WORKER’S COMP OFFSET NOTES AND MINI REFEERENCE GUIDE WC Offset Notes and Mini Reference Guide
My office procedure when filing an initial SSDI claim that involves WC is to provide the following to SSA at the initial step: 1) 2) 3) 4) 5) 6) 7) 8)
SSA 1696 Fee Agreement SSA 827 SSA 1709 with Section I completed and signed Printout of payments to date * Signed copy of any Lump-Sum settlement, if applicable Any medical records, IME’s, FCE’s, in claimant’s possession A short narrative, if needed, as to the current status of the claim
This will usually save several months of back and forth mailing with the Field Office before the claim is forwarded to the DDS office for a medical determination. * Some states, Washington as an example, have a website where a claimant can review their claims, payments, medical records and other documents. These sites are a gold mine for payment records and medical records. If I have a client in one of these states I schedule an in-office appointment and review everything in the work comp file. I print any and all records that may be pertinent to the SSDI claim.
Information needed in order to determine whether or not a claimant would be subject to offset if granted SSDI benefits. PIA - Primary Insured Amount. You will probably have to contact SSA directly for that figure. I will usually call the FO with the client present and request PIA and Fam Max (if applicable). Work Comp periodic payment amount - This is the amount your client (or potential client) receives from the work comp surety. Checks are usually biweekly. Most claimants will be able to tell you when payments started, stopped or changed. ACE - Average Current Earning Calculating an ACE: Highest single year within 5 years of injury, divided by 12, multiplied by .8. Or Highest 5 years of earnings, divided by 60, multiplied by .8. Use whichever formula is most beneficial to claimant.
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SECOND QUARTER 2020
