Trump’s Budget Director Attacks Social Security Disability As “Very Wasteful Program”

On a recent appearance on Face the Nation, Trump’s budget director, Mick Mulvaney, finished his interview with an attack on Social Security and Social Security disability in particular.

“Do you really think that Social Security disability insurance is part of what people think of when they think of Social Security? I don’t think so,” Mulvaney said. “It’s the fastest-growing program. It grew tremendously under President Obama. It’s a very wasteful program, and we want to try and fix that.”

The truth is that while Social Security retirement enrollment has continued to increase at a steady pace since 2008, disability is far from the fastest-growing Social Security program. It’s not even growing with enrollment that barely expanded between 2012 and 2014 before steadily declining. At a peak in 2014, disability enrollment reached 8.95 million disabled Americans but it had fallen to 8.81 million by last year, dropping about 3% in two years.

Social Security trustees predict disability enrollment will pick up again in the coming years but at an average pace of around 0.5% a year. On the other hand, retirement enrollment is expected to increase from 41.5 million last year to nearly 69 million in 2036, or 66% compared to 11.7% with disability over the same time period.

Calling the program wasteful is also a stretch. The average disabled worker receives just $1,165 per month under Social Security disability for an annual income of just $13,985. That’s hardly more than the federal poverty level of $12,060.

The myth that Social Security disability is a waste and huge amounts of government money go to people who are gaming the system is damaging and potentially complicating the claims process for workers who find themselves disabled. Despite anecdotal evidence, the disability error rate in the program is less than 1%, which includes underpayments and overpayments.

Disability benefits are not easy to obtain, contrary to popular belief, but may involve a long certification process that may take many months. Only around 40% of disability applicants even end up receiving benefits.

Government officials perpetrating these harmful misconceptions can have a very real effect on the 11 million workers and their family members who depend on disability benefits to get by.

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Trump’s Budget Director Attacks Social Security Disability As “Very Wasteful Program”

On a recent appearance on Face the Nation, Trump’s budget director, Mick Mulvaney, finished his interview with an attack on Social Security and Social Security disability in particular.

long term disability appeal“Do you really think that Social Security disability insurance is part of what people think of when they think of Social Security? I don’t think so,” Mulvaney said. “It’s the fastest-growing program. It grew tremendously under President Obama. It’s a very wasteful program, and we want to try and fix that.”

The truth is that while Social Security retirement enrollment has continued to increase at a steady pace since 2008, disability is far from the fastest-growing Social Security program. It’s not even growing with enrollment that barely expanded between 2012 and 2014 before steadily declining. At a peak in 2014, disability enrollment reached 8.95 million disabled Americans but it had fallen to 8.81 million by last year, dropping about 3% in two years.

Social Security trustees predict disability enrollment will pick up again in the coming years but at an average pace of around 0.5% a year. On the other hand, retirement enrollment is expected to increase from 41.5 million last year to nearly 69 million in 2036, or 66% compared to 11.7% with disability over the same time period.

Calling the program wasteful is also a stretch. The average disabled worker receives just $1,165 per month under Social Security disability for an annual income of just $13,985. That’s hardly more than the federal poverty level of $12,060.

The myth that Social Security disability is a waste and huge amounts of government money go to people who are gaming the system is damaging and potentially complicating the claims process for workers who find themselves disabled. Despite anecdotal evidence, the disability error rate in the program is less than 1%, which includes underpayments and over payments.

Disability benefits are not easy to obtain, contrary to popular belief, but may involve a long certification process that may take many months. Only around 40% of disability applicants even end up receiving benefits.

Government officials perpetrating these harmful misconceptions can have a very real effect on the 11 million workers and their family members who depend on disability benefits to get by.

If you are in need of assistence for Social Security disability insurance, then contact the best disability insurance attorneys in Philadelphia, which is Edelstien Martin & Nelson. Contact them today to discuss your case.

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Own Occupation vs Any Occupation Disability: What You Should Know

back painWhen it comes to long-term disability insurance, few areas are as confusing and difficult to overcome as how the insurance policy defines a disability. Disability insurance falls into two primary categories: own occupation policies and any occupation policies. The type of policy you have will have a dramatic impact on whether the insurance company even considers you disabled. Here’s what you should know about the difference between these two types of disability claims.

What is Own Occupation vs Any Occupation?
When the policy covers “own occupation” disability, it means your policy requires that you be unable to perform the duties of your particular occupation to be classified as totally disabled. More commonly, disability insurance uses the “any occupation” standard. This means disability is defined much more broadly to the inability to perform any occupation for which you are reasonably suited based on your work experience and education.

With most long-term disability group insurance policies, the policy offers benefits under the “own occupation” disability definition for the first two years. To continue receiving disability benefits, you must be considered disabled under the “any occupation” standard.

Without the “own occupation” coverage, you face the risk that the insurance company may decide you could work in some other capacity. This is especially important if you have a high level of skills or training that could lead the insurance company to determine you are able to work in another occupation, even if you would be unable to perform your current job.

What is Your Own Occupation?
While the “own occupation” clause is fairly specific in terms of defining your disability, it does leave room for question. An experienced LTD attorney will argue that your policy’s “own occupation” definition should be limited to the exact work you were doing at your job when you were hurt, not an occupation performed in a similar setting in the general industry in which you worked.

There are also two types of “own occupation” clauses: one states that you are disabled when you can no longer perform the duties of your own job but you are not gainfully employed in another area, while a “true own occupation” definition just means you can’t perform your own occupation. In the latter case, you can still find employment in another industry without sacrificing your disability benefits. This type of “own occupation” clause is most favorable but it’s rarely found in group insurance plans.

The “own occupation” clause is an important form of protection as it can also give you the ability to work in another field if you can. If you find work in another industry, you can still receive long-term disability benefits under this clause without negative consequences. As an example, a surgeon who is determined to be totally disabled and unable to perform his or her own occupation could work as a general practitioner and still receive disability benefits.

Understanding how your insurance company defines disability is crucial and every insurance company is different. It’s important to work with a long-term disability attorney who has extensive experience handling LTD claims to help you build a strong case. Contact Edelstein Martin & Nelson today for a free consultation with a Philadelphia long-term disability lawyer to discuss your case.

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The Case of Del Gallego versus the Plan on the Offset of Disability Benefits

John Del Gallego, an employee, was injured at work and granted permanent partial disability (PPD) workers’ compensation benefits. The Plan, Wells Fargo and Company Long Term Disability Plan and insurer Metropolitan Life Insurance Company (MetLife), offset such award by the amount of John’s long-term disability benefits. The employee filed suit under Employee Retirement Income Security Act (ERISA), 29 USC  § 18, against the Plan and MetLife, saying that the offset was improper. Judge Vince Chhabria of the Northern District of California granted summary judgment to the plan and MetLife, but Del Gallego appealed.

“Other Income Benefits”

The Plan incorporates group certificate of insurance, which was issued by MetLife. It provides long-term disability benefits reduced by other income benefits, which it defines as including workers’ compensation or similar law. It also states that periodic benefits, substitutes and exchanges for periodic benefits will all be accounted.

The court interprets ERISA terms in the popular and ordinary sense, as would a person of average experience and intelligence. The Plan’s plain language provides that a covered worker’s long-term disability benefits will be reduced by periodic compensation benefits and the district court did not err in interpreting the Plan.

Russell versus Bankers Life Case

workers comp benefits and justice for allHowever, Del Gallego argues that other income benefits are only the ones paid for lost wages and includes only temporary disability payments. He relies on the case of Russell versus Bankers Life Company, but this involved a contract defining income from other sources as any payment under Workmen’s Compensation Act providing benefits for loss of time from employment. Since the Plan does not limit other income benefits to loss of time from employment, the case is inapposite.

Del Gallego’s Arguments

Del Gallego also cites the workers’ compensation phrase as ambiguous since a reasonable person would not anticipate that payments for the worker’s future would be offset from the disability insurance benefits. However, Plan’s language unambiguously covers all compensation benefits. The employee also asserts that because the Plan asks for proof of the amount attributable to lost income when a worker receives other income benefits in lump sum and not in monthly payments, reduction should be limited to the portion of the lump sum attributable to the income lost. He cites the provision only applies to lump sum and not to periodic benefits, so the Plan did not offset the lump sum compensation settlement that he received against his Plan benefits.

Del Gallego also asserts that even if his weekly permanent partial disability benefits were for loss of future earning, these are not income. Additionally, the term periodic benefits are ambiguous. Since the Plan has particular language exempting lump sum payments from the setoff, it is impossible to interpret periodic payments as lump sum payment.

The Panel’s Decision

The Ninth Circuit US Court of Appeals panel rejected the arguments of John Del Gallego that partial permanents disability benefits were not income and that periodic benefits is facially ambiguous. Del Gallego was represented by Laurence F. Padway while Rebecca Ann Hull represented the Plan and MetLife.

If you are in need of a personal injury attorney in Philadelphia, Pa, then you should call Edelstein, Martin & Nelson at http://www.philadelphiadisabilityinsurancelawyer.com/ or you can call them at the following number (215) 731-9900 and schedule an appointment to sit down and discuss your case.

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Long-Term Disability Risk Increases After Seniors Visit ER

working seniorAccording to a new study, older adults who are treated in an ER for an injury or illness are more likely to become less agile and more disabled over the next six months. The study, published in the Annals of Emergency Medicine, was a follow up on research that found seniors suffer from reduced physical agility and disability after hospitalization.

During the study, researchers tracked more than 750 patients aged 65 and older over 14 years, including some adults who were treated in an ER and some who were not.

Researchers discovered that seniors who were discharged from an emergency room were more likely to be living in a nursing facility, become disabled, or die over the next six months compared to seniors who were not treated in an ER.

The extra cost for medical care and long-term care for newly disabled older adults is estimated at $26 billion per year. One strategy to potentially address the issue may include employing geriatric advanced practice nurses to assess older patients’ risk for decline.

Last year, a separate study found that more seniors are working now than any time since the turn of the century and today’s senior workers spend more time on their jobs than their peers. Almost 9 million people, or 19% of seniors in America, were employed part- or full-time. The number of older men and women who are in the job market has grown over time, although working during what many consider the retirement years still largely affects men.

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Nurses At High Risk of Workplace Injuries

nurse disability claimsWhile nursing may not be at the top of the list of most dangerous occupations, nurses still face higher-than-average risk of health complications due to their career and they are more likely to suffer overexertion injuries than most professionals in Pennsylvania.

Nurses working in Philadelphia hospitals, care facilities, and nursing homes play an important role, but many at some point face health problems due to their job that prevent them from working.

Nursing Is a Physically Demanding Job
Nursing is a very physical career that often requires strenuous tasks such as moving patients. According to the New York Times, the average nurse works a 12-hour shift that can feel even longer due to the physical strain. The same article reported that 75% of nurses suffer a strain or sprain in the workplace and about 50% of all nurses experience lower back pain or injuries within any given year.

Nurses are at a higher risk for a variety of potentially disabling injuries, especially overexertion injuries caused by sudden or repeated trauma or exertion. Nurses who work in a hospital are twice as likely as other workers to suffer these injuries while nursing home workers are three times as likely to suffer an overexertion injury.

In addition to the physical demands of the job, nurses and other healthcare shift workers are at a higher risk of sleep disorders, heart disease, diabetes, and stress than the general public.

Sometimes injuries sustained by nurses can be shown to be a work-related accident and qualify for workers’ compensation, but this can be very challenging in some cases, especially with heart disease and back injuries. Nurses who have become disabled and unable to work may qualify for workers’ compensation and/or a long-term disability claim. If you are unable to work and need help filing an LTD claim or appealing a decision, an experienced LTD attorney in Philadelphia can help.

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Canadian Study Finds Link Between GDP And Long-Term Disability Claims

philadelphia LTD claimsIn a pioneering study conducted by Canada’s RBC Insurance, a link has been found between long-term disability (LTD) claims and GDP. The link is counter-intuitive, showing that long-term disability claims actually rise with economic growth. When GDP falls, LTD claims do as well.

It may seem odd to find claims increasing when economic times are good, but RBC Insurance believes it’s a similar phenomenon to adrenaline rush stressing the body.

“During challenging or uncertain economic times, workers are worried about job security and performance, creating significant mental and/or physiological stress,” RBC Insurance said in a statement. “As GDP rises and the economic outlook brightens, workers begin to feel more secure and that pent up stress and anxiety takes its toll, which results in them succumbing to illness and taking a leave from work to recoup.”

As with the United States, most LTD claims are related to stress, including mental and nervous system disorders like depression and circulatory disease like heart attacks and stroke, not workplace accidents and physical impairments as many believe.

The correlation was found after studying six years’ worth of data from more than 300,000 group benefit clients. RBC Insurance says it’s created an algorithm for companies to predict disability rates up to two years ahead.

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Lawsuit Claims Government Illegally Garnished Disability Benefits Over Student Debt

New evidence shows the student loan crisis affects many more Americans than younger college-age adults. According to a new study, more than 173,000 people in 2015 alone had their Social Security benefits reduced due to old student loans, including many younger adults on Social Security disability.

One borrower, army veteran Hector Rodriguez, has filed a lawsuit after losing part of his needed Social Security disability benefits due to a student loan that was already eligible for forgiveness. The lawsdisability lawyer Philadelphiauit claims the government is needlessly forcing disabled borrowers to lose their benefits over defaulted loans.

Rodriguez took out the loans in the 1970s to pay for college, but he was forced to drop out due to frequent hospitalizations. He later defaulted on the student debt. He was diagnosed with schizophrenia in 1973 and began receiving Social Security disability benefits shortly afterward and continuously since.

His disability was severe enough that he qualified to have his student loans forgiven through a total and permanent disability discharge (TPD), but he received a notice in 2013 that the government was going to garnish part of his disability benefits to pay off the loan. According to the lawsuit, the notice did not indicate that his student loans could qualify for a disability discharge and the information was never provided by the government-hired debt collector when he told them he was disabled.

After receiving the notice, the government began garnishing his disability payments and taking $177 out of his $1,184 monthly check. While the 67-year-old veteran eventually spoke to an attorney who told him he was eligible for the disability discharge, it took 11 months to prove and he lost $1,300 in garnishments.

This lawsuit highlights the government’s often extreme approach to collecting on defaulted student loans. A growing number of Americans are losing disability benefits to sometimes decades old student loans. Of the 114,000 borrowers over 50 who had government benefits garnished, over half were receiving Social Security disability benefits, not retirement benefits.

While the government has sometimes alleged that borrowers should know their debt is dischargeable, activists are trying to raise awareness of the government’s sometimes aggressive actions. In the case of Rodriguez, the government had information available to it to indicate the debt was dischargeale, yet still chose to hire debt collection companies anyway.

The Department of Education has taken some action to prevent this sort of problem. In 2016, the agency cross-referenced its records with the Social Security Administration to identify about 400,000 borrowers who qualify for a discharge, including 100,000 of which were at risk of losing Social Security benefits or tax refunds.

If your disability benefits have been garnished, it’s important to discuss your options with a disability attorney in Philadelphia.

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Department of Labor Publishes New Rules Affecting ERISA Disability Claims

disability insuranceThe Department of Labor has published new regulations that will affect ERISA disability insurance claims as well as the appeals process. The new rules will apply to any claims for disability benefits filed on or after January 1, 2018.

These rules will apply to any ERISA-governed disability plan, includig short-term and long-term disability plans and other plans that offer benefits based on whether a participant is disabled, including pension plans and 401(k) plans.

The following are the most important changes coming to the ERISA claims process.

#1. All claims and appeals must be decided impartially and independently.
This means that the individuals who decide to approve or deny claims cannot have an incentive to deny claims. This rule will prohibit a plan from offering bonuses to claims adjusticators based on the number of claims they deny. It will also prevent plans from contracting with medical providers based on their reputation for giving outcomes that benefit the plan in contested cases. This is an important change as insurance companies routinely contract supposed independent medical providers who have an incentive to deny claims that would cost their employer too much money.

#2. Denial letters must include specific information.
The new regulations will require claim denial letters to include:
– A notice of the claimant’s right to access their claim file and other documents.
– An explanation about why the plan did or did not agree with the opinion of medical providers or with any disability determinations that were made by the Social Security Administration.
– Any internal guidelines the plan used while deciding whether to approve or deny the claim.
– Linguistically and culturally appropriate. As an example, a denial letter sent to an address in an area in which at least 10% of the population is literate only in the same non-English language must have a statement that the information provided is available in other languages. The notice must be provided in the claimant’s native language upon request.

#3. Claimants must receive notice and an opportunity to respond before an appeal is denied.
Before an appeal can be denied, the plan must give the claimant sufficient notice and a fair chance to respond if the denial is based on new or additional evidence or opinions. All appeal denial letters will need to describe any plan-imposed time limits on filing a lawsuit and the date of expiration for any limitations.

#3. Claimants cannot be barred from filing a lawsuit due to failure to exhaust the plan’s claims process in some cases.
When the new rules take effect, a claimant will be allowed to sue even if the plan’s claims procedure is not exhausted if the plan fails to comply with its own claims procedures.

These regulations will take several important steps to protect disabled workers from unfair denial of disability benefits.

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Is Your Disability Insurance Policy Subject to ERISA?

Most people who file a disability insurance claim are unfamiliar with Employee Retirement Income Security Act (ERISA) — but it can have a big impact on your claims process and taxes on your benefits. ERISA is a federal law that is designed to give affordable employee benefits that protect workers. Unfortunately, ERISA regulations have generally been interpreted by courts in a way that favors insurance companies. An important goal for any disability attorney is proving that a claim is not governed by ERISA to improve the odds of collecting benefits.

Group vs Individual Long-Term Disability Insurance

Is your disability insurance policy ERISA regulated? disability lawyers in philadelphiaThere are two main types of long-term disability insurance policies: group policies provided by an employer and individual policies which are purchased independently through an insurance agent. Group policies are usually subject to ERISA regulations whereas most individual policies are not. Over 80% of people with disability insurance have a group policy through their employer.

Is Your Policy Subject to ERISA?

There are five key requirements for a policy to fall under ERISA regulations:0

  • A “plan, fund, or program”
  • That is established or maintained
  • By an employee organization or employer
  • To provide surgical, medical, hospital care, accident, sickness, disability, death, vacation, or unemployment benefits
  • To plan participants or their beneficiaries.

ERISA-governed disability policies are usually part of an employee benefits package and it may require that some amount of the premium be paid by the employee.

Even if you have a group insurance policy, it may not be subject to ERISA if:

  • No contributions are paid by the employee organization or employer,
  • Participation is voluntary for members or employees,
  • The primary functions of the employer in terms of the program are to allow the insurer to publicize the program to employees, collect premiums through payroll deductions, and remit them to the insurer, and
  • The employer receives no financial benefit from the program other than reasonable compensation (not profit) for administrative services.

There are several differences between ERISA and individual disability policies, including premium costs, portability of coverage (whether it moves with you regardless of employer), benefits taxation, and the appeals process. Not sure if your disability policy is governed by ERISA? An experienced LTD attorney in Philadelphia can help you understand your policy and your rights. Contact Edelstein, Martin & Nelson today for a free consultation with a long-term disability lawyer to discuss your case.

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