26 Aug Qualifying for disability benefits

Q. My son was injured while working. What kind of disability might he be able to get?
— Trying to learn

A. We are sorry to hear that your son was injured, and we hope it’s not too serious.

Assuming that he does not already own an individual long-term disability policy that will cover him, the good news is that he will probably have a few other options to check out for disability coverage.

Just about every state (New Jersey included) requires employers to carry workers’ compensation insurance to cover employees who suffer job-related injuries or illnesses, said Matthew DeFelice, a certified financial planner with U.S. Financial Services in Fairfield.

He said workers’ compensation benefits typically include medical care, rehabilitation expenses, and disability coverage to compensate for lost wages.

DeFelice said in looking at the options, he’s assuming you’re not talking about your son suffering a permanent disability so severe that he will never be able to work again. If that is the case, he may be eligible to receive permanent disability benefits and lifetime care through workers’ comp.

However, the vast majority of workers compensation cases are considered a temporary total disability — one that prevents you from working at all, but only for a limited amount of time, DeFelice said. In other words, you can’t work now, but you will be able to work at some point down the road once you recover from your injury. You will typically be covered for approximately two-thirds of your customary salary until you are able to return to work, he said.

Most people do not realize that once they are receiving workers’ comp disability benefits for an on-the-job injury, they may also be eligible for a permanency award through the carrier in addition to their lost wages, he said.

“This occurs when there is some permanent loss of use of a body part due to the injury — but it is not as ominous as it sounds,” he said, offering an example.

Let’s say you break your right ankle at work. You never had any previous issues with that foot and always had 100 percent mobility. After receiving medical treatment and full recovery has occurred, it is determined that now you only have 90 percent usage/mobility. You have recovered and are back to work, but your right ankle will never be quite the same as it was before that injury.

“In simple terms, there is a table that is used to determine the monetary award you are entitled to for that loss of use,” DeFelice said. “If your son’s injury is serious enough, I highly recommend you contact a workers’ comp attorney who specializes in these cases to see what your options are. Consultations are usually free and a good lawyer can help you get what you are entitled to.”

It should also be noted that once you apply to workers’ comp for disability benefits, all of your medical care and treatment will fall under that claim, DeFelice said. Medical benefits available through workers’ compensation include hospital and medical expenses that are necessary to identify and treat your injury.

“Although the specifics vary in each state, workers’ compensation generally covers things like doctor visits, medication, and surgeries,” he said. “If you need special medical equipment — such as a wheelchair or larger vehicle — to help you deal with your injury, workers’ compensation will likely cover that cost as well.”

But be aware: for the most part, only generally acceptable medical practices will be covered, DeFelice said. And in the state of New Jersey, workers’ comp is directed care – which means they choose what doctors you see and when/how long you will receive rehab benefits like physical therapy during your recovery.

“This means that you likely will not be able to use your own doctors, and if you tried to your health insurance would likely decline payment for treatment since everything related to your injury is now under the workers’ comp umbrella,” he said. “I have seen first-hand where this has become an issue, and there is nothing more frustrating than fighting with a workers’ comp carrier over treatment when you are trying to heal. This is another reason why having a good workers’ comp attorney on your side can be worth its weight in gold.”

While workers’ compensation will be your first line of defense, DeFelice said, there are other disability options to check out if for some reason your workers’ comp claim is denied.

New Jersey is one of a handful of states that requires employers to carry short-term or temporary disability insurance (STD) for their employees, he said.

“It usually covers approximately two-thirds of your wages up to a maximum cap for a period of about six months after a 14-day waiting period,” he said. “But most short-term disability policies (STD) provide for an exclusion — they do not pay for work related injuries.”

In the rare case that an STD plan does pay for work related injuries, it will claim a credit for any workers’ comp payments you receive and reduce the STD benefit accordingly, he said.

Your son may be eligible to qualify for disability benefits through Social Security.

DeFelice said both workers’ compensation and a short-term disability policy through work may require him to apply for Social Security Disability (SSDI) benefits when a claim is filed, and then request a credit if any SSDI benefits are received.

“There are occasions when you can receive both SSDI and workers’ compensation benefits,” he said. “With an injury, if you are disabled and expect to be disabled for at least a year and a day — and have paid in the necessary funds to be covered under the Social Security Disability system — you may be able to draw some portion of both SSDI and workers’ compensation benefits simultaneously.”

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This post was first published in August 2016.