WORKERS’ COMPENSATION & SSD BENEFITS
Workers’ compensation provides benefits to those who suffer an on the job injury. Benefits include medical treatment for work related conditions. Benefits also include cash payments that partially replace lost wages.
Workers’ compensation pays temporary total disability benefits benefits while you recover from your injury. If the condition has lasting consequences, then the program may pay permanent disability benefits. In the case of the death of a worker, the family of the worker receive survivor benefits.
Each state designs and runs their own workers’ compensation program. The programs vary across states in terms of who provides insurance. They also vary in terms of which injury or illness they will pay for and the level of benefits. Generally, state laws require employers to obtain insurance. In the alternative, an employer must prove they have the financial ability to carry insurance at their own risk.
WORKERS’ COMPENSATION BENEFITS
Workers’ compensation in the United States is a large program. The only other programs that are bigger are the Social Security Disability Insurance and Medicare Benefit programs. These three programs are the largest programs to provide cash and medical benefits to workers.
Although SSD benefits and workers’ compensation are the two largest benefit programs, the two programs are quite different.
For example, workers are eligible for workers’ compensation benefits from their first day of their work. By contrast, Social Security benefits are paid only to workers who have a long work history and can prove they meet the SSD rules.
Also, in contrast to SSD benefits, workers’ compensation provides benefits for both short term and long term disabilities. The program also pays for partial and total disabilities. However, workers’ compensation benefits only cover disabilities arising out of the course of employment. Social Security benefits cover all physical and mental conditions, whether they began on the job or not.
THE CONTRAST BETWEEN SSD BENEFITS & WORKERS’ COMPENSATION BENEFITS
SSD benefits are paid only to workers who have long term medical conditions that prevent all gainful work. Benefits pay out regardless of whether the condition arose on or off the job.
By law, SSDI benefits are paid only to workers who are unable to engage in any substantial gainful activity by reason of a physical or mental condition that will last for at least a year or result in death.
The medical condition has to be so severe that the worker is not only unable to do his or her previous work, but is also unable to do any other type of work. Social Security benefits begin after a 5 month waiting period.
Workers’ compensation and other public disability benefits may offset or reduce your SSDI benefits. However, disability payments from private sources, such as private pensions or private insurance benefits, do not affect your Social Security Disability Insurance (SSDI) benefits.
Additionally, other public disability payments may affect your monthly Social Security benefits. For example, unemployment benefits can count against you. Federal, state, or local government agencies make these payments. Examples include civil service and state temporary disability benefits. It also includes state or local government retirement benefits that are based on disability.
If you receive workers’ compensation or other public disability benefits and you also receive SSDI benefits, then your SSDI benefit will be lower. The reason for this is the law. The total amount of these various benefits cannot exceed 80% of your average current earnings before your disability.
PUBLIC BENEFITS THAT DO NOT AFFECT YOUR SSD BENEFITS
Your monthly SSD benefits will not reduce if you receive certain types of public benefits. The following benefits do not reduce your SSD benefits:
- Veterans Administration benefits that are service connected.
- State and local government benefits, if Social Security taxes were deducted from your earnings.
- Supplemental Security Income (SSI).
Specifically, excluded from offset provisions are all Department of Veterans Affairs’ benefits. Additionally, needs based benefits and federal, state, or local disability benefits that are based on employment that was covered by Social Security are also not part of the offset rules. Finally, they also cannot subtract private pension or private insurance benefits.
Medical and legal expenses incurred by the you (the worker) in connection with workers’ compensation may also be excluded when figuring out any offset.
SETTLEMENT OF WORKERS’ COMPENSATION CLAIMS
When a workers’ compensation claim is settles, the language of the settlement contract can control the Social Security disability offset. Your workers’ compensation attorney should write the settlement agreement to be in your favor. Typically, this means that the agreement states the SSA should calculate any offset for the lifetime of the worker.
You can exclude payments for legal fees, medical costs, future medical costs, and skilled home health care. These type of payments may be excluded from the gross workers’ compensation settlement when calculating the offset. See Social Security Administration, Program Operations Manual System §DI 52001 and 20 CFR § 404.408. Medical expenses paid by Medicare are not excludable. Furthermore, you must document any expenses or fees or the SSA will not allow the deduction of the fees and expenses from the workers’ compensation payments.
In most states, SSDI is offset by the amount necessary to reach the 80 percent cap. However, in certain states it is the workers’ compensation payment that is reduced. You need to determine how this affects you considering the state you live in.
FIGURE OUT YOUR REDUCTION IN SSD BENEFITS
Your monthly SSD benefits, including benefits payable to your family members, are added together with your workers’ compensation or other public disability payments.
The SSA then considers three factors to determine your offset:
- (1) your monthly workers’ compensation benefit;
- (2) your monthly SSD benefit; and
- (3) your average current earnings (ACE).
If the total amount of these benefits exceeds 80% of your average current earnings, then the excess amount is offset from your Social Security benefit. Your Social Security benefit will be reduced until the month you reach your full retirement age. Or, the month your other benefits stop, whichever comes first.
HOW TO DETERMINE YOUR AVERAGE CURRENT EARNINGS
The 1965 Social Security Amendments requires that Disability Insurance benefits be reduced when the worker is also eligible for periodic or lump sum workers’ compensation payments.
The combined amount of workers’ compensation and Social Security benefits does not exceed 80 percent of your average current earnings. The combined payments after the reduction, however, will never be less than the total amount of SSDI benefits before the reduction. The definition for the average current earnings are the highest of:
- average monthly wage on which the unindexed disability primary insurance amount is based,
- the average monthly earnings from covered employment and self employment during the highest 5 consecutive years after 1950, or
- average monthly earnings in the calendar year of highest earnings from covered employment during the 5 years ending with the year in which disability began.
Total earnings, including those above the Social Security taxable maximum, determine your average current earnings.
The intent of the offset rule is to ensure that the combined benefits from workers’ compensation and Social Security are not excessive. Benefits for a spouse or children are offset before the offset applies to the benefit of the worker.
Under the 1965 law, the Social Security benefit will not offset if the state workers’ compensation law provides for a reverse offset (a reduction of the workers’ compensation benefit of a worker also getting Disability Insurance).
REPORT ANY CHANGES IN WORKERS’ COMPENSATION PAYMENTS
The SSA has different formulas to calculate your average current earnings. Which formula they use depends on your specific circumstances. Contact the SSA for information about how they calculate your average current earnings. You can reach them on the SSA website. If there is a change in the amount of your other monthly payment, or if those benefits stop, then let us know.
If the amount of your workers’ compensation or other public disability payment increases or decreases, then contact the SSA. Any change in the amount of these benefits may affect the amount of your Social Security benefits.
If you get a lump sum workers’ compensation or other SSD payment in addition to, or instead of a monthly benefit, the amount of the Social Security benefits you and your family receive may change. Let the SSA know right away if you receive a lump sum disability payment.
LUMP-SUM WORKERS’ COMPENSATION BENEFIT
The offset rate should be in the language of your lump sum workers’ compensation settlement. Typically, the best offset for you is when the benefit rate is based on your life expectancy. If not (or if Social Security determines the rate is not reasonable), the agency will use other methods to calculate the figure.
For example, the rate can be based on your periodic workers’ compensation payment before the settlement, if you were getting one. Likewise, the calculation can use your wages before your injury or before you became ill. Similarly, it is possible for the SSA to use the legally set maximum workers’ compensation rate in your state.
The offset continues until the prorated “payments” reach the settlement amount or you reach full retirement age. At that point your SSDI benefit switches to a retirement benefit. After that change, the offset no longer applies.
APPLY FOR SSD BENEFITS ONLINE
The best way to apply for benefits is to visit the Social Security website. There, you can obtain information and use their online services. You can apply for benefits and find the SSA rules. Also, you can get answers to common questions. You can find out how much your monthly SSD benefit is too.
We recommend filing for benefits with the help of your SSD lawyer. Even though the SSA denies 70% of all SSD and SSI claims, we still win most of our cases. We win SSD & SSI cases because we understand the law.
Also, we know what medical evidence the SSA needs to grant your ongoing SSDI benefits. Additionally, our lawyers and staff work with you to build your case. Consider us to be part of your team. You need a legal team on your side.
In the past 30 years, our Salt Lake City based Social Security attorneys have won benefits for over 20,000 clients. We have also won over $100 million in back due and ongoing SSDI and SSI benefits for our clients.
When you hire an attorney, you want one you can trust. You can trust our lawyers and staff. With our team approach and our years of experience, you can trust us to fight for your benefits. We will also make sure to get the most from your benefits, including workers’ compensation benefits. Give us a call. Put our experience to work for you. You can contact our SSD law firm.
HOW TO APPLY FOR SSDI & SSI BENEFITS
If you can’t work, then there are two types of benefits you can file for under the Social Security program: Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits. In order to receive benefits, you must first file an application. You can do this on Social Security’s website. Below, please find an explanation as to each type of benefit you can apply for if you can’t work:
Social Security Disability Insurance (SSDI):
SSDI benefits are for those who have worked in the recent past and can no longer work at any job due to a medical condition. The amount of money you will receive from SSDI benefits every month is based on how much Social Security tax you have paid during your work history. To qualify for SSDI benefits, you must have earned enough “work credits” to qualify. A work credit is an amount of taxable income. Learn about work credits.
You can earn up to 4 work credits per year. The amount of work credits you will need will depend on how old you are when you apply. If you haven’t earned enough work credits for your age at the time you apply, you will only qualify for Supplemental Security Income benefits.
Supplemental Security Income (SSI):
SSI is a needs based benefit and it is for those people with little to no income, such as children and the elderly. Anyone who makes more than a certain amount of money per month cannot receive SSI benefits. The SSA counts the income of those in your house, not just your income.
If you have a spouse who earns more than $4000 a month, for example, then that income will be the factor in whether you can receive SSI benefits. You cannot qualify for SSI benefits, no matter how severe your medical condition, if you do not meet the income and asset rules for SSI.
THE ATTORNEYS AND STAFF AT OUR LAW FIRM
If you want to learn more about the lawyers and staff at our law firm then review our About Us page. For example, Andria Summers can help you with your Medicare advantage plan. She has also won thousands of SSDI and SSI cases. Dianna Cannon has been helping her clients win SSD benefits for thirty years. Brett Bunkall also has experience helping people obtain their SSI and SSDI benefits. We are experts. You can trust us to help you receive SSDI and SSI benefits.
In the past 30 years, we have won over 20,000 SSDI and SSI cases for our clients. Also, we help our clients get all of their Medicare benefits. Our experts can help you apply for SSD benefits using the SSA’s website. However, we will need your help to apply for SSI benefits. Why? Because only you know your personal financial information. SSI benefits require you to have minimal assets and low monthly income.
Likewise, if you need an appeal, we can help you do that too. There are also many forms you will need to fill out. But, don’t worry. If you have questions about these forms, we will answer them. You can learn about SSA’s appeal forms. Call us for free today.
WE WORK FOR FREE UNTIL YOU WIN BENEFITS
If you have a workers’ compensation claim or Social Security Disability case, then you should hire an attorney. An attorney can help you with your SSDI case. In order to hire our law firm, all you need to do is call or contact us. We offer a free review of your case. And, it doesn’t cost anything to call us.
Better yet, it also doesn’t cost you any upfront money to hire us. Why? Because you only pay us an attorney fee if we win your case. This means if we win your SSD case, then you pay the attorney fee out of your back benefit. If you do not win benefits, then there is no attorney fee to pay.
The attorney fee has a cap or a limit. The SSA sets the limit of the attorney fee at 25% of the back benefit or the maximum attorney fee cap, whatever is less.
If there are costs in your case, then you pay those. But usually those costs are less than $100. Once we win your case, the attorney fee comes from your back benefit. But, to hire most lawyers, you have to pay upfront. We don’t work like that. You don’t have a job. So, the only way to pay us, is for us to win your case. That is our goal. Call and see what we can do for you.
Additionally, we represent clients in many states, including Nevada, Utah, Idaho, and California. Find information about Nevada SSI and SSDI benefits. Learn about Utah SSD benefits and California SSDI benefits. We have information about Idaho SSI benefits. No matter where you live, we will answer your questions about workers’ compensation benefits. We want to be your legal team.
