Lump Sum Settlements
Most Michigan workers’ comp settlements are made in a lump sum. In a lump sum settlement, the insurance company agrees to make one payment that resolves your entire workers’ comp claim.
A lump sum settlement is different than a voluntary payment (VP) agreement. A VP agreement simply means that the insurance company has agreed to voluntarily pay you a certain amount in workers’ comp benefits. If you signed a brief voluntary payment form (Form WC-115) and did not attend a redemption hearing (see below), you did not settle your case. You can still demand ongoing benefits or file an appeal if the insurance company disputes your benefits in the future.
Administration (SSA) maintains a “Listing of Medical Impairments” (known as the blue book) that automatically qualify you for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), provided certain conditions are met. If your medical condition, or its equivalent, is on SSA’s Listing of Impairments, then you are generally considered disabled and therefore eligible to receive SSA disability benefits. If your medical condition is not on the list, you may still be eligible under other SSA guidelines.
Medically Approved List of Impairments
The SSA’s Listing of Impairments is generally broken down by bodily system or function. There are separate lists for adults and children under the age of 18. For adults, the medical conditions that qualify for SSDI or SSI include:
Musculoskeletal problems, such as back conditions and other dysfunctions of the joints and bones
Senses and speech issues, such as vision and hearing loss
Respiratory illnesses, such as asthma and cystic fibrosis
Cardiovascular conditions, such as chronic heart failure or coronary artery disease
Digestive tract problems, such as liver disease and inflammatory bowel disease (IBD)
Neurological disorders, such as multiple sclerosis, cerebral palsy, Parkinson’s disease, and epilepsy
Blood disorders, such as sickle cell disease or hemophilia
Mental disorders, such as depression, anxiety, schizophrenia, autism, or intellectual disability
Immune system disorders, such as HIV/AIDS, lupus, rheumatoid arthritis, and kidney disease
The list of medical conditions for children under the age of 18 is virtually identical to the one for adults. Growth impairment is the only medical condition covered for children that isn’t covered for adults. For a complete list of impairments, including detailed evaluation methods, visit www.ssa.gov.
What If Your Medical Condition Is Not on the List?
Even if your medical condition isn’t on the Listing of Impairments, you may still qualify for SSDI or SSI if certain criteria are met. First, the medical condition must be a medically determinable impairment. A medically determinable impairment is a medical condition that has been the subject of clinical and laboratory testing. In other words, your medical condition must be supported by clinical reports.
Next, the medical condition must limit your residual functional capacity (RFC). RFC is determined by looking at the most demanding activity you can still do despite your medical limitations. Based on your residual functional capacity, a disability claims examiner will determine your exertional level. Exertional levels vary from sedentary work to very heavy work and are based on how much weight you can lift and carry.
The RFC also includes non-exertional limitations, like the ability to climb or bend down, the use of hands, the capacity to cope with anxiety or depression, and any environmental restrictions. The disability claims examiner will take your medical history, reports, and residual functional capacity into consideration to determine if your medical condition qualifies for disability benefits.
What Medical Evidence Do I Need to Show?
Medical evidence for a Social Security disability case can include:
Treatment notes or reports
Mental health records
Blood work panels
The medical evidence must be recent and must encompass the time period from when you became disabled to the present time. Further, your medical records must show that your condition is severe enough to prevent you from performing your standard work-related duties.