't know percentage, [15:33] but in regularly and in many, many cases, [15:37] I am instructing my clients to go down [15:39] to the welfare office and apply [15:42] for their welfare insurance, which is Medicaid. [15:44] They can also get it by applying for SSI, [15:47] but we use Medicaid as a way to get our clients' treatment [15:51] so that they can ultimately pursue their work comp injury. [15:54] Get the treatment they need. [15:57] Complicating factor is if we settle that case [16:00] or if we win that case, [16:01] we've got to make sure that Medicaid, [16:03] the state has a big stick. [16:05] So we have

to make sure we get Medicaid paid back, [16:08] but that's in the big scheme of things, [16:10] that's something we can deal with very easily [16:12] and it's imperative, critical, crucial, [16:14] whatever word you want to use. [16:16] We need people to treat, they need to treat, [16:19] we need them to treat for legal issues [16:21] so we can fight their case and get them paid, [16:23] so that's simple, unfortunately. [16:25] If another benefit pays for lost wages [16:28] or medical expenses after that work injury, [16:30] can there be reimbursement issues later, Mike? [16:33] There can be, but it goes back to what I've said earlier. [16:36] I really don't care. [16:37] I mean, we're able to get people paid back. [16:39] So if somebody gets their short-term disability, [16:42] if we have this happen regularly, [16:44] a client gets STD benefits and then they go on to LTD [16:48] while we're fighting their work comp claim for a year. [16:52] We're gonna have to pay back STD, [16:54] we're gonna have to pay back LTD. [16:55] It's gonna be paid back either as a credit, [16:58] which means the comp's gonna reduce [17:00] what they owe them when we win the case, [17:02] and if they owe them 15, they're only gonna pay them 10 [17:04] because they got $5,000 of STD benefits, who cares? [17:08] They had money while they were needed it, [17:10] and then they win their case. [17:11] That LTD is gonna get paid back one way or another, [17:16] but it doesn't matter. [17:17] It's money that kept them in their house, [17:19] paying their bills, feeding their family, [17:22] while we litigated that work comp claim. [17:24] And in the end, if we ultimately have to do some things [17:26] to get LTD paid back, it happens all the time, honestly. [17:30] It happens all the time. [17:31] Then we deal with it at the end, [17:33] but at least that's a way that my client [17:35] has some income coming in and that's important. [17:37] My last one before I get you out of here, [17:39] what information should an injured worker keep track of [17:41] if they're receiving workers compensation [17:43] along with another type of benefit? [17:46] And just keep track of the amounts. [17:48] In the end of a case usually if there's been an STD [17:51] or an LTD issue, the work comp carrier, [17:54] the attorney who is there for them is usually able [17:56] to get that from the employer. [17:59] But I've learned over the years, [18:00] I always want my clients to be able to verify things. [18:03] So I get a letter from the employer attorney [18:05] that says, hey, we paid short-term disability [18:07] from this date to that date. [18:10] And it was funded this percentage by the employer [18:13] and that percentage by the claimants [18:14] so we're entitled to this much back. [18:17] I want my client to be able to look at that [18:19] and have some clue on when they received benefits, [18:21] how much they received, if there were any reductions. [18:25] And oftentimes who paid for many clients [18:28] don't know who pays for their short-term [18:30] and long-term disability benefits. [18:33] They think the employer is paying for it [18:34] but it's actually a deduction out of their paycheck. [18:36] So that's not unusual [18:38] because the amounts usually aren't huge. [18:41] So keep track of that sort of thing. [18:44] Always make sure that any question that you answer [18:47] on any form for any type of benefit, [18:50] whether it's a state benefit or otherwise. [18:53] If it asks you if it's a work comp claim [18:56] or a work comp injury, [18:57] you need to make sure you're honest on those forms [18:59] and put it on there. [19:01] Even if the answer to that question's going to hurt you [19:04] if it's a work injury, [19:05] you still want to be honest [19:06] because things will come back being honest [19:09] is always the best choice. [19:11] It's good stuff, Mike. [19:12] Thank you so much for your time, sir. [19:13] Hey, my pleasure. [19:14] I hope this helps people understand. [19:16] There are lots of benefits out there [19:18] and again, Evan, my big advice to people [19:20] is if you have the availability of STD or LTD benefits, [19:25] take advantage of them, get them in place. [19:28] We never hope that never want people to have an injury [19:31] but having those benefits in place [19:33] can make a huge difference in your future. [19:35] That's it for today's episode [19:36] of the Western PA Work Injury Podcast. [19:38] If you're receiving workers' compensation [19:40] along with other benefits and have questions about [19:42] how they may affect each other, [19:44] you can learn more. [19:45] Get in touch with my man Mike Russell [19:47] at attorney Michael Russell.com. [19:49] Thanks for listening. [19:50] Don't forget to subscribe, share, and leave a review [19:52] so more injured workers in Western Pennsylvania [19:54] can find that information that they need [19:56] and we'll see you all next time. [20:02] Thanks for watching. [20:03] Be sure to hit that like and subscribe button [20:06] and leave us a review in the comments.