Understanding Workers' Compensation The Workers’ Compensation system has its own unique version of ‘legalease.’  The last thing you want to do when you’re hurt is figure out what the state and the workers’ comp carrier are talking about.  Especially when getting it wrong means not getting the money you deserve. Here on the Knisley Law blog, we’ve written about how to successfully file a claim for workers’ compensation and social security disability.  We want to make sure you know some of the key steps to take.  But the forms and steps we tell you about are full of words people will never see outside courts and state bureaucracy. We want you to know these eight workers’ comp claim terms to help you understand the process better: Workers’ Compensation Workers’ Compensation is insurance that gives you wage replacement and medical care, if you were injured in the course of employment.  The Ohio Bureau of Workers’ Compensation was established in 1912.  It covers about two-thirds of the state’s workforce. It’s the second-largest provider of workers’ compensation in the country. Employee / Employer According to Ohio workers’ compensation law, an “employee” is anyone who works for someone else.  They’re expected to make more than $160 per quarter.  The law has a long list of ways a person could be an employee.  If someone meets 10 of those criteria, they’re considered an employee. “Employers” include the state, counties, cities and any person, firm or organization that has one or more qualified employees. Course of Employment “Course of Employment” means it happened at a time or place related to your job.  It can also mean other places related to your employment, like training or off-site activities.  It does not mean you had to be “on the clock” at the time, or performing a job task.  But if you were doing something for personal business without your employer’s knowledge or permission, it may not be “course of employment.” Injury An “injury” in workers’ comp is any physical injury or illness caused by things or events in your job.  Workers’ compensation law in Ohio does not count some things as injuries.  Most psychiatric conditions, natural aging and some pre-existing conditions are not legally work injuries. Claim Pending If the Ohio BWC says your workers’ compensation claim is “pending,” that means your claim is still being investigated.  It’s a step past “new claim” because it has been coded with the right medical codes for your injuries. Disallowed vs. Allowed A workers’ comp claim is “disallowed” when the investigation is done and they’ve decided your injury does not meet their requirements to be paid.  The claim is “allowed” when they’ve decided the opposite – that your injury and how it happened meets the legal requirements.  In Ohio’s system, both statuses can be appealed within a certain amount of time. Dismissed A workers’ compensation claim is called “dismissed” when you withdraw a claim before the BWC has a chance to rule on it one way or another.  It’s neither allowed nor disallowed, and you can apply again later if you choose to. Settled Your claim is “settled” when it has been closed out in exchange for a lump sum payment from insurance or your employer.  A settlement agreement may happen if you and your employer agree that a lump sum is better for your situation than a series of payments.  If the employer no longer does business in Ohio or you were no longer employed with them by the time the claim was made, this may be the outcome. Bonus term:   Authorized Representative “Authorized Representative” is someone that you can select or hire to help and represent you with your workers’ compensation claim.  The experts at Knisley Law can help you by being your authorized representative.  Make sure you receive the compensation for your injuries that you deserve.  Contact us today to discuss your case!

The Social Security Disability claim system is challenging no matter where you were employed before your disability.  Furthermore, if you become disabled, while running your own business or being an independent contractor; the process becomes even more complicated.  Knisley Law Offices, however, wants you to know that receiving Social Security Disability Income (SSDI) is still possible for you, and they want to teach you how to give your claim the best chance at success after years of paying into SSDI as a self-employed worker. How Are Self-Employed People Eligible For Social Security Disability Income? Self-employed workers pay into the Social Security and Medicare systems through self-employment taxes on Form 1040-SE each year.  If you have $4,880 or more in profit from your business or work for the year, you earn four quarterly credits.  This gives you the same credit in the system as someone who has worked as an employee for that full year. Depending on your age, you need to have paid into the Social Security system for a certain number of quarters, either as an employee or by paying the minimum in self-employment taxes.  The maximum number of credits required is 10 years worth, or 40 quarterly credits. Self-employed workers, including freelancers, small business owners, and independent contractors do not officially have an employer who pays the employer contribution portion of the taxes.  You, as a self-employed individual, must pay both sides of the contribution. Theoretically, if you become disabled, your access to benefits should be the same as someone who has worked for someone else.  In practice, this is not necessarily true. Common Stumbling Blocks for Self-Employed Social Security Disability Claims SSDI evaluates the medical evidence for your disability and whether you are able to continue with ‘Substantial Gainful Activity,’ or SGA. The terms ‘substantial’ and ‘gainful’ mean that you are doing significant physical or mental activity in any kind of work that people usually get paid to perform. The gainful part is often the stumbling block for the previously self-employed. People who use time during their disability to volunteer, plan for future projects, or help a family member with a business can be declined for SGA reasons. If the work you are doing as a volunteer (or in an unpaid position but may result in business profit later) is “worth” more than $1,090 a month, it is considered “gainful.”  Your work for your previous business or a new business you started after becoming disabled could be considered SGA, even if you take a net loss. Social Security looks at your SGA work ability at the time you make the original claim as well as 24 months into your benefits. They call this evaluation “The Three Tests.”  This assessment consists of the following questions: Are you rendering significant services to the business? Has the business earned more than $1,090 a month? Is your work is comparable to the work of persons without disability in your community in similar businesses? Is your work worth more than SGA level in terms of the effect on the business or what you would pay if you hired an employee to do the work? If you were to answer “yes” to any of these questions, Social Security would say that you are not – or no longer – disabled. How to Improve Your Chances for a Self-Employed Disability Claim If you were an independent contractor or owned your own business and became disabled, you should talk with an SSDI expert, like us at Knisley Law, to make sure that you are not accidentally performing SGA-level work for your old business or whoever took it over when you became sick or injured. Your self-employment taxes have paid your fair share into the SSDI insurance system.  Do not let technicalities and legal mistakes keep you from the support you deserve.   Contact us today to discuss your case and give your claim the best chance of success. # self-employed # ssdi # benefits

Today's market demands home delivery of both goods and services, oftentimes with the expectation that the good or service be provided almost immediately after the request.  As a consequence, more employers in Ohio and the midwest find it necessary to employ individuals capable of traveling throughout the state/region/country.  Interstate travel has become a common feature of modern employment, but with it comes risks natural to travel.  When a majority of an individual's work day is spent in transit, they are obviously placed at a far greater risk of an accident than your typical desk job. Employers in Ohio are well aware of this risk and are becoming increasingly aware of their ability to mitigate the cost of this risk by compelling Ohio employees to accept what is essentially a state sanctioned forum selection agreement. Forum selection clauses and mandatory arbitration agreements alike have been rightfully derided by consumer rights advocates as a predatory practice, and have come under increased scrutiny in recent days for their ability to insulate corporate America from liability by providing them with a home court advantage.   When it comes to workers' compensation in Ohio, the C-112 form provided by the Bureau of Workers' Compensation enables this insulation for multi-state employers by acting as a waiver to a right otherwise codified by statute, in this case R.C. section 4123.80.  The unfortunate reality for Ohio employees is that you may be granted inadequate benefits from an alternative jurisdiction in the event of claim allowance, or alternatively you may be compelled to litigate your claim in an inconvenient venue in the event of claim denial. The General Assembly has compounded this issue by enacting R.C. section 4123.542, which precludes the pursuit of a claim in Ohio in the event a determination on the merits is issued by an alternative jurisdiction.  In neighboring jurisdictions, a variety of different parties are able to file a claim on behalf of the injured worker, oftentimes without the injured worker's consent or acknowledgment.  This means multi-state employers can file a workers' compensation claim for an injured worker in a neighboring jurisdiction to avoid liability in Ohio provided a determination on the merits of the claim is issued before the merits of the Ohio claim are considered.  A determination of the merits, for purposes of the language expressed in the code, means any decision concerning the compensability of the claim.  In jurisdictions other than Ohio, this decision is oftentimes made by a private insurance company, with ample economic incentive to deny coverage, after a cursory review of the evidence. As an Ohio employee exposed to risk on the roads and highways of our state, it is incumbent upon you to know your rights and to protect your interests before agreeing to the terms of hire. Do not forfeit your right to coverage in Ohio, do not allow or enable your employer to abdicate their coverage responsibilities.  Please speak to an attorney in the event you suffer a work injury while in transit.  There are unfortunately too many opportunities for the Bureau of Workers' Compensation to deny coverage, or for your employer to contest coverage in the event of an automobile accident. # forumselectionclause # mandatoryarbitration # employmentcontract # knowyourrights

Denied Social Security Claims Everyone knows the legal system can be complicated.  Whether you are dealing with an issue big or small, any legal component can take a long time and require a lot of effort.  Usually, the complicated legal system can be beneficial because it ensures the fair results that we want and deserve.  However, there are certain situations when the burden of evidence and the ins and outs of the legal system come at a bad time. One such example is providing medical evidence to win a Social Security claim when you are injured or have a pre-existing condition. At this trying and stressful time in life, the last thing anyone wants to do is deal with lawyers and courtrooms. However, medical evidence is a necessary burden.  Here, at Knisley Law Offices, we want to give you the best possible chance at winning your Social Security Disability claim by providing the right Social Security Disability Claim medical evidence. Providing Evidence: The right kind of evidence for you “Medical evidence” is a broad term for factual evidence regarding your particular injury or disability.  In layman’s terms, it is a very complicated doctor’s note.  Essentially, the people treating you for your condition testify that you really do suffer from a condition and that it does impact your life in various ways.  The best kind of medical evidence comes from the doctors, hospitals or clinics treating you directly because they best understand your needs and your care. There is a scale of the evidence that can be provided and how impactful it can be to your case.  The best example, as above, is straight from the horse’s mouth with your doctor or clinic proving that you have the disability or condition in question. Your medical professionals are required to provide evidence such as: Lab tests Imaging tests Visit results Treatment records Lower down on the priority lists are the non-licensed professionals that can attest to you or your child’s conditions. These non-licenses professionals include school administrators, teachers, etc. While these testimonies will not carry as much weight, they are still vital to your case. Best Practices with Your Medical Evidence Unfortunately, certain cases of Medical Disability claims are not cut and dry. There can be disagreements between you and a medical professional or even between two credible sources about whether or not some condition exists and whether or not it affects a person in the way claimed. In these cases, it is important to work with a Medical Disability lawyer who can help you present your evidence in a way that works best for you. It is important to present acceptable evidence, such as the examples above, while avoiding evidence that cannot help you – like testimonies from friends or relatives or unlicensed professionals that have no bearing on your case. Social Security, Medicine, Law and You Social Security Disability Claims are benefits designed to help those in need. The process, while fair and just, can be complicated, slow, and cumbersome. Therefore, it is imperative to work with a licensed attorney as well as other professionals to ensure the most ideal outcome. While Medical Evidence sounds easy to provide, it can be tricky with the amount of paperwork and red tape to go through. It is important to work to put yourself in the best position to provide the most accurate results. While it is possible to win a claim for yourself, save yourself the anxiety and the hassle by contacting an experienced attorney at Knisely Law Offices today to help get you the money and benefits that you need and deserve. Tagged: evidence , social security disability , medical evidence