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How To Reduce or
Eliminate Drug Cost

 June 20, 2009

By  Brian

Rightfully so, there is a system in place, which varies somewhat state to state as far as regulation and administration, but is designed to provide needed medical care and remuneration to those workers who become injured while on the job.  Employers are required to carry insurance to meet these needs, and most do so. (although I have handled cases in which the employer had not complied with the law and had no worker’s compensation insurance—but that is another story for another day)

One might believe this system could be managed appropriately, and be set up to expedite services to the injured worker—and, indeed, this ought to be the case.  After all, the injured individual (in a preponderance of cases) was fulfilling his or her obligation or contract to work, and through accidental circumstances sustained an injury, leading in many cases to permanent conditions which represent a loss of the ability to, say, lift any more than 10 pounds, or compromise the use of one’s arms or legs.  Perhaps loss of an eye, or cut off a hand.

In other words, a negative situation.  Just imagine waking up one morning, feeling fine, going to work, and within the hour, suffer a tremendous fall,  breaking your back.  Your life has changed forever, and you might feel that you are owed, at least, immediate and professional medical care coupled with a system enjoined to ‘make things right’ with you, since you are the one who suffered the loss.

In addition to the pain, fear, and horror of your situation, you must now rely entirely on this ‘system’ to ensure you receive medical care, your monetary benefits, and some form of vocational rehabilitation, should your injuries preclude your working in the same or similar job.  Those who have been through this experience will doubtless relate the fear and frustration, even when the ‘system’ is working as it is supposed to.  That is, with an eye toward taking care of the injured individual, providing positive steps forward to allow for return to gainful employment, or in worse case scenario, become classified as permanently disabled, requiring application to the Social Security Administration to obtain disability benefits.

Bearing in mind that the quicker this process plays out in each case, the more effective it is in totality—where the individual is able to get to the best level of recovery (and future employment) as possible, and where the system incurs the least cost.  However, the majority of these cases simply do not work this way.

One might think that the insurance industry believed that needless delays, complicated rules and regulations, mis-communications, and outright misanthropy should drive the engine of the worker’s comp system, and many companies bear the guilt of this philosophy and its actions.

These are not specious charges— rather they are based on personal observations and encounters with well over 500 vocational rehab cases, where many individuals had been subjected to a variety of the above referenced insurance company actions, and had suffered permanent emotional damage as a result, in addition to having to deal with whatever malady was responsible for the disabling condition.

To put it bluntly, the worker’s comp insurance carriers have designed and implemented a system of care which, in many cases, requires the services of an attorney to force compliance, and even then, continue to cause lengthy delays, utilizing mystifying rules which prevent a situation of best practices.

To what end, one might ask?  Why do they act the way they do?  Simple financial analysis show that it is more costly for the insurance companies when they behave in such a problematic manner.  One can only surmise that an underlying tenet of these companies promulgates the notion that if they can devise some way  to not have to pay for medical care, or pay monetary benefits, then they will be more profitable.  This is the height of absurdity, and represents the depth of lack of genuine concern for humanity.

Our free online magazine, The Disability Digest,  is no stranger to encountering situations like this.   Much like Social Security Disability, the worker’s comp system continues to behave in ways which not only further harm the individual, but simultaneously create conditions which account for the necessity for paying additional expenses.  This is a lose-lose for everyone.

A recent member of our organization, Ron Markowicz, has been embroiled with a worker’s compensation case for approximately two years, and is far worse off now medically (and emotionally) than he was at the onset of his injury.  There were surgical mistakes, communication errors, bad professional practices, and outright lying, all creating a horrific situation for Mr. Markowicz.  At 38 years old, he has diligently and responsibly worked in his profession for 20 years.  Today, he cannot even pick up his 2 year old daughter to give her a hug.

As this missive has become rather lengthy, I am enclosing a URL which further explains the details of his situation.  We are attempting to assist Ron with his case, but I would kindly ask any disability solutions or worker’s comp advocates for any input which could help.  This is about as bad as it gets.

Email me directly: john at thedisabilitydigest.com

Ron’s case information:

http://affiliate.kickapps.com/service/displayKickPlace.kickAction?u=7955544&as=12966&b=

Best to all,

Advocate

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Understanding Continuing Disability Reviews: Key Updates and Guidance


Welcome to our latest blog post where we delve into the critical topic of Continuing Disability Reviews (CDRs), which are essential for individuals receiving disability benefits. The focus today is on recent statistics and personal anecdotes that highlight the ongoing importance of staying informed about CDRs.

What is a Continuing Disability Review?
A Continuing Disability Review is a routine process for individuals who have been approved for disability benefits. The Social Security Administration (SSA) conducts these reviews to determine if the health of a beneficiary has improved to the point where they can return to work, and thus no longer qualify for benefits.

Recent Case and Discussion
Recently, a case surfaced involving a person who had been receiving Social Security Disability Insurance (SSDI) for end-stage kidney failure since they were 20. Despite their condition remaining unchanged, they received a notification of health improvement at age 50 and were at risk of losing their benefits. This situation underscores the unpredictability and significance of understanding the CDR process.

How CDRs Work
During a CDR, beneficiaries might be asked to complete a short or long form detailing their current health status. The forms are then reviewed, and if further information is needed, a full medical review may be initiated. It's crucial for recipients to respond promptly to any communications from the SSA to avoid complications or cessation of benefits.

Statistics and Trends
In 2022, approximately 1.5 million of the estimated 9 million disability recipients underwent CDRs. Of these, about 125,000 had their benefits terminated. These statistics reflect a consistent review rate, with an apparent annual increase in the number of reviews conducted, emphasizing the necessity for beneficiaries to stay vigilant.

Key Takeaways
Stay Informed: Always keep your contact information up to date and pay close attention to all correspondence from the SSA. Missing a notification or failing to respond can lead to benefit termination.
Understand the Review Frequency: Depending on the expectation of medical improvement, reviews may occur more frequently. Typically, conditions considered likely to improve are reviewed sooner and more often.

Prepare Adequately: If a review is scheduled, ensure all medical documentation is current and complete. Understanding the review process and preparing accordingly can significantly affect the outcome.

Seek Expert Advice: Engaging with professionals who specialize in disability rights and CDRs can provide crucial support and guidance. For instance, next week, we will feature an in-depth discussion with Attorney James Mitchell Brown, a veteran in the field of social security disability.

Conclusion
Continuing Disability Reviews are a standard part of the disability benefits process, but they can be daunting. By staying informed, prepared, and proactive, beneficiaries can navigate these reviews successfully. Remember, the goal is not only to retain benefits but also to ensure that the support aligns correctly with the individual’s current health needs.

Stay tuned for more updates and expert insights in our upcoming posts, and don't hesitate to reach out with your questions or for further information.

Brian


My name is Brian Therrien, and I'm a professional researcher. So when a number of my friends went through unexpected downturns in their life and required disability assistance, I left no stone unturned to try and help them.

At first, I was concerned with how to qualify for disability, ... but as I learned more about the system, I realized that people also really needed help with getting approved, maximizing their benefits, and most importantly, supplementing their income without losing their benefits when they were ready to transition back to the work force.

That's why when you subscribe to my FREE disability newsletter you'll get concrete help with ALL the issues you'll encounter in the disability system

Brian Therrien

related posts:


The Spoon Theory: A Real-Life Guide to Managing Energy with Chronic Illness


What To Do If SSA Surveillance Leads to a Mistake — And You’re Blamed for It


 Documenting Every Condition, Head to Toe

Questions? Comments? Get in touch... we're happy to help!