Workers Compensation Newsletters

Compensation for longshore, harbor, and maritime workers

The LHWCA provides medical benefits, compensation for lost wages, and rehabilitative services. Additionally, should an employee suffer a fatal injury, the LHWCA provides for survivor benefits and the payment of reasonable funeral expenses. Eligible survivors include not only spouses and children, but also siblings, parents, grandparents, and grandchildren. However, the existence of a widowed spouse and child would preclude the receipt of benefits by the other beneficiaries.

Effect of Incarceration on Social Security Benefits

An individual who resides in a penal institution such as a jail or prison for a full calendar month can no longer receive Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) benefits. Individuals who are incarcerated must notify the Social Security Administration (SSA) of their changed status with respect to the incarceration. Payments that are received in the face of a jail term lasting longer than a month will be considered overpayments and must be repaid. Though a prisoner’s social security benefits are suspended while he remains incarcerated, the payment of benefits to his eligible family members will be unaffected. With respect to SSDI benefits, individuals who are in jail awaiting trial will continue to receive their benefits until such time that they are convicted.

Employee Susceptibility to Occupational Disease

Every employee brings his own idiosyncrasies to his employment. This includes pre-existing weaknesses, hypersensitivities, and other susceptibilities that could impact the employee’s health. The minority rule in workers’ compensation coverage is that there is no recovery for an occupational disease where a pre-existing condition, such as asthma, contributed to the resulting disease. The minority states consider the disease to be the result of the employee’s own innate susceptibility rather than to the peculiar conditions of his employment.

Injury “By Accident”

For the recovery of workers’ compensation benefits, many jurisdictions require proof of injury “by accident.” While some states define accidental injuries in their workers’ compensation statutes, others do not leaving the courts to sort out the meaning intended. Generally, “by accident” signifies that an identifiable, yet unexpected, event caused the injury. Whether an injury has occurred “by accident” has been heavily litigated among the applicable states with the result being a developing definition of the phrase. For example, one court defined an “accident” as an unanticipated occurrence as opposed to one that was expected. Another court has defined “accident” as an unexpected and precipitous event that happens suddenly and produces an injury based on objective findings.

Supplemental Security Income Appeals Process

Aggrieved individuals may appeal initial determinations of the Social Security Administration with respect to a variety of issues. A non-exhaustive list of appealable issues includes whether an individual is eligible to receive Supplemental Security Income (SSI) benefits, the amount of an individual’s SSI benefit, whether an overpayment has occurred and the amount to be repaid, and whether the individual suffers from a “disability.” Though individuals have sixty days to initiate the appeal process, only those individuals who appeal within ten days may have their benefits continued until the appeal is decided. If ultimately, the individual’s appeal is unsuccessful, the payments he received in the interim will be considered overpayments. After each decision in the appeal process, the individual has another sixty days in which to appeal to the next level.