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Attorney, Keith R. Siskind of the Law Offices of Steinhardt, Siskind and Associates, LLC, attended the American Conference Institute seminar on Litigating Disability Insurance Claims held in Boston on September 14 and 15, 2016.  The seminar addressed multiple issues associated with disability insurance claims.  These issues include the applicability of ERISA, remedies, discovery, and contractual limitations.  Cases often turn on the applicable standard of review to be applied by the court when resolving disability claims.  The Department of Labor has proposed new Federal Regulations that will help create a more even playing field for a claimant by providing claimants with an opportunity to respond to medical reviews obtained by the insurance carrier before a final decision is issued on appeal and requiring strict compliance from insurance carriers.  It is hopeful that these new regulations will become effective shortly.

More importantly, this seminar reinforced how critical it is for claimants to have experienced legal counsel when pursuing disability insurance claims.  The process is cumbersome.  Insurance companies increasingly seek more information to document a claimant’s disability.  A claimant needs an attorney to help sort through the complex medical and other documentation that is required to get a claim approved.  An attorney can assist with reviewing the claim, obtaining applicable records, securing appropriate evaluations and challenging a denied claim by the insurance company.

When a claimant becomes disabled and is unable to work, it is often a  stressful time both emotionally and financially for the claimant and their families.  Not only does the claimant have to deal with their medical condition and the financial loss of income, but also the minutiae of information that the insurance company seeks to document a disability.  Do not try to pursue such a claim without experienced legal counsel to navigate you through this process.  It can be overwhelming.  You need the support that an experienced disability attorney can provide.

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car-1449764Recently, a pedestrian was in critical condition after a hit and run, in which the pedestrian was thrown across an intersection. The driver of the car didn’t stop, and the pedestrian had to go to a trauma center to be treated for life-threatening injuries. The police searched the area and found the vehicle involved parked in a complex with the pedestrian’s belongings still embedded in the grill. The driver was located nearby and brought in for questioning. Police believed that the initial reason for the crash was the pedestrian’s failure to yield the right of way to the car, but the investigation is ongoing.

It is illegal for a driver to flee the scene of a car collision. Whenever somebody is involved in a motor vehicle accident in Maryland, they are legally obliged to stop and exchange insurance information with the other party. If there are injuries, you are required to call the police and file a formal accident report. A hit and run driver who leaves the scene of an accident involving injuries may face criminal charges. Those convicted may face up to five years in prison and a $5,000 fine. Many hit and run drivers are not insured, and this is why they flee. It’s estimated that about 12% of Maryland drivers are uninsured.

In many cases, the driver is never located, and as a result, victims of these hit and runs are unable to sue the driver for damages resulting from their injuries. In Maryland, a victim of a hit and run for which the driver is never located or is uninsured may be able to make a claim against the uninsured motorist coverage of his own automobile insurance policy.

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young-police-officer-1-1515554In State v. Okafor, a police officer driving to work in uniform was in a car accident. His patrol car had been having engine trouble, so he took it to a repair facility for patrol cars, and he was driving his own car at the time of the accident. His car was clipped, resulting in him losing control of the car and hitting a tree. He suffered personal injuries and pursued a workers’ compensation benefits claim.

The police officer’s employer, the State, brought an action for judicial review in the Circuit Court and filed a motion for summary judgment, which the court denied. The State argued that his claim was barred by the going and coming rule. Under this rule, you cannot recover workers’ compensation benefits for injuries sustained while going to or coming from work. There are certain exceptions however, including a special errand exception and an exception when an employer requires an employee to use his own car for work.

The police officer explained that when he dropped off the car for repair, there weren’t other patrol cars he could use, which was why he was driving his own car at the time of the accident. When driving his own car, he can arrest someone he sees committing a felony and help if he passes an accident. However, he can’t write tickets or chase vehicles or make a traffic stop.

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floor-tiles-1194781In Long v. Injured Workers’ Insurance Fund, the court considered a case in which the owner of a flooring installation company, a sole proprietor, was injured. Before 2011, the owner had elected to be a covered employee under LE § 9-227. His company did work as an independent contractor for the contractor Ryan Homes. The contractor paid the sole proprietor every week for the hours worked by the owner.

While installing carpet for the contractor, the owner sustained a serious back injury. He was able to come back to work temporarily, but due to the severity of the injury he couldn’t work after fall 2011. According to his attorney, he would be 100% disabled for the remainder of his life. Six months after the accident, the owner filed a claim notice with the Commission.

The claimant filed a tax return for 2011 claiming no wages, although he did declare a business income of $16,879, which represented the sole proprietorship’s net profit. At a Commission hearing, there was a question as to how the Injured Workers’ Insurance Fund (IWIF) calculated workers’ compensation premiums. IWIF had sent a letter trying to get information from the claimant so that it could establish premiums based on his estimate of payroll.

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garbage-truck-924177-mLocal government employees in Maryland are restricted in their ability to sue for injuries caused by an employer or coworker. In Blue v. Arrington, a Baltimore City employee (Arrington) hurt another employee (Blue) while they were working at their jobs for the City. The injured plaintiff was working as a Seasonal Maintenance Aide on a garbage truck. He was side mounted on the outside of a truck driven by Arrington. Arrington was on the cell phone, tried to turn, and crushed Blue between a fence and brick wall.

The injured employee received workers’ compensation for permanent disability, medical expenses, and lost wages, but he also sued Arrington for negligence for the same injuries. The plaintiff alleged the coworker owed a duty to operate the vehicle properly and breached the duty of care by failing to properly turn the vehicle while keeping a lookout for Blue.

The city filed a motion to dismiss on its employee’s behalf, relying on the Local Government Tort Claims Act, which prevents local government employees from suing coworkers for tortious acts or omissions that are committed in the scope of employment if Maryland workers’ compensation covers the injury. It argued that the plaintiff’s exclusive remedy was worker’s compensation. Continue reading →

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beach-1-49307-mIn the unpublished case Tanner v. Social Security Administration, the Fourth Circuit Court of Appeals considered a case in which the Social Security Administration had twice denied a claimant’s disability insurance benefits claim. The case arose when the claimant, a special education teacher, got in between two fighting students. Her shoulder, neck and upper extremities were injured. She received medical treatment for a wide range of physical and mental ailments in 2006, including PTSD and depression.

She applied for disability benefits in 2007, and her claim was initially denied, and denied again upon reconsideration. She sued the Commissioner in court arguing that the administrative judge failed to look at her physicians’ opinions, failed to look at her credibility, and failed to look at the combination of her impairments.

The magistrate judge to whom the case was referred recommended further consideration of opinion evidence to the district court. The district court accepted the magistrate judge’s recommendation and rejected the other arguments.

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In a recent Maryland Court of Appeals case, the Court  determined that even though a contractor did not have workers’ compensation insurance, they could be an employee of the general contractor, and therefore  covered under the  general contractor’s workers’ compensation insurance policy. The Court looked at the employer-employee relationship under common law principles. In this case the injured worker installed windows and doors for the company. Although he had a home improvement license, he did not have workers’ compensation insurance.  However the company he contracted with, scheduled all his appointments and provided the supplies and materials. The injured worker also wore the company’s shirts with their logo on them.  As a result the Court of Appeals determined that the injured worker was covered by insurance.

 

If you are hurt at work, contact the attorneys at the Law Offices of Steinhardt, Siskind and  Associates, LLC. Our initial consultation is free, and there are no costs or expenses unless we win your case!

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agreement-signing-251732-m-2In the 2012 case of Garcia v. The Hartford, the surviving spouse of Jose Garcia, Elvira Garcia, sued the insurance company The Hartford for a violation of ERISA. The decedent had participated in his employer’s long-term disability plan. The plan was insured and administered by The Hartford and was governed by ERISA.

The purpose of the plan was to give policyholders protection against loss of income in the event of disability. The covered employees were to receive long-term disability benefits—a portion of monthly income—if they were so disabled they couldn’t work. The payments would end when the disabled employee could come back to work. By the policy terms, The Hartford had the authority to interpret all terms and provisions of the plan.

In 2004, the decedent had a heart attack, and the insurer approved his long-term disability benefits claim. However, the insurer told him that the payments would be reduced by other benefits, such as Social Security Disability Insurance (SSDI). At the time of the approval, he wasn’t receiving SSDI, but the insurer directed him to apply. Subsequently, he signed a reimbursement agreement in which the insurer claimed he had applied for other benefits. Continue reading →

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railway-sign-1334757-mRecently, a train hit a car in Westminster, Maryland at the intersection of Route 27 and Winters Street at night, and a woman was injured and taken to the shock trauma department of a hospital. The conductor sounded its horn, and the train signal was activated. The train hit the passenger side and dragged it for a while before stopping near Main Street.

Train accidents tend to have more devastating consequences than car accidents due to the weight and high speed of trains. According to the Federal Highway Administration, train accidents happen every two hours in this country. Accidents often happen because of two trains colliding, derailment, collision with a smaller vehicle such as a car or motorcycle or bus, a mechanical failure, dated tracks, or conductor negligence. Derailment sometimes results in derailment accidents, which can result in many injuries. One of the most common types of accidents is an accident at a railroad crossing. Over 80% of crossings in America do not have adequate warnings for cars and pedestrians.

Sometimes collisions happen because signals on the track are not working. If this is the result of railroad negligence, the railroad will be held responsible for any resulting injuries. On the other hand, if the signal is defective, it may be possible to hold the manufacturer of the signal responsible. Continue reading →

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In a recent social security disability case, a Maryland District Court considered a situation in which the plaintiff, Kowana Chase, had been denied benefits. The plaintiff claimed disability from August 2005 through 2009 and filed her application in 2007. The disability claimed was the result of musculoskeletal connective tissue injury, status post cervical fusion, and obesity. The Commissioner denied her claim, as did the ALJ.

The District Court explained it would find her legally disabled if she was unable to do any substantial gainful activity because of a medically determined physical or mental impairment that could either result in death or could be expected last continuously for at least 12 months.

The first step was to determine if the claimant was doing substantial gainful activity. Someone able to do such activity is not disabled. The second step was to determine whether the plaintiff had a medically determinable physical or mental impairment that meets the requirement of severity and duration. The third step is whether the plaintiff’s impairment equals or meets the listings and meets the duration requirement. If she has this type of impairment, she is disabled. If she doesn’t have an impairment that meets the listings, the court must decide if she retains residual functional capacity to perform relevant work she has performed before. If she can’t, the next step is to see if she can perform any work given her age, work experience, and education. If she can’t perform any other work, she is disabled. Continue reading →