Battered and Broke: Making Ends Meet When Your Workers' Compensation Claim is Denied
Your Pennsylvania worker’s compensation claim has been denied. You have a mortgage, utility bills, and a family to support. How will you put food on the table while your claim is pending? Order at the left or click Get It Now on the bottom of the page and discover the benefits that may be available to you, including:
- Sickness and accident benefits
- Short and long term disability payments
- Unemployment compensation
- Heart and Lung Act or Act 534 benefits
- Vacation pay
- Veteran’s benefits
I wrote Battered and Broke: Making Ends Meet When Your Workers' Comp Claim is Denied for individuals who have suffered work-related injuries or diseases and need to find a way to receive income while they go through the litigation process. The information contained in Battered and Broke, however, applies to anyone who has suffered a disabling condition, whether from an on the job injury or not.
The easiest way for any Pennsylvania resident to apply for benefits other than workers' compensation benefits is to use the Compass web site, which you can reach by clicking here. If you need to seek a modification on your mortgage, click here.
Most of the benefit programs described below can be accessed through Compass. For a more comprehensive review of benefits that may be available to you if you are sick, injured, or disabled, I suggest that you download a copy of Battered and Broke: Making Ends Meet When Your Workers' Comp Claim is Denied. For more detailed assistance on the benefits available in your county, click the appropriate link below:
You may well be eligible for unemployment compensation benefits even if you are sick, injured, or disabled. To be eligible you have to have earned enough money and worked enough time to qualify based on the Pennsylvania unemployment compensation law. Furthermore, if your disability is so severe that you are unable to work in any capacity, you are not eligible for benefits. To be eligible, you not only must have earned enough money and worked enough time, you have to be, at a minimum, physically capable of sedentary employment.
If you are seeking workers' compensation benefits, there is usually no reason not to apply for unemployment compensation benefits. It is entirely possible that you are disabled from your regular occupation but are capable of performing sedentary work. If your employer is not willing to provide you with sedentary work, you are eligible for unemployment compensation benefits.
If you are applying for Social Security disability (SSD) benefits, however, you should think carefully about applying for unemployment compensation benefits. To be eligible for SSD benefits, you must be disabled from all substantial gainful employment. To be eligible for unemployment compensation benefits, you must be physically capable of performing substantial gainful employment. If you apply for and receive unemployment compensation benefits and your application for SSD benefits is denied, an Administrative Law Judge may look at your application for unemployment compensation benefits as evidence that you are not disabled within the rules of the Social Security Administration. Other Administrative Law Judges are more forgiving on this issue, realizing that people need to eat.
In Pennsylvania, the Office of Vocational Rehabilitation (OVR) helps individuals whose disabilities interfere substantially with their ability to find a job. OVR has 21 district offices around Pennsylvania. OVR provides a rehabilitation services handbook for individuals who want to work but who have disabilities that substantially interfere with their ability to find or hold employment. For a copy of the handbook, click here.
As noted in the handbook, if you apply at OVR, they will assign a counselor to assist you. You may undergo vocational and other types of tests to try to determine what services, if any, OVR can provide to you. Under most circumstances, OVR will tell you whether they can provide you with assistance within 60 days of the application.
As a practical matter, I recommend that people be very persistent when dealing with OVR. The counselors are often overworked, and it is difficult for them to make decisions when there are so many people seeking assistance. The people that show the greatest motivation are those who are most likely to get the attention of OVR.
It always helps if you have skills that are transferrable to another career. If OVR can successfully find employment for you or retrain you for a new career, it is not only good for you, it is good for the organization, which can point to your experience as a success.
You should therefore prepare for any interview by a counselor at OVR by thinking about your past job experience and what you might want to do in the future. If you have an interest in a particular type of employment, be prepared to talk about that. If you want or need training, it would be best to know what type of training you need. Be prepared to discuss any training that you have in the past, or skills that you have such as typing and facility with computer programs that may make you a more attractive candidate for assistance by OVR.
DEPARTMENT OF HUMAN SERVICES
For all Pennsylvania residents, there are a variety of benefits available to you through the Department of Human Services. You can apply for these benefits through the Compass web site, which can be accessed here. You can also fill out an application for benefits, which you can access by clicking here. Once you have filled out the form, bring the completed form to your County Assistance Office (CAO).
People who cannot earn money sufficient to support themselves or their families or who cannot work because they have suffered a disabling injury or illness may be eligible for cash assistance. The four main cash assistance programs are the Temporary Assistance for Needy Families (TANF), Diversion, State Blind Pension, and Refugee Cash Assistance programs. The TANF program provides cash assistance to pregnant women, and dependent children and their parents or other relatives who live with them. To apply for any of these benefits, you can file an application with your CAO or file online using Compass.
To be eligible for the TANF program, you must be both a resident of Pennsylvania and a United States citizen, though certain non-citizens who are lawfully admitted may also be eligible. You're required to look for a job or participate in employment or training programs. You also must cooperate with a caseworker to complete a plan called an agreement of mutual responsibility which is designed to set forth a plan for you when you are no longer receiving public assistance. To get cash assistance for a dependent child, you have to cooperate with paternity and child support obligations. You resources cannot be more than $1,000.00, and you have to report income from any other sources, including child support, Social Security benefits, workers' compensation benefits, unemployment compensation, interest, or lottery winnings. You are limited to a total of 60 months cash assistance over the course of your entire life, so make sure that you really need these benefits.
The Diversion program is designed to provide short-term assistance for people who do not need the Long-term assistance provided by the TANF program. The State Blind Pension program provides benefits to individuals with visual disabilities. The Refugee cash Assistance program provides up to 8 months of benefits for refugees and their families who do not qualify for TANF benefits.
Supplemental Nutrition Assistance Program (SNAP)
SNAP used to be called the food stamp program. These benefits are used to help eligible low income households in Pennsylvania buy food. If you are eligible, you will receive a Pennsylvania Electronic Benefits Transfer (EBT) ACCESS card that you can use to purchase food. For more information on electronic benefits transfer, click here. To apply for SNAP, you can use the Compass web site, or you can file an application with your County Assistance Office. The general application for benefits described above can also be used to apply for SNAP benefits.
Pennsylvania also provides healthcare coverage assistance for workers who have disabilities. Again you can always apply using Compass or the general application for benefits, but if you wish, you can fill out a specific application for medical assistance which can be accessed here. If you are a worker with a disability, to be eligible for this type of assistance, you must be between 16 and 65, your resources cannot exceed $10,000.00, and your income must be less than 250 percent of the federal poverty income guideline. Finally, you must meet the definition of disability according to the Social Security Administration. You can do so either because you are receiving Social Security disability insurance or you have received Supplemental Security Income within the past 12 months. If you can't meet either of those criteria, the Department of Public Welfare will review your disability to determine whether you meet the requirements.
There are a variety of other programs available to individuals whose income or assets are low, including medical assistance for long-term care support and services, the Low Income Home Energy Assistance Program, and subsidized childcare. For more information on these programs, click here.
LONG TERM DISABILITY
If you become disabled from your regular employment, you may be eligible for long-term disability benefits. Check with your personnel office to see if such benefits are available. You may have benefits that are provided to you by your employer pursuant to the Employee Retirement Income Security Act (ERISA). It is also possible you have private disability coverage. To apply for benefits, you need to follow the instructions set forth in the insurance policy. There may be separate short term disability benefits available as well. Determinations on applications for these types of benefits are made fairly quickly. If you are denied either short term or long term disability benefits, you should contact a Pennsylvania long-term disability lawyer such as Fenner & Boles. If you wish to hire Fenner and Boles to handle your application for benefits, we will provide you with free assistance at the initial stage. Do not file an internal appeal of a denial of benefits for short term or long term disability benefits without consulting a lawyer. Pay attention, however, to the deadlines that the insurance company has for filing any appeals.
These policies usually have an internal appeals process that you must go through before you file legal action against them. It may sound ridiculous, but this internal review process is the equivalent of going to court. The decision that the insurance company makes internally has the same force and effect as a decision by a judge. Getting such a decision reversed on appeal is very difficult unless the groundwork has been laid by an attorney before your appeals are exhausted.
SOCIAL SECURITY DISABILITY BENEFITS
If you are disabled from employment and the disability has lasted for a year or more or is expected to last for more than a year, you may qualify for benefits under the Social Security Administration's Social Security Disability (SSD) or Supplemental Security Income (SSI) programs. You may want to consider hiring a Pennsylvania Social Security disability lawyer such as Greg Boles to assist you in applying for benefits or handling an appeal from any denial.
To be eligible for Social Security disability benefits, you must have earned sufficient income and worked long enough to qualify for those benefits. If you have little or no earnings history, you may be ineligible for Social Security disability benefits but eligible for Supplemental Security Income benefits. For a description of the Supplemental Security Income benefits program, click here.