Get Answers to Your Legal Questions in Our FAQ
Dealing with a legal issue whether it be applying for and receiving disability benefits, fighting for a personal injury claim, or navigating through a divorce, can be a challenge, and many people are left with questions about what they can do to get the help they need. At the law offices of Loyd J. Bourgeois, we understand how hard it can be to get the answers you need. That’s why we’ve put together the following list of Frequently Asked Questions (FAQs) and answers dealing with family law, personal injury, disability benefits, claims, and appeals and the related law in Louisiana.
The following are some FAQs that I receive as a Louisiana attorney. They may answer some of the questions you have regarding your Social Security Disability appeal, your long-term disability insurance denial, your personal injury claim, or your Louisiana divorce. If you have a question that is not answered here, please call the legal team of Loyd J Bourgeois, LLC at 985-240-9773.
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How Much is a Spinal Cord Injury Worth in Louisiana?
What Is My Spinal Cord Injury Claim Worth?
The spinal cord, protected by your vertebrae, is a delicate bundle of nerves that forms your central nervous system. It is one of your body’s most important structures and injury to the spinal cord can cause severe pain, paralysis, or death. In the United States, the leading causes of spinal cord injuries are motor vehicle accidents, followed by falls, violence (primarily gunshot wounds), athletic or recreational activities, and medical complications or malpractice.
Even in the best of circumstances, a spinal cord injury can be a devastating blow. Besides insurmountable medical bills, survivors may deal with ongoing health challenges, such as respiratory difficulties, increased risk of illness, and loss of motor and sensory functions, as well as new financial challenges, and loss of quality of life.
The Settlement Value of a Spinal Cord Injury Will Depend on Its Type and Location
Three Main Spinal Cord Regions:
- Cervical spine (upper back and neck)
- Thoracic spine (mid-back)
- Lumbar spine (lower back)
When a vertebra is damaged, it will impact the parts of the body that are below the location of the injury. The amount of compensation you are owed will depend on the location and severity of your spinal cord injury.
Common types of spinal cord injuries include:
- Fractured Vertebrae
- Herniated or Ruptured Discs
- Bulging Discs
- Pinched nerves
- Spinal Stenosis
2 Types of Spinal Cord Injuries: Complete and Incomplete
Complete Spinal Cord Injuries:
The most severe spinal cord injuries are complete spinal cord injuries. These occur when the injury to the spinal cord eliminates the brain’s ability to send signals below the injury site. For example, an injury to the lumbar region can lead to paralysis below the waist while maintaining function in your upper body (paraplegia).
Incomplete Spinal Cord Injuries:
Though less severe, incomplete spinal cord injuries result from compression or damage being inflicted to the spinal cord that reduces the brain’s ability to send signals below the injury site. Incomplete spinal cord injuries will vary greatly from person to person because of the partially compromised condition of the spinal cord. For some, motor and sensory functions may only be slightly compromised, for others, function may be nearly eliminated.
How Will My Spinal Cord Injury Settlement be Calculated?
Your personal injury attorney will push for a settlement so that you receive the compensation you need without spending years in the litigation process.
The amount of damages you are owed is based on a number of factors such as the location and severity of the injury, cost of medical bills and future care, pain and suffering, loss of quality of life, and the degree of negligence involved.
Because spinal cord injuries can be such severe and devastating injuries, settlements tend to significantly larger when compared to other personal injury claims.
Settlements of several hundred thousand dollars to upwards of 1 million are not uncommon.
What Types of Compensation Am I Entitled To For Spinal Cord Injury?
Due to the fact that spinal cord injuries are so damaging and can require extensive treatment, rehabilitation, and physical therapy, the majority of your settlement will go to covering your medical expenses.
The amount you receive will be based on the severity of your injury and take into account if your injuries are permanent or if you need lifelong care.
Be aware that your medical insurance company will be entitled to repayment from your settlement or verdict. This is called subrogation.
Pain and Suffering:
Because spinal cord injuries have a massive impact on your life, a large portion of your settlement will come from emotional, non-financial damages. Chronic pain, emotional distress, and loss of quality of life are all common emotional damages related to spinal cord injuries. In general, the more severe your injury is, the higher your amount of pain and suffering will be.
Loss of Wages:
Due to the seriousness of a spinal cord injury, you could be out of work for several months to several years. You may be in the hospital for a long period of time for treatment of your injury and that will likely be followed up by a lengthy recovery period.
If you can return to work, you will probably have to miss work frequently for doctor's appointments, rehab, and physical therapy treatments.
If you are unable to ever return to work, you can also claim compensation for loss of future earnings.
Seek Local Advice Before Signing Anything!
If you were involved in an accident and suffered a spinal cord injury, the insurance company or your employer will try to get you to sign paperwork right away. Don’t do it!
The insurance companies will try to get you to settle for the lowest amount, often before you’ve been properly diagnosed, and your employer may have you sign away your right to compensation.
The advice of an experienced, local attorney will be an invaluable asset for you at this time.
They will work with your doctors to make sure your spinal cord injury is properly documented, and that extent of your injury is fully understood.
They will also deal with the insurance company for you, so that you can avoid the stress and focus on your treatment.
If your spinal cord injury was caused by someone else's negligence, call us today at 985-240-9773 and tell us how we can help you win your claim.
Do I Need An SSDI Representative? Your Chances Improve by 300% If You Have One
I am sure you have heard that you do not need a Louisiana Social Security Disability Lawyer to win your disability case. Well, you heard right.
An often asked question is "do I really need a representative for my Social Security Disability case?" After all, many people claim to have received benefits on their own - you can probably do it as well - right?
Except of course, if you are one of the over 62% (based on the 2009 Social Security Statistical Report) of people who have their social security disability claim denied initially.
Can you win disability without a lawyer?
Yes, but it won't be easy. There's going to be a lot of red tape.
Most of our social welfare policies are designed in such a way where they’re a lot more concerned about preventing people who aren’t eligible from accessing benefits than ensuring that those who are eligible actually receive them. We’re fixated on fraud and abuse, which is extremely low in social welfare programs — something like 1 to 2 percent of cases. And even then, it’s not what people mean when they think of “fraud and abuse.” It’s mostly people making mistakes because they didn’t understand eligibility rules.
The problem with this unjustified obsession with fraud and abuse is that it means 20 to 30 percent of people are unable to access these programs even when they’re clearly eligible for them, because they’ve created all these administrative burdens designed to target people they don’t want on the programs. So it’s a huge disconnect in terms of trying to meet the broader goals of these programs. -Pamela Herd, author of Administrative Burden: Policymaking by Other Means
The statistics show that once your Louisiana Social Security Disability claim reaches the hearing level (or above), you have a significant increase in the odds of being found disabled.
Why is this? While I do not know for sure, I suspect it is because this is the stage that Social Security attorneys get involved and help their clients get benefits.
In 2008, at the hearing level or above, greater than 80% of claimants were awarded social security disability benefits.
So while you may not need a Social Security Disability Lawyer, you may want to get one to help you navigate through the system and improve your chances of obtaining benefits.
Should I hire a lawyer before applying for disability?
A recent study by the Government Accounting Office found typical adults who had representation, by attorneys or others, had a three times better chance of receiving benefits than those who applied on their own! This means your chances improve by 300% if you have a skilled, disability representative on your side presenting your case.
Here are some other interesting tidbits from the study:
Age is an important factor! Those 55 and older were allowed 4.3 times higher than those 35 yrs old.
Type of Impairment is important! Those with heart failure or MS were allowed 4-5 times more often than those with asthma.
Type of claim important! SSDI claims were allowed 1.7 times more often than SSI claims.
The entire report is interesting but the main takeaway is this: I’m no mathematician but I’ll take a 300% better chance any day of the week. What about you?
If you're preparing to apply for Social Security disability or appeal a claim denial, I've written a book 9 Mistakes that Can Disable Your Social Security Disability Claim. This is a helpful and informative guide that will guide you through some of the common mistakes and errors that lead to unfavorable Social Security Disability decisions.
Don't make a costly mistake that could cause you to lose the benefits that you need to survive! I'd love to send you a copy. Just click here to receive your free copy of my book 9 Mistakes That Can Disable Your Social Security Disability Claim.
Can I negotiate my own personal injury settlement? And if so, where do I start?
Sure - you can negotiate your own personal injury claim. There is no law that says you have to hire a lawyer. But, just like you can change your brakes without being a mechanic or install a new roof on your house without being a roofer – some things are best left to the experts.
And, unlike hiring a mechanic or a roofer, you don’t have to pay anything upfront to have a personal injury attorney give you legal advice or start working on your case!
Louisiana Personal Injury Lawyers are paid by receiving a portion of the money they are able to win for you.
An attorney doesn’t just file personal injury lawsuits, they will do all the frustrating and time-consuming work like dealing with the insurance adjuster for you and collecting the needed medical records.
Additionally, most lawyers will front the costs of the case (like filing fees, expert costs, deposition costs, etc.) until the case is resolved.
If you choose to pursue your own case, you will be responsible for all costs, which sometimes run into the thousands of dollars.
Settling a Personal Injury Claim with an Insurance Company
Insurance companies are aware that individuals do not have the training or the legal skill necessary to file a lawsuit and try a case to a successful conclusion and as a result will often offer a significantly lower amount of money to someone trying to negotiate their own claim.
Without the legal skill and training, you may not accurately understand the value of your case or take into account all of your damages.
Damages for your accident claim include lost wages, medical expenses, pain and suffering, property damage costs, and sometimes punitive damages.
If you can answer yes to all of these questions, you can likely negotiate a fair settlement with the insurance company without an attorney:
- Does the accident have clear liability? In other words, is the other person clearly at fault in the car accident or incident?
- Did you have minimal injuries and treatment?
- Do you have no prior injury history?
- Did you have an immediate presentation of injuries? In other words, did your injuries show up right away?
- Were your injuries soft tissue only?
- Did you have no gaps in medical treatment? Did you obtain treatment quickly and consistently?
If you answered no to any of those questions, then it's probably in your best interest to at least consult with an attorney before negotiating or accepting a settlement offer.
If you can answer yes to every one of those questions, then you can most likely negotiate a fair settlement with the insurance company without the help of an attorney. In those cases, an attorney will most likely not be able to obtain enough additional money for you to cover their fee.
If you want to negotiate with the at-fault party’s insurance company yourself, start by reading all the articles on this blog – we have great advice about insurance adjuster tactics and what documentation you need to prove your case.
It is important to go into the negotiations with an idea of what your case is worth.
What is My Torn Labrum Shoulder Injury Worth?
How Much is the Average Settlement for a Torn Labrum Claim?
Like all other personal injuries, there is no set amount for a torn labrum. Labral tears often occur with other shoulder injuries so an experienced personal injury attorney will be best equipped to assess your situation and come up with a fair settlement amount.
The damages you receive for your shoulder injury will be based on the extent of your injury, any loss of quality of life, and the circumstances which led to you being injured.
Depending on the severity of your injury, a torn labrum can settlement amount can be anywhere between several thousand to up to a hundred thousand dollars. Some of the damages that will be factored in to your settlement amount include:
- Medical bills
- Physical therapy
- Lost wages
- Physical pain and suffering
- Emotional pain and suffering
- Future medical bills
- Future lost wages
An experienced personal injury attorney will work with your doctors to get a full understanding of the extent of your labral tear and how that injury has affected your quality of life.
Your lawyer will come up with a settlement amount that covers your medical bills, lost wages, pain and suffering, and any medical bills and lost wages that you may accrue in the future.
What is a Labral Tear Shoulder Injury?
The labrum stabilizes the ball-and-socket joint of the shoulder by keeping the ball (humeral head) in the socket (scapula). The shallow, socket-like opening of the shoulder where the labrum is located is called the glenoid. Shoulder labrum tears can happen anywhere around the glenoid socket.
If you experience pain or swelling of the shoulder after an accident, you should visit a doctor or ER right away.
3 Main Types of Labral Tears:
- SLAP or Lesion Tear:
- Superior Labrum, Anterior to Posterior (SLAP) tears occur when the tear is above the middle of the glenoid and means “front to back”. This injury is common with anyone who uses a lot of overhead motions (think tennis, basketball, or baseball players).
- Bankart Tear:
- Common is young people with dislocated shoulders, this injury occurs when there is damage to the lower half of the glenoid socket.
- Posterior Labrum Tear:
- Rare; occurring in only 5 to 10 percent of all shoulder injuries. Happen when injuries are to the back of the shoulder joint.
Symptoms of Labral Tear Shoulder Injuries:
A torn shoulder labrum often occurs with other shoulder injuries. If you were in an accident and dislocated your shoulder, have rotator cuff tears or injuries, have a torn bicep, or another shoulder problem, you may have a torn labrum as well.
Torn labrums often occur along with injuries to the shoulder socket and/or upper arm bone, muscles, and tendons.
These injuries are very painful and symptoms include decreased range of motion, loss of strength, pain while doing daily activities, shoulder instability, and feelings of catching, locking, popping, or grinding.
Don’t Get Ripped Off by the Insurance Company!
After your accident, the insurance companies will want you to settle right away and usually for the lowest amount. Don’t do this! Shoulder injuries aren’t always diagnosed immediately after an accident. If you settle with the insurance company, you will lose the ability to seek further damages.
If you injured your shoulder in a car accident, fall, or because of someone else’s negligence, you probably have a good personal injury case. You may feel like your injury may not be serious enough or that you are not the type of person to sue, we understand, but there is no shame in recovering the money for medical bills, lost wages, and property that were taken from you.
An experienced local attorney will work with your doctors to get a full understanding of the severity of your injury and get you a settlement amount that is fair and covers all your damages.
How Much Compensation Can I Expect for a Concussion Injury?
How Much is My Concussion Settlement Worth?
The value of your concussion settlement will vary greatly depending on the severity of your injury.
Like all personal injuries, putting a dollar amount on your injury is difficult because each case and injury is unique.
If you have suffered a concussion in an accident or because of someone else’s negligence, you need an experienced personal injury lawyer who is familiar with the particulars of concussion injury cases and concussion settlement values.
Is a Concussion a Serious Injury?
A concussion is a type of traumatic brain injury (TBI) and should not be taken lightly.
Concussions are caused when the head hits a hard surface and the brain strikes the inside of the skull.
The blow to the head is not what causes the concussion; it’s the reverberation of the brain inside the skull. This can cause chemical changes in the brain and damage brain cells.
Concussions are not limited to football/nfl players and contact sports; they frequently occur in car accidents and slips, trips, and falls.
The symptoms can be relatively subtle and not show up immediately after an accident. They can also be hard to self-diagnose.
Concussions can cause lasting cognitive impairment, including memory loss, personality changes, loss of concentration, and attention span.
How Do You Prove You Have a Concussion?
The symptoms of a concussion can range from mild and barely noticeable to extreme.
If you experience any of the following symptoms in the days, weeks, or months after an accident, seek medical help right away. (The signs and symptoms of a concussion are not limited to this list.)
- Pressure (feeling like you’re wearing a hat that is too tight)
- Blacking Out/Loss of Consciousness (even if it’s only for a few seconds)
- Confusion/ Disorientation
- Looking Dazed/ Feeling “Foggy”
- Ringing in the Ears
- Memory Loss
- Nausea/ Vomiting
- Poor Balance/ Lack of Coordination
- Slurred Speech
- Sensitivity to Noise and Light
Your doctor may want to order imaging tests such as an MRI or CT scan to check for brain swelling or bruising or bleeding of the brain.
If, after seeking medical treatment, these symptoms do not improve, you or the accident victim may be suffering from another traumatic brain injury (TBI) called post-concussion syndrome.
One of the best ways to keep track of your symptoms is to log them daily.
Our “Injury Victim’s Diary” will make it easy for you to record your accident and keep track of your injuries and symptoms. By writing everything down, it will be easier for your personal injury attorney to prove loss of quality of life when seeking damages.
How Much Compensation Do You Get for a Concussion?
If you or a loved one have suffered from a concussion in an accident or from someone else’s negligence you may be entitled to damages.
Because each case is so unique, there is no set amount when it comes to personal injury cases.
While a concussion is usually thought of as a mild traumatic brain injury, the results can in some cases be severe.
The amount of damages you receive will be based on the severity of your injury, degree of impairment, and the circumstances involved that led to you being injured. Some of the factors that your personal injury attorney will examine to determine your settlement amount will be:
- Medical Bills
- Lost Wages
- Loss of Future Earnings
- Property Damage
- Physical Pain and Suffering
- Emotional Pain and Suffering
Can You Sue For a Concussion?
Yes, you can sue for a concussion, but you should never try to represent yourself in court or reach a settlement on your own. If your head injury occurred in an accident, the insurance companies will try to get you to settle right away.
By doing this, you are taking a risk of getting significantly less than what you may be entitled to because the symptoms of a concussion can take several days to several weeks to show up.
For tips on avoiding common mistakes following an accident, get our free book "Quick Guide to Louisiana Accident and Injury Claims".
Concussion cases can be complicated and you’ll need the help of an experienced local attorney. Your personal injury attorney will work with your doctors to determine the severity of your concussion injury and make sure that the amount of your settlement will be enough to cover your medical bills and future expenses.
The best way to determine if you have a case worth pursuing is to call our office at (985) 240-9773. We will discuss your case and help you determine the next plan of action.
What should I do when my disability claim has been denied?
Have you applied for Social Security Disability but your claim has been DENIED? If so, you’re in the right place.
You are frustrated because you have submitted your medical records and answered all the questions SSA asked – but you have still been DENIED.
A denied claim is not the end of the road; you have the right to appeal.
How do you appeal a SSDI denial?
Here’s how the process works:
In Louisiana, upon receiving your denial letter, you have 60-days to file a Request for Hearing before an Administrative Law Judge (SSA Form HA-501).
During the hearing, you will likely testify, you or your representative may call witnesses, and there may be governmental paid-for experts that testify.
The testimonies and evidence in your claim file will be carefully reviewed, and a decision will then be made.
If the ALJ’s decision is still not favorable, you may appeal to the Social Security Appeals Council.
Similar to the ALJ, the Appeals Council will review all evidence in your case and either reach a decision itself or refer your case back to the ALJ. It’s important to point out that although the Appeals Court considers every request for review, it may decide to not to consider your request and thus the ALJ’s decision will stand.
If you still disagree with the decision up to this point, your final step is to submit your case to Federal District Court for review. Here, at this final step in the process, a district court judge will review the evidence in the case and order a determination on whether the SSA‘s decision should be overturned.
Although the disability appeal process may seem long and cumbersome, it’s important to note that you do have the right to appeal your case.
It is also important to note that you cannot skip any step. That is, you cannot take your case straight to federal court if you are not happy with the initial decision. You have to go to the ALJ first, then the Appeals Council, before getting to federal court.
Do you know why your application was denied?
The first step to an appeal is knowing why your claim was denied.
The letter the SSA sent you to tell you that your SSDI claim was denied can provide you some insight. But do you know what the letter means when it says – We have determined that you can perform your past work? What about when the letter says – We have determined that you are not disabled from performing work generally available in the region.
Do you know what you need to do to give yourself the best shot of succeeding in your appeal? Do you know what specific medical records can help establish that your disability meets a listing, and thus qualify you for social security disability? Do you how a medical source statement can be used to dramatically increase your chances of success on appeal?
An SSDI attorney familiar with the specific rules and laws of the social security system can be the difference between you getting disability benefits and not.
Did you receive a denial or termination of benefits letter and are unsure of the next steps? We will review your denial letter with no cost and no obligation and give you a detailed strategy for moving forward.
How much is my burn injury claim worth in Louisiana?
If You Have A Burn Injury Caused By Someone Else’s Negligence, You May Be Owed Compensation.
Obviously, there is no one kind of burn injury case. Burn injuries can happen in a variety of ways, including workplace injuries, faulty consumer products, arson, or another intentional burning, and any kind of accident caused by negligence.
In addition to car accidents, several industries in the New Orleans area job market are vulnerable to the risk of burn injury, particularly in fields where people have to handle hot or caustic items, are exposed to chemicals and gases, are exposed to steam or open flame, or have to work with molten metals or materials.
Chemical manufacturing facilities, oil refineries, nuclear power plants, welding, and the food industry are just a few of those local professions where burn injuries are unfortunate hazards of the occupation. Though each of those industries has its own set of safety standards, accidents can and do happen.
The Centers for Disease Control and Prevention (CDC) Classifies Burns Into 3 Categories:
- First-Degree Burns: Burns only affecting the top layer of skin, causes swelling and redness.
- Second-Degree Burns: Burns that damage the top two layers of skin, causes blisters, swelling, and deep redness.
- Third-Degree Burns: The most severe type of burn, these penetrate the entire thickness of the skin and can permanently damage tissue. This type of injury requires immediate medical attention.
How Much Is My Burn Claim Worth?
There is no way to estimate the average settlement value for a burn injury claim because the amount a victim may receive after a burn depends on the severity of the injury and the circumstances surrounding their case.
Burn injuries are regarded similarly to other personal injury claims and as with any personal injury, it’s difficult to determine an accurate settlement amount.
However, because burn injuries can be extraordinarily more painful and lead to severe, permanent disfigurement, burn injuries tend to be awarded more favorably.
The biggest factors are the location and severity of the injury and the degree of negligence involved.
Besides being painful, second and third-degree burns often involve the joints and nerves and, in addition to scarring, can cause permanent damage and a limited range of movement.
If caustic chemical substances get into one’s eyes or are inhaled, that person may experience temporary or permanent vision loss or may have difficulty eating or trouble breathing.
Typically, second-degree burns can take anywhere from several weeks to several months to heal and third-degree burns can take up to several months to over a year.
Healing time will vary and be dependent on several factors such as the extent and location of the injury, age and health of the victim, and the nature of the cause of the burn.
Another consideration is what type of medical treatment was needed, for example, skin grafts.
How Much Compensation Do You Get for a Burn Injury?
Both sides will negotiate based on what they believe the plaintiff will be awarded at trial.
Settlements will be based on the defendant’s degree of liability so knowing how and where the injury occurred is important.
For example, if a plaintiff was burned by an accident at work that may or may not have been preventable, the perceived value of the case will be much lower than if the accident was caused by the employer’s failure to follow safety regulations.
The lower the perceived value, the lower the settlement amount will be.
As a side note, a workplace injury that does not involve employer negligence will usually only be paid out by the workers’ compensation carrier.
It must be noted that just because you suffered a second or third-degree injury doesn’t mean you are automatically eligible for compensation.
First, you must show that you were owed a duty of care by the negligent party and that your injury was caused when they breached this duty.
Examples of this breach of duty are failure to follow set safety standards, knowledge of unsafe working conditions or broken equipment, or disregarding traffic laws.
The amount of compensation you are owed will depend on the location, type, and nature of the burn and the amount of negligence.
Seeking Compensation for Physical and Emotional Pain and Suffering for Burns
In addition to being compensated for medical bills and lost wages, a liable defendant may also be responsible for both your physical and emotional pain and suffering.
What that means is that they may be responsible to not only compensate you for the physical pain the burn caused and may continue to cause but also any emotional pain that a disfiguring burn has caused you to suffer or will suffer in the future.
The amount of damages for physical pain and suffering will depend on the extent and nature of the disfigurement.
Seeking Punitive Damages for Negligence for Burn Injuries
Punitive damages are meant to punish the defendant and can be awarded to a burn victim if it is proven that the defendant acted intentionally or with gross negligence.
One example of gross negligence would be a product manufacturer failing to conduct safety testing on a product that frequently comes into contact with an open flame, like an oven mitt.
Another example of this is being burned with a hot liquid, like in the infamous McDonald's coffee burn injury lawsuit.
Though punitive damages for gross negligence are harder to predict, the threat of punitive damages will generally make a defendant more likely to settle the case at a higher amount.
If You’ve Suffered A Burn Injury, Seek Advice Before Signing Anything!
If you’ve suffered a burn injury, be wary of your employer or insurance company trying to get you to sign paperwork right away.
The insurance company may want to settle your burn injury for the lowest amount before you’ve even been properly diagnosed, and your employer may want you to sign away your rights to compensation.
You’ve suffered a painful injury and there’s no shame in getting reimbursed for your medical bills and lost wages.
An experienced, local personal injury attorney will be able to assess your case and point you in the right direction.
What is an onset date for SSDI?
Your onset date is defined as the first day you are unable to work because of your disability.
What is an Alleged Onset Date?
The alleged onset date, or AOD, is the date you claim on your Social Security Disability application as you became unable to work because of your medical condition.
The onset date may or may not be the same as the date your medical condition was diagnosed or your injury occurred.
A typical AOD is the date last worked.
However, depending on the circumstances and the medical support, the onset date could be after the date last worked.
Why is the date of onset important?
This onset date determines when you were first eligible to receive Social Security Disability Insurance (SSDI) benefits and how far back your "back pay" will go.
For SSDI, Social Security Administration (SSA) can retroactively pay benefits as far back as 12 months before your application date if you were disabled before that date, again subject to the 5-month non-payment period.
There is usually little to be gained from alleging an onset date of more than 17 months before your application since you are not eligible for social security disability benefits for that time period. Here are some examples:
- You apply on January 1, 2020 stating your onset date was January 1, 2019 and are approved with the AOD. You are entitled to benefits starting June 1, 2019. Why? Although SSA can pay you for one year prior to your application date, your five-month elimination period started on January 1, 2019 and ended on May 31, 2019.
- You apply on January 1, 2020 stating your onset date was January 1, 2018 and are approved with the AOD. You are entitled to benefits starting January 1, 2019. Why? SSA only pays for one year prior to your application date (or January 1, 2019) and your five-month elimination period started on January 1, 2018 and ended on May 31, 2018.
- You apply on January 1, 2020 stating your onset date was January 1, 2020 and are approved with the AOD. You are entitled to benefits starting June 1, 2020. Why? Your five-month elimination period started on January 1, 2020 and ended on May 31, 2020.
The exception to this is if your Date Last Insured (DLI) is more than 17 months before your application date. You must select an alleged onset date that is BEFORE your date last insured to be eligible for disability payments. If you did not become disabled prior to your DLI, you are likely not eligible for SSDI benefits on your own record.
*Note: The information about Onset Date and DLI is for SSDI only. For Supplemental Security Income (SSI) claims, SSA can only pay from the date of application OR onset date, whichever is later.
What happens if the ALJ wants to change my onset date?
Some times, a "partially favorable" decision is issued by SSA or the ALJ. One potential reason for this partially favorable decision is because SSA or the ALJ agree you are disabled currently but do not agree with your AOD and instead believe you became disabled at a later date. This can be referred to as an amended onset date.
The impact of such partially favorable decisions is often a person will receive future disability benefits, but the amount of lump sum back payments are reduced or eliminated.
What is an Established Onset Date?
The date that Social Security determines that you became disabled and unable to work is called the established onset date.
To determine your established onset date, the Social Security Administration will look at your alleged onset date, your work history, and your medical evidence. SSA may agree with your AOD or may select its own onset date.
In addition to affecting your lump sum back payment amount, the established onset date can also determine your eligibility for benefits. You must be unable to work for 12 months to be eligible for disability benefits. If you are expected to recover to the point of being able to work and the judge disagrees with your alleged onset date and moves it back, it could mean that there is no longer a full 12 month period where you are unable to work. Therefore, you are not eligible for benefits at all.
How do I select my alleged onset date?
Choosing the correct onset date is very important to your chances of obtaining disability benefits and obtaining the maximum back payment you are entitled to receive.
Selecting a specific onset date is difficult since most likely your symptoms and impairments built up over time. Unless you were injured in an accident, it's not likely that all of your issues began on the same date.
You should pick a date that is supported by evidence in your medical records as well as your work history. If you are having difficulty, consulting with an experienced disability attorney can help.
Often you can tie the onset date to a certain event, either the day you last worked or a major date in your medical history like your date of diagnosis or a date when you were hospitalized.
Other things that can affect your onset date are incarceration, citizenship status, the last day worked, and receipt of or application for unemployment benefits.
Whatever date you choose, make sure the alleged onset date that you select can be supported by medical evidence from around that time period that shows impairments that affect your ability to work.
If you are unsure of what to put as your alleged date of onset on your Social Security Disability application, my office is happy to provide guidance. We've analyzed onset dates for hundreds of disability claims. Give us a call at 985-240-9773.
What is subrogation?
Subrogation is the substitution of one person or group for another with respect to a debt or insurance claim accompanied by the transfer of any associated rights and duties.
Subrogation typically arises in property insurance claims and health insurance claims.
Health Insurance Subrogation
Your health insurance (including Medicare/Medicaid) will want reimbursement for the money it paid for your treatment.
This has to come from any money that you recover. However, you or your personal injury attorney may be able to negotiate with them how much you payback. It often depends on your insurance contract.
Subrogation Health Insurance Example
As a result of the same automobile crash, you are injured. When you go to the doctor, you present your health insurance card to receive treatment for your injuries.
The total cost for medical treatment in your case is more than $150,000.
Because the crash was caused by someone else, your healthcare carrier is subrogated to your rights against the offending driver for the amount of medical expenses it paid (more than $150,000).
That means if you recover money from the other party or their insurance carrier, $150,000 must be repaid from that money to your health insurance company. (Suddenly, those big amounts that are flashed on the "Get a Check" commercials don't seem quite as large!)
Short-Term or Long-Term Disability Subrogation
Another often forgotten subrogation claim - any short-term or long-term disability company that paid you (like AFLAC or CIGNA or sometimes your own employer) for missed time from work.
They are entitled to recover that money from any money that you receive from a settlement.
Your Own Insurance Company Subrogation
If you have MedPay coverage and filed a claim, your auto insurance company may want reimbursement when you recover from another party.
Also, if your car insurer pays for your property damage repair or replacement while awaiting payment from the other party, they will be entitled to that money that you recover from the at-fault party.
Car Insurance Subrogation Example
You are involved in a car crash that damages your brand new truck. The damage costs $25,000 to repair. You file a claim to get your truck repaired quickly.
Your carrier is now subrogated to your right to sue the other party and/or their insurance carrier for the $25,000 that it paid to you and will seek reimbursement.
When considering a settlement offer, take into account the subrogation process and all of the money that may be owed or subrogated to other parties.
You need to ensure that an offer covers all of your expenses and any amount of money that may be owed to other parties.
How will the COVID-19 pandemic affect my Louisiana legal case?
"How will my case be affected by the novel Coronavirus pandemic?"
This is the one question many are asking right now as this crisis continues to persist.
First, please know that we are actively and tirelessly working on all of our cases.
For the safety of our clients and staff, we are not having in-person client meetings at this time.
We are using phone, video-conferencing, and online document signing for client and new-client consultations.
Court closures have affected cases differently depending on case type.
How will the COVID-19 pandemic affect my Social Security Disability claim?
If your case is currently awaiting a decision or a hearing, SSA continues to process cases. If you are currently receiving monthly SSA benefits, those should continue without interruption.
For a more detailed explanation of the effects of the novel Coronavirus on Social Security Disability claims, read my in-depth blog post.
How will the COVID-19 pandemic affect my Personal Injury case?
We continue working on our personal injury cases and they are progressing as expected. If a lawsuit was filed or will be filed in your case, all deadlines and hearings have been extended during this crisis by order of the Louisiana Supreme Court and Governor.
For a more detailed explanation of the effects of the novel Coronavirus on Personal Injury cases, read my in-depth blog post.
How will the COVID-19 pandemic affect my Family Law case?
Unless your matter involves an emergency situation, all deadlines and hearings have been extended during this crisis by order of the Louisiana Supreme Court and Governor.
For a more detailed explanation of the effects of the novel Coronavirus on divorce, custody, and other family law cases, read my in-depth blog post.
How ill the COVID-19 pandemic affect my Long-Term Disability claim?
We continue working on our long-term disability cases and they are progressing as expected. If a lawsuit was filed or will be filed in your case, most deadlines and hearings have been extended during this crisis by order of the Court. If you are receiving monthly payments from an insurer, those should continue without interruption.
For a more detailed explanation of the effects of the novel Coronavirus on Long-Term Disability claims, read my in-depth blog post.
Here at LJBLegal we are continuing to work on all of our clients' matters. We are not meeting in person, but are available by phone to answer all of your questions. Give us a call at 985-240-9773