(Frequently Asked Questions)
Social Security Disability FAQs
Do I have to wait 12 months after being out of work before I can apply for benefits?
No. You can and should apply shortly after going out of work if you suffer from a condition you believe will last at least 12 months. It is best to apply as soon as possible because it will likely be longer than 12 months from your application until you get a final decision or any benefits.
Does my doctor have to say I am disabled or agree to help me before I can apply for or get benefits?
No. You do not need any health provider to say you are “disabled” or even say that you cannot work in order to apply for and receive your benefits. The decision about your disability is up to the SSA. Only the judge can determine disability. The decision is based upon your age, education level, past work experience and all of your physical and/or mental limitations.
Do I have to wait until my Workers’ Compensation or personal injury case settles or ends before I can apply for benefits?
No. As long as you have a condition that you believe will cause you to be out of work 12 months, you should apply. No matter when you actually became disabled, SSI benefits cannot begin until the month after you first apply and SSDI benefits only back one year prior to application with exceptions. (If you previously applied, we may be able to re-open your prior applications.) Failing to apply until the conclusion of your other case could cost you lost benefits and extra delay in Medicare eligibility.
Do I get Medicare as soon as I win my disability?
Not necessarily. With a few limited exceptions, you are not eligible for Medicare benefits until two years after you have been eligible for disability insurance benefits. If you only get Supplemental Security Income (SSI) benefits, you receive Medicaid only.
How do I receive Medicaid?
Medicaid for the disabled adult is administered through your county’s Department of Social Services. You need to apply in person at your county DSS. This is in addition to applying for SS benefits through the SSA office. These are separate programs with separate application processes and rules. They both require you be “disabled” and both use the same definition of disability. However, you need to appeal both your SS disability and your Medicaid denials. Appealing one does not appeal the other. Broker & Hamrick, P.A. will represent you through the hearing level of your Medicaid application.
Who is required to provide Workers’ Compensation coverage?
Any employer who regularly employs three or more employees.
What do I do if I am hurt at work?
Report your injury to your supervisor or boss or the employer immediately by telling them and also in writing. The law requires you to submit it in writing within 30 days. If you do not file your claim within two years of your injury, you may lose your right to any benefits under this law. Seek medical treatment immediately.
Are all injuries at work covered by Workers’ Compensation?
No. The law in NC requires that you have an accident while doing your job and is caused by your job. Any resulting disability has to be proved to be from your specific injury. You might also suffer from an occupational disease, such as carpal tunnel syndrome or tendonitis, but a doctor needs to link your job to the disease. Back injuries do not require an “accident” however, they do require a specific moment in time on a specific date that the pain or symptoms began. It is important to seek medical care as soon as possible after getting hurt at work and as important to report any pain or symptoms to your boss as soon as you notice them, even if you think the injury is not serious at the time.
What if my employer fails or refuses to report my injury?
Even if your employer does not file a report, any injured Employee must file a claim (Form 18 or 18B) within thirty days (but no later than two years) of the accident with the Industrial Commission. Please e-mail completed forms to firstname.lastname@example.org or mail it. You can also just write out your own statement of what happened and give to your employer, but make sure you keep a copy for yourself and put the date on it.
Who provides and directs medical treatment?
The employer or its insurance company, subject to any Commission orders, provides and directs medical treatment. The employee may petition the Commission to change physicians or approve a physician of employee’s selection when good grounds are shown. However, payment by the employer or carrier is not guaranteed unless written permission to change physicians is obtained from the employer, carrier, or Commission before the treatment is rendered. If you are having a medical emergency you should go to the nearest hospital emergency room or urgent care and make sure you report it as an on-the-job injury.
Do I get paid mileage going to/from my medical treatment?
If an employee travels 20 miles or more round trip for medical treatment in workers’ compensation cases, they are entitled to be paid mileage. The amount per mile changes from time to time with the most current amount on the N.C. Industrial Commission website.
When do I get paid for being out of work?
No benefits are paid for the first seven (7) days of lost time unless the disability later exceeds 21 days.
How often are compensation payments made?
Weekly, but the Commission can authorize payments on a monthly basis in some circumstances.
At what rate of pay?
66 2/3% of the average weekly wage, not to exceed $862.00* (2012 maximum) per week.
* The maximum weekly benefit is adjusted annually.
How long can I receive lost-time weekly benefits?
Until a doctor has released you to return to your job or another job that is available within your restrictions. If your doctor releases you and you disagree, you have other rights available.
What is permanent partial disability?
Total loss or partial loss of use of a part of your body (leg, arm, back) or inability to earn the same wages in any employment as earned at the time of injury.
Who determines permanent partial disability?
The Industrial Commission, based on the impairment ratings of a physician or evidence of consideration of wage earning capacity. Or the parties can agree on a rating assigned by a doctor.
What happens when the employer refuses to acknowledge my claim?
When liability for payment of compensation is denied, the Commission, claimant, his or her attorney (if any), and all known providers of health care shall be promptly notified of the reason for such denial. The denial Form 61 shall not be worded in general terms, but must detail the exact reason for the denial of liability.
If a claim is denied by the insurance company or self-insurer, the employee may request a hearing before the Industrial Commission by submitting a Form 33, Request for Hearing.
Can medical providers bill directly and seek to collect from the injured worker for treatment given for the Workers’ Compensation injury?
No. If the worker files a claim, medical providers may not bill the employee during the life of the claim. It is a criminal misdemeanor for them to do so. Only after it is determined by the parties and the Industrial Commission that it is not a compensable Workers’ Compensation claim, can they begin billing the injured worker.