Gallon, Takacs, Boissoneault & Schaffer Co., L.P.A.
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SERS Disability Process

Earlier, we discussed benefits available to public employees thru OPERS. Today we are going to talk about another disability program in Ohio - SERS. SERS, or the School Employees Retirement System of Ohio, has 2 different types of disability programs - depending on whether you were a member before or after July 29, 1992, however, many of the requirements remain the same. These programs cover school employees who are not teachers.

To be eligible for disability benefits, you must have at least 5 years of service credit. You earn 1 year of credit for completion of 120 days of school employment between July, 1 and June, 30. There is also the possibility to purchase service credit thru SERS in some instances.

In order to qualify for disability benefits, the member must show that they have a disabling impairment (physical or mental) that is presumed to be permanent for a 12 month period following the filing of your application that prevents the member from being able to perform their last assigned primary duty as an employee.

To start the process you must file your disability benefit application along with: a job description; statement from your attending physician; and medical releases so that SERS can obtain medical records to support your claim. Your application must be filed within 2 years of your last contributing service. Next, SERS will schedule you for an exam with a doctor that they set up. That report, along with your medical records, is reviewed by the Medical Advisory Committee and a recommendation is made to the SERS Board. The Board will then vote on your application for disability benefits.

If you are denied benefits, you have the right to appeal. Your appeal must be filed within 15 days of the date of the notice denying your benefits. This is a very short timeframe so it is important to act quickly to appeal a denial of benefits. You also have the right to submit additional evidence and to request an in-person hearing before the SERS Board on your appeal. Most importantly, you have the right to be represented by an attorney during these proceedings.

Once your disability benefits have been granted, SERS can have you examined yearly to show you are still disabled. When looking at whether your disability is ongoing, if you are under a leave of absence, the standard remains the same as it was when you filed - an inability to perform your last assigned primary job. However, when you are no longer considered under a leave of absence (either 3 or 5 years after your disability started) the standard changes. If your disability benefit started before January 7, 2013, a member must show they are not capable of resuming employment that is the same or similar to that from which they were found disabled. If your disability started on or after January 7, 2013, you have to so you are unable to return to a job that: replaces not less than 75% of your final average salary; is reasonably found in your regional job market; and is a job that you are qualified to perform through your experience and education. You also have an obligation to undergo treatment/vocational rehabilitation as recommended by the SERS Board doctor or other consultants. If you fail to follow thru with these treatment recommendations SERS may suspend or even terminate your benefits.

If you are unable to work and are fighting SERS for the disability benefits you deserve, please contact us. We can help.

Justice Denied: Ohio Workers' Compensation Law and Post Traumatic Stress Disorder in Emergency Responders

Much has been written, and rightly so, of the heroism of fire fighters, police officers, and emergency medical personnel following the events of September 11, 2001. In the past two weeks, the bombing of the Boston Marathon and the tragic explosion at a fertilizer plant in West, Texas have reminded us once again of the vital services provided by men and women in these professions. The nature of their occupation requires that they rush to scenes of catastrophes to aid the victims, regardless of the danger to their own safety. A growing body of evidence makes clear, however, that the dangers confronting them go beyond the obvious physical hazards of the jobs they do. Studies of New York City police and firefighters who worked at the site of the World Trade Center have shown significantly elevated rates of acute stress disorder, post-traumatic stress disorder, and depression.

It should surprise no one that first responders have a higher rate of work-related mental health conditions than most other occupational groups. According to the diagnostic criteria adopted by the American Psychiatric Association, PTSD can result from exposure to an extreme traumatic stressor which involves the threat of death or serious physical injury, or by witnessing events which involve the death or serious injury of another. Decades of research into the causes of post-traumatic stress disorder have made it clear that just as combat veterans who were not wounded in action may develop PTSD, civilian workers exposed to the aftermath of terrorist attacks, explosions, or accidents resulting in death or serious bodily injury of another person can develop PTSD, even though they were not physically injured.

According to Article II, Section 35 of the Ohio Constitution, workers' compensation laws exist "for the purpose of providing compensation to workmen and their dependents for death, injuries, or occupational disease, occasioned in the course of such workmen's employment." It cannot be doubted that emergency responders are often exposed by the very nature of their employment to exactly the types of events which have long been known to cause post-traumatic stress disorder. It would seem logical, therefore, that workers' compensation laws should provide protection for the men and women called upon to risk their physical and emotional well-being to aid and protect us in times of great danger. Ohio workers' compensation law, however, does not.

Under the Ohio workers' compensation act, a psychiatric condition is not considered to be an injury, unless it was caused by some physical injury or disease sustained in the course of employment. The Ohio General Assembly has made it the law that psychological conditions are covered if, and only if, the psychological condition arose as a complication of a physical injury sustained in the course of employment. This means that police officers, firefighters, paramedics and other workers who develop PTSD as the result of exposure to extreme psychological trauma in the course of their employment are denied the compensation and medical benefits which the workers' compensation act is supposed to provide to all employees who suffer work-related injuries. For men and women in these occupations, the duties of employment require that they subject themselves to events and conditions known to cause serious and sometimes debilitating psychological harm. It is simply wrong for the law to turn its back on them.

The votes of a legislative majority may have made it the law in Ohio that there can be no psychiatric injury in the absence of a physical injury, but no legislative enactment can ever make this the truth. Fortunately, wrongs caused by acts of the legislature can be righted in the same fashion. If you think that the men and women who risk everything for our protection deserve better than they get under the present law, please contact your state representatives and state senators.

The Law of Teacher Terminations

Right wing politicians and greedy corporate interests have increasingly been at the forefront of efforts to do away with publicly funded education. These efforts have led to a piecemeal erosion of the historical responsibility of government to ensure that education is freely available to all, as well as to an increase in public education being supplied by for-profit corporations and entities.

But the attacks on the educational system has not been limited to institutional changes. On the contrary, efforts to eliminate the promise of public education has included ad hominem assaults on teachers and their unions, and more specifically, vocal demands for changes in statutory protections which afford teachers protections against arbitrary terminations. Clearly, the interests lobbying against public funding of education and against teachers would like nothing more than to strip teachers of basic civil rights which protect them from unwarranted discharge.

Nevertheless, Ohio currently provides teachers with strong protections against unfair terminations. Ohio Revised Code Section 3319.16 is the primary Ohio statute which regulates the termination of tenured teachers. Thus, under this statute a teacher's contract may not be terminated unless there exists "good and proper cause." If a Board of Education wishes to terminate a teacher it must first provide a teacher with notice and a full specification of grounds why the school Board is considering terminating the teacher in question. Once such notice is provided to the teacher, the teacher then has the option of demanding a hearing before the Board of Education or before a neutral referee. Inasmuch as it is unlikely that a Board of Education considering termination of a teacher could be impartial, teachers overwhelmingly demand their matter be heard by a neutral referee.

At the hearing before a referee, the teacher has the full right to be represented by an attorney, have witnesses testify under oath, cross-examine witnesses, have a record made of the proceedings, and have subpoenas issued to complete the attendance of witnesses. After the hearing, the referee submits a report to the parties. The school Board of Education then decides whether to accept or reject the referee's report. A teacher who is affected by a school Board's acceptance or rejection of a referee report then has the right to appeal to the Court of Common Pleas by filing a complaint against the school Board.

Thus, current Ohio law affords adequate protection to Ohio teachers against arbitrary discharge and contract termination. While the forces of the far right will continue to seek to modify these protections in order to erode the special status enjoyed by teachers, so far, those efforts have been unsuccessful. In the interim, teachers should be aware of their statutory rights and readily invoke them for their protection.

Ohio Public Employee Retirement System Has A Disability Program Too

The attorneys of Gallon, Takacs, Boissoneault & Schaffer represent clients in several different types of disability cases; we do not only handle disability cases with the Social Security Administration. So over the next few weeks, I am going to highlight some of those other disability cases that we may be able to help you with - starting with OPERS.

In Ohio, if you are a public employee, instead of paying into Social Security you are paying into PERS (Public Employee Retirement System). In order to qualify for disability benefits you must have at least 60months (5years) of contributing and/or purchased service and a disability or illness (physical or mental) that renders you unable to perform the duties of your last public employment position. Also, this condition must be expected to last for a continuous 12 month period and must relate to an injury/illness that either: occurred before you terminated your contributing service, or was present before you terminated your contributing service but did not manifest itself for up to 2 years after.

In order to process your claim for disability, you must file several forms, including a physician report from your doctor. Once the application is filed, OPERS will schedule a medical review and then your application for disability benefits will go to the OPERS Board for approval. If the Board denies your application for disability benefits you do have the right to appeal and provide additional medical evidence. However, it is important to know that you do not have a large window to appeal your decision. Your appeal must be filed within 30 days from the date of the denial. Once the appeal has been filed, you have 45 days (with another 45 day extension upon request) to file your additional medical evidence - which must include a new physician report from your doctor. The Board will then review your appeal and make their decision on your disability application.

Once approved, the Board will periodically review your case to determine whether you are still disabled. For OPERS members who file for disability after January 7, 2013, after 3 years of receiving a disability benefit they will be re-evaluated under their any occupation standard. Under this standard, the member is disabled only if they can show that they are no longer physically or mentally capable of performing any position that: replaces 75% of the members' final average salary (FAS); that is reasonably found in the member's regional job market; and for which the member is qualified to do based on their education and experience.

Our firm can help you get the benefits you deserve thru OPERS. If you, or someone you know is in need of help, or has questions, please contact us.

Don't Add to the Delay in Your Disability Case

In recent months we have seen an increase in claimants who attend a hearing, unrepresented, and then seek counsel at the request of the ALJ who continues the hearing until they obtain representation.

Obviously this adds an extra step in the process, and puts the claimant at a disadvantage because of further delay. The attorney then has to go back and collect records, establish the theory of the case, and prepare the claimant for hearing when all of this could have been accomplished much earlier.

The moral of the story is this: obtain representation as early as possible if you are seeking disability.

We are here to help you from the very beginning, and we can file an application electronically, eliminating your need to deal directly with the Social Security Administration application process.

Remember, early representation results in a more efficient presentation at the hearing, as well as at the initial application and reconsideration levels.

Spring is Here - Time to Think About Motorcycle Safety

I know it hasn't felt very warm lately, but spring is here and soon warmer weather will be upon us. With the arrival of warm weather motorcycle riders will be hitting the open roads, increasing the risk for serious bodily injuries or even death. With that in mind, all motorists need to take extra care, and make sure that they share the road with motorcycle riders.

On the road, a motorcycle rider is in a much more vulnerable position than a passenger in a typical motor vehicle. In fact, according to the Department of Transportation's National Highway Traffic Safety Administration per mile traveled, motorcyclists are almost 40 times more likely to die in a traffic collision.

All motorists need to take care and follow these quick tips...

· Remember, a motorcycle is a vehicle with all of the rights and privileges of any other motor vehicle.

· Always allow a motorcyclist the full lane width-never try to share a lane.

· Perform a visual check for motorcycles by checking mirrors and blind spots before entering or exiting a lane of traffic, and at intersections.

· Always signal your intentions before changing lanes or merging with traffic.

· Don't be fooled by a flashing turn signal on a mo­torcycle - motorcycle signals are often not self-canceling and riders sometimes forget to turn them off. Wait to be sure the motorcycle is going to turn before you proceed.

· Allow more following distance - three or four sec­onds - when behind a motorcycle so the motorcyclist has enough time to maneuver or stop in an emer­gency.

· Never tailgate. In dry conditions, motorcycles can stop more quickly than cars.

· Never drive while distracted.

Motorcyclists need to do their part as well, and increase their safety by...

· Avoiding riding in poor weather conditions;

· Wearing brightly colored protective gear and helmet;

· Using turn signals for every turn or lane change, even if the rider thinks no one will see it;

· Combining hand signals and turn signals to draw more attention to themselves;

· Using reflective tape and stickers to increase conspicuity;

· Positioning themselves in the lane where they will be most visible to other drivers; and

· Never driving while impaired.

With a little extra care and attention all motorists can safely share the road.

Workers' Compensation and Medical Treatment

When you have been injured or diseased on the job and covered under Workers' Compensation in Ohio, in addition to having a variety of monetary benefits available to you under the claim, the claim should afford you full payment of all reasonably related and necessary medical charges for treatment of the allowed or recognized conditions in the claim. The injured worker should not have to bear any expenses the evaluation, diagnosis, of treatment of the injuries that are covered - no co-pays, no deductibles, and nothing out-of pocket.

Many people are not aware that they have the right to choose their own doctor for the purposes of rendering care under a claim. If you are covered under a Workers' Compensation claim in Ohio, you are not required to treat with doctors chosen by your employer or its representatives, a managed care organization, or by the Bureau of Workers' Compensation (BWC). In the latter scenario, far too often it seems that physician chosen for the injured worker as opposed to by the injured worker are more concerned with what will benefit the employer or the BWC (i.e., cost savings), as opposed to what is in the best interests of their patient.

If an injured worker chooses to exercise the right to choose her/his own doctor, the only restriction is that the physician selected must be BWC certified, meaning that they are willing to take and handle Workers' Compensation cases and comply with the policies and procedures set forth by the law and rule here in Ohio.

The BWC website provides an up-to-date list of BWC certified physicians both inside and outside of Ohio. Please note that not all providers who are BWC certified are necessarily friendly or favorable to injured workers. When in doubt, it is always wise to contact an experienced attorney to determine if the physician you are contemplating is the right one for you.

Medical Insurance Available to Residents of Lucas County

Getting medial treatment is an important step in your disability case. Your treatment by your doctor can outline the problems you are having and show an objective basis for your symptoms. Unfortunately, the problem that many people going through the disability process run into is that when they were forced from the workforce due, they also lost their medical insurance - and with it their means to see a doctor.

For residents of Lucas County, Care Net offers a solution. You may qualify for Care Net if you are not eligible for other public or private health insurance, have been a resident of Lucas County for at least 6 months and meet their income requirements. On the application is a list of doctors in the area who accept Care Net insurance and you will select the doctor that you would like to see. In addition to seeing a doctor, you may be able to get help with your prescriptions as well.

If you are having trouble with your disability case or if you have any questions about Social Security, please contact us.

Why Do We Have Workers' Compensation Laws?

Before the enactment of workers' compensation laws, work related injuries were governed by the common law of torts. An employee injured on the job could sue the employer for damages. In order to recover, the injured employee or the dependents of an employee killed in an industrial accident had to prove that the employer was liable under common law negligence principles, for causing the accident. In many cases, the employer could escape liability under one or more of a trio of defenses. The defense of "contributory negligence" held that if the injured employee's own negligence contributed, however slightly, to the accident, there could be no recovery. The "fellow servant rule" prevented recovery if the injury or death resulted from the negligence of a co-worker, and the "assumption of the risk" doctrine barred recovery if the injured or deceased worker was aware of the dangers of the job.

Under the common law, the injured workers or their surviving family members very rarely recovered. In the early days of the twentieth century, a study of 370 fatal work-related injuries in Cuyahoga County revealed that the survivors recovered damages or received a settlement in only 36 per cent of these cases. The average recovery was less than $850.00. A study of non-fatal injuries during the same period showed that in these cases less than 2o per cent of the injured workers ever made any recovery.

Workers' compensation laws were enacted in Ohio because it came to be widely believed that the common law tort system was inadequate to meet the problems associated with work-related injuries in an increasingly industrialized economy. The vast majority of work-related accidents resulted in no recovery of lost wages and medical bills, and in the few cases where some recovery was made, it was typically inadequate to compensate for the economic loss caused by the accident. Workers' compensation laws, which provide for payment of medical bills and at least partial replacement of lost wages resulting from a work-related injury without regard to negligence or fault, were adopted throughout the United States because the common law system often resulted in injured workers and their families being reduced to poverty.

Why it is important to bring up what, to many, may seem like ancient history? My answer is "People who forget the past are doomed to repeat it." Legislation limiting the types of injuries covered by workers' compensation has been common over the last twenty years. Vocational rehabilitation programs rarely make a serious effort to help workers who will never be able to return to their previous jobs to gain the knowledge and skills they need to make a successful transition to a new occupation. Court decisions have developed a body of law on the subject of "voluntary abandonment of employment" which often results in injured workers being denied compensation for reasons having nothing to do with whether their work-related injuries have left them unable to work.

A century ago, lawmakers in Ohio were committed as a matter of public policy to workers' compensation laws to prevent injured workers and their families from being reduced to poverty. Today, there is reason to ask whether that commitment survives.

Is It Time To Review Your Estate Plan?

The beginning of a New Year is a good time to set goals for the year. Most of the time, people are focused on setting goals for their personal health or physical appearance. The popular New Year's resolutions are to "lose weight", "start exercising", "stop smoking" or to "get in shape". However, goals for our financial well being are just as important as goals for our physical well being. Why not consider adding a goal to review your Estate Plan and Estate Planning Documents this New Year?

I generally advise clients to make it a practice to review their estate plan and planning documents every 3-5 years. However, changes in life events may necessitate a change to your estate plan. The death of a named beneficiary, the addition of children or grandchildren to the family, a marriage or a divorce may be the type of event that will require a change to your estate plan.

Its not too late to make one of the following New Year's Resolutions for 2013:

1) Review your estate plan - Is it complete? - If not consider getting it done in 2013;

2) Is your estate plan up to date? If not consider a plan review and insure your plan is current;

3) Have you given copies of plan documents to named agents of family members? - If not make it your resolution to give copies of documents to Family members; and

4) In addition to the review of your estate plan, have you reviewed the estate plans of aging parents and/or grandparents?

Take the time to review your estate plan and make 2013 a great new year!

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