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  1. #1
    Join Date
    Nov 2007
    Posts
    15

    Default Social Security Hold Back Question

    I am in the process of a mediated settlement and I was told that the settlement amount I will receive will reduce my monthly SS check by approx $300.00. Is there any way to do this so that my SS check will not be reduced. Also the start process of an annunity for my medical has begun. Is it true that after my yearly set aside is used up I will be responsible for doctor Co-pays , etc and what about the drug donut hole if I get there? I appreciate any help I can get. I read alot of annunity posts however I am still confused as there are different types of annunities and their costs and restrictions. THANK YOU !

  2. #2
    Join Date
    Dec 2006
    Posts
    2,169

    Default Re: Social Security Hold Back Question

    CRJ, the proceeds of your settlement need to be "characterized" in a very particular way in your settlement papers in order to potentially reduce the amount of the SSDI offset.

    The medicare set-aside for Future Medical, atty fees/costs, should be EXCLUDED, for they are NOT "monthly benefits", and you will be having to pay your atty fees and costs out of your settlement.

    Your PD benefits (and any retro TTD now being paid) need to be characterized as "monthly benefits". This is done by using your Life Expectancy, based on the Life Insurance Acturarials. For Females it is age 79, for men 74.

    If you are a male, and you are 50 at the time of settlement, then you are expected to live another 24 years. Convert this into MONTHS, and divide your PD amount by the number of MONTHS. This amount would be characterized as your "monthly benefits", paid over the next 24 years, and it should be reflected as such in your written settlement agreement.

    You need to have your attorney REVIEW and REVISE the settlement agreement to make sure that your interests are protected where Medicare/SSDI is concerned.

    You might be able to negotiate more money to help out with co-pays, etc. This money should NOT be put in the set-aside, but into a different designation in your settlement.

    BiVA is an whiz re the annuity issues and set-aside, as is Steel. Maybe they will jump in and give you further, detailed information.

  3. #3
    Join Date
    Jan 2007
    Posts
    430

    Default Re: Social Security Hold Back Question

    Quote Quoting Charles Stevens View Post

    Your PD benefits (and any retro TTD now being paid) need to be characterized as "monthly benefits". This is done by using your Life Expectancy, based on the Life Insurance Acturarials. For Females it is age 79, for men 74.

    If you are a male, and you are 50 at the time of settlement, then you are expected to live another 24 years. Convert this into MONTHS, and divide your PD amount by the number of MONTHS. This amount would be characterized as your "monthly benefits", paid over the next 24 years, and it should be reflected as such in your written settlement agreement.
    See now here's what really gets me about this whole messed up system.
    When you're at MMI and rated, they take that percentage and calculate it with 400 some odd Weeks, I can’t remember the exact number, 425 or 452…

    Anyway, after this is done, S/S comes in and figures in the Years you’d have worked until age 65 then tries to penalize you for the W/C settlement. Where’s the justice in that???

    If I get a settlement I’m going to use it to buy some kind of Home for my Family then S/S is going to say hey there, you only get half your benefits because you got such a big W/C settlement, and it’s up to you to make sure your lawyer is up to snuff with all the legal crap because if not then you’ll really be screwed.

    Where in the World is the fairness and ethics toward someone who’s been disabled and can’t work anymore over being injured at work?

    No wonder People go bonkers and shoot up the place they used to work. I’m not saying I’d do it, but I understand… :O)

  4. #4
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,045

    Default Re: Social Security Hold Back Question

    Quote Quoting CRJ49 View Post
    I am in the process of a mediated settlement and I was told that the settlement amount I will receive will reduce my monthly SS check by approx $300.00. Is there any way to do this so that my SS check will not be reduced. Also the start process of an annunity for my medical has begun. Is it true that after my yearly set aside is used up I will be responsible for doctor Co-pays , etc and what about the drug donut hole if I get there? I appreciate any help I can get. I read alot of annunity posts however I am still confused as there are different types of annunities and their costs and restrictions. THANK YOU !
    It would be to your advantage to investigate a Structured Settlement BEFORE you agree to a final settlement of your WC case.

    In a settlement by Structure, there would be an annuity purchased for your PD indemnity that will continue to pay your weekly benefits for life, this money is NOT TAXABLE, state or federal. The money from a lump sum deposited in an interest bearing account IS taxable.
    In a structure you can get a lump sum payment up front AND the weekly/monthly payments. You can also set this up to receive perodic payments/lump sum in the future.
    Doing a settlement with a structure WILL NOT affect your SSDI benefits. In fact, IF this is done correctly, you will receive your maximum SSA/SSDI benefits without an offset...a BIG PLUS to you in the long run.

    The people at SSA are more than happy to help you with the language in your settlement agreement to see that you receive the maximum benefits you are entitled to. They have no interest in seeing your benefits cut in any way.

    As to your WCMSA issues.
    With a MSA, if you're doing it this way... an annuity is purchased to fund the MSA with annual payments. AND another annuity is purchased, SEPERATELY....to take care of co-pays, deductibles, and your Rx needs. You DO NOT use ''regular Medicare" for ANY treatment/service needs to your work injury UNTIL/UNLESS your setaside funds become exhausted. Also, you DO NOT use the setaside funds for any other treatment/service that is not related to your work injury. The funds in the "other" account are not associated with the WCMSA and are basically yours to do with as you see fit. You don't have to account for this money in your annual reporting to CMS/Medicare like you do for the WCMSA. The 'other' account is for the costs associated to your injury that Medicare is not "normally" responsible for. A WCMSA can be very confusing, and the annual accounting time consuming as well as frustrating.

    When you're at MMI and rated, they take that percentage and calculate it with 400 some odd Weeks, I can’t remember the exact number, 425 or 452…

    Anyway, after this is done, S/S comes in and figures in the Years you’d have worked until age 65 then tries to penalize you for the W/C settlement. Where’s the justice in that???


    If you can show me where the "400 some weeks", or the calculation of the time you "would have worked"... comes from, where in the Social Security rules it say this is the way it's handled, I can probably come up with an explanation for you. I have never seen or heard of this being done, and I've kept track of SSA/SSDI for over ten years. I think there's some confusion here because your SSA/SSDI benefits are not calculated that way, nor are the 'offsets'.

  5. #5
    Join Date
    Nov 2007
    Posts
    15

    Default Re: Social Security Hold Back Question

    Thank you very much, Charles Srevens and BvIA. Your information is extreemly helpful. I went in to my mediation scession knowing nothing about annunities and the settlement of my case. Silly me I wish I knew about this web site before mediation. I was told that I would get a lump sum settlerment and an annunity to cover my wc medical for life. It all seemed good and fair at the time and I trused my attorney to do it right. I am having alot of second thoughts about this annunity and how to set it up to protect my interests. Fortunately, I think, I have not signed the final state forms for the buy out of my claim and my medical is open untill a MSA can be formed. I did however sigh the mediation agreement and the paperework to start the CMS review of my files for the MSA application process. However I now beleive that I was not knowledgable enough about annunities and their impact on my future medical coverage at the time of mediation. Hopefully I can now cry fowl and revisit the the issues for a better resolve. Thank you again and any more suggestions would be appreciated.

  6. #6
    Join Date
    Dec 2006
    Posts
    2,169

    Default Re: Social Security Hold Back Question

    CRJ, here is the link to an excellent article about Medicare Set-asides, which was written by an attorney for OTHER attorneys as part of their "continuing education" requirements:

    http://www.medicareapproval.com/PCBA...e%20Update.pdf

    You might want to print it out and discuss it with your attorney...

  7. #7
    Join Date
    Feb 2007
    Location
    Western New York State
    Posts
    1,341

    Question Re: Social Security Hold Back Question

    A question if you please, and if it has been answered please excuse my stupidity:

    If I settle my workers' compensation case in NYS for $250,000.00, without future medical and after paying my attorney's fee will the remainder of my settlement case cause problems with my anticipated SSDI award which is awaiting an ALJ hearing in the near future?

    I have a second comp injury separate from this one which may never settle but if I did I wouldn't settle without medical as it involves my back. This second injury I am currently recovering from major back surgery of multi level disc fusion. If I settled this case with an $$ benefit for future payments, then I would probably need a ssdi set aside for future medicals (correct?), and since this will contribute to me now receiving SSDI how will this effect my original SSDI amount I'll be receiving; if five years down the road I settle the aforementioned back portion of this case?

    Thank you.

  8. #8
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,045

    Default Re: Social Security Hold Back Question

    A question if you please, and if it has been answered please excuse my stupidity:

    If I settle my workers' compensation case in NYS for $250,000.00, without future medical and after paying my attorney's fee will the remainder of my settlement case cause problems with my anticipated SSDI award which is awaiting an ALJ hearing in the near future?


    There aren't any "stupid" questions...just people stupid for not asking about something they question...

    If you have an anticipated WC/injury settlement, and it's worth $250K...WHAT happened to the medical ?
    It would seem very unlikely to have an award in that amount and there not to be medical involved. If there was medical treatment provided to you due to a work related injury, the 'future medical' will be addressed in any settlement you enter into.

    The SSA rule is that "IF you are receiving SSDI benefits, or anticipate receiving SSDI benefits and become Medicare eligible within 30 months due to age, application or disability, Medicare's interests MUST be taken into consideration.

    It doesn't matter how you split up the award...the ENTIRE amount of the award is taken into consideration when CMS/Medicare determines the issues in your case. The dollar threashold determines whether or not CMS must review the settlement.

    will the remainder of my settlement case cause problems

    What do you mean by "cause problems"...?

    I have a second comp injury separate from this one which may never settle but if I did I wouldn't settle without medical as it involves my back. This second injury I am currently recovering from major back surgery of multi level disc fusion. If I settled this case with an $$ benefit for future payments, then I would probably need a ssdi set aside for future medicals (correct?), and since this will contribute to me now receiving SSDI how will this effect my original SSDI amount I'll be receiving; if five years down the road I settle the aforementioned back portion of this case?

    ANY TIME you do something that affects/changes the liability of your medical treatment, and you are or become Medicare eligible, Medicares interests MUST be taken into consideration, and protected. Period.

    When you are receiving SSDI, and attempt to settle your claim by C&R, you must first request your SSA records to determine if Medicare made any advance conditional payments. This is how you protect Medicare. Any advance payments must be noted in the C&R and reimbursed to Medicare.
    Depending on the value of your future medical it will be determined IF you are required to have a WCMSA..and CMS/Medicare will review a setaside proposal and determine if one is required, and how much is to be allocated.

    You can find all the answers to your questions about SSA/SSDI/Medicare at their web site...www.ssa.gov
    Just follow the links...

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