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Workers Compensation

Acts Benefiting Employee

When an employee undertakes an activity that is outside his regular or established duties, the question arises whether an injury resulting from such activity was incurred during the course of his employment. Though compensation is not altogether likely when the act benefits the employee, there are instances where it is possible for an employee to recover workers’ compensation benefits. With respect to self-improvement activities, courts have allowed compensation where the employee was injured while attempting to register for a vocational class. The decision hinged on the fact that the vocational education was called for in the contract for hire. Additionally, an employee required by his union to take educational courses, which were paid for by the employer, was allowed compensation.

Corporate Executives and Partners

Depending upon an individual’s position within a company, he may or may not be covered by workers’ compensation. Generally, it is “employees” who may claim workers’ compensation benefits. Officers, such as a chief operating officer, president, corporate secretary, or chief financial officer, are usually covered just like regular employees. However, if such an officer gains a controlling ownership interest in the corporation, workers’ compensation coverage may be lost. This is because the corporation has essentially become the alter ego of the officer and vice-versa. If workers’ compensation coverage was still to be extended to the officer in such a situation, it would be like calling the officer both the employer and the employee. For coverage to be affected, some states require that the officer serve on the corporation’s board of directors in addition to owning shares in the corporation.

Determining “Dependency” for Workers’ Compensation Death Benefits

The issue of “dependency,” with respect to the receipt of workers’ compensation death benefits, is generally determined either as of the date of the worker’s death or the date of the accident that caused his death. Those individuals who are, therefore, “dependents” on the requisite date will be eligible to receive death benefits in an amount commensurate with the measure of dependency on the worker, i.e. total or partial dependency.

Payment for Representation of a Social Security Claimant

A social security claimant may choose to be represented by a third party in his dealings with the Social Security Administration (SSA). If the third party accepts the role of “representative” on behalf of the claimant, he is prohibited from charging the claimant a fee without prior authorization from the SSA. This holds true even if the claim is denied. To obtain approval from the SSA, the representative must use either of two fee authorization processes.

Supplemental Security Income Appeals Process

Aggrieved individuals may appeal initial determinations of the Social Security Administration with respect to a variety of issues. A non-exhaustive list of appealable issues includes whether an individual is eligible to receive Supplemental Security Income (SSI) benefits, the amount of an individual’s SSI benefit, whether an overpayment has occurred and the amount to be repaid, and whether the individual suffers from a “disability.” Though individuals have sixty days to initiate the appeal process, only those individuals who appeal within ten days may have their benefits continued until the appeal is decided. If ultimately, the individual’s appeal is unsuccessful, the payments he received in the interim will be considered overpayments. After each decision in the appeal process, the individual has another sixty days in which to appeal to the next level.

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