This issue is very common for recovering job injury victims who reach MMI but don’t qualify for long-term workers’ compensation disability. Maximum Medical Improvement, basically means the person’s post-injury physical condition is as good as it’s going to get, so there’s no point in continuing physical therapy. Insurance companies quickly pull the financial plug in these situations and argue in court that the victims aren’t “disabled” enough to receive long-term benefits.

SSDI after a Workers’ Comp Settlement

Workers’ compensation is no-fault insurance that covers job-related injuries and illnesses. Likewise, Social Security Disability Insurance pays no-fault benefits to qualifying individuals, regardless of the cause of their injuries or illnesses. These qualifications are:

  • Sufficient Work Credits: These rules are quite complex and change every year. Generally, if the applicant has consistently worked at least part-time for about the past ten years, the applicant probably has enough work credits.
  • Long-Term Disability: SSDI benefits are available if the applicant’s medical condition is terminal or is expected to last at least a year. Usually, the Social Security Administration requires annual examinations to determine if the applicant’s condition has improved and benefits should be terminated.
  • Disabling Condition: Most MMI workers’ comp applications fail on this last point. Essentially, applicants must be unable to work because of their mental, physical, or other conditions. The SSA also considers an applicant’s ability to transition to another career, if any.

A collateral condition changes things. Assume Phil hurts his back at work, reaches MMI, but his back is still messed up. As a result, he becomes sedentary and gains weight. Obesity could be a qualifying SSDI condition.

Third-Party Lawsuits

Almost all states have exclusive remedy laws. Job injury victims cannot sue their employers in court for said injuries, no matter how negligent the employer was. However, job injury victims can sue third parties, like the manufacturer of a defective product, for their injuries, at least in most states.

To obtain disability compensation, these victims must normally prove a product defect, which could be a manufacturing or design defect, caused their injuries. Asbestos exposure is a good example.

Assume Alex’s boss sent him to demolish an old building without proper personal protection. Almost every structure built before 1980 contained asbestos. Alex inhaled a fiber and, several decades later, developed mesothelioma. Alex cannot sue his boss in court, because of the exclusive remedy law. However, Alex might be able to sue the company that manufactured the asbestos-laced materials.

If Alex’s third-party lawsuit is successful, his employer or insurance company is usually entitled to a subrogation lien. In plain English, that means the court must reduce his damages and repay the insurance carrier for the benefits it paid.

If you find yourself in a similar situation, it’s worth scheduling a consultation with an attorney.  

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