Social Security and Workers Comp Settlement

[Catgirl]

Since Social Security offsets any income dervied from Workers Comp I only get SS during the summer because I'm a teacher and do not receive my WC benefits during the summer.
My Social Security case worker intimated to me that when the time comes to reach a settlement, be careful of how it's worded because it could hold off any Social Security payments to me over a lenghty time. She kind of hinted without coming right out and telling me how it could be done, but a settlement could be worded in a way that I could continue my SS benefits.

Does anyone know how this could be done. Is it something in the way the settlement is worded, is it up to the judge, how can this be done?

My SS isn't enough to sustain me as I am a single mother with two children.

Also what is the average type of settlement? What can they range from? I hurt my leg and back, have had two surgeries and I am implanted with spinal cord stimulator. I am in my mid 40s and the chance of being able to work is nil (that comes from 3 different Independent Medical Examiners). The fact that I have been almost house bound for 2 years is depressing enough, I just don't know how I'm going to be able to keep my house and support my family with the situation as it currently is.

A decent settlement plus SS gives me a little hope that we won't become homeless. The horror stories you read on these boards are really scaring me.

Thank you in advance to anyone who either has been through this or knows the system.

[BvIA]

Your SSA/SSDI benefits are based on qualifying wages as reported on by your ER, and your payment of FICA taxes... when you begin to receive 'regular retirement' or SSDI benefits, those payments should be paid monthly...there is no connection between your WC TTD benefits and your SSA/SSDI benefits other than SSA taking an offset based on the 80% rule.
Basically, you can receive 80% of your pre-injury average gross earnings, from all sources.
This is traditionally the period right before your injury because that is your highest earning period.

When there is a settlement to your WC claim, the language used should show that any PD indemnity is based on your weekly PD rate as though it were paid out over time. That way, SSA will pro rate the lump sum payment over that same time period, and calculate the offset based on the weekly amounts.

As you will be Medicare eligible soon, you must take steps to protect Medicare interests where there is any settlement that affects your future medical benefits.
This has been discussed in much detail here, do a search for 'medicare and settlement's' and read through the multitude of posts...then come back with your questions...

The best way to settle a WC claim where there is PD indemnity is through a Structured Settlement...that way there would be annuities purchased that would guarantee an income stream for life...tax free.

There would also be an annuity purchased for the WCMSA to fund the setaside and another to provide money to you for the Medicare co-pays and deductibles.

There is a LOT to consider before you entertain any settlement to your WC claim...READ as much information before you agree to any offer you might receive...
Go to WWW.SSA.GOV, and WWW.CMS.GOV, and you can also get a lot of information here..http://wcmsainfo.com/, and http://wcmsainfo.blogspot.com/, and http://www.jjcelderlaw.com/EffectiveMSAMSABull.htm
There is information on structures here...http://www.workerscompensation.com/s...ettlements.php (this is your best bet in settling your claim)

[bugmann]

Dear Cat girl, There are many factors to consider when talking about WC benefits and SS benefits received at the same time, as well as any work agreements in force at the time of injury? If you are rated MMI technically your WC benefits have ended, and medically your condition is considered pre existing in nature.

I did get your message sent to my private box here and have replied with my direct address and we can get into all of this in great detail, and specifically what you need to know about the wording of the award as well as what you are to identify your continued benefits, if you qualify.

First if you are awarded SSDI this is based on past work history, not need as in the case of SSI. So you will want to be on SSDI as your income will not effect your SS benefits, like you may believe to be the case. I'll add this it is difficult for an SS rep to accurately answer a SS question let alone one dealing with WC. I think the SS rep was referring to your award effecting your SSI benefits as your income WILL effect these benefits!!!!! However your award is considered compensation for your work injury; specifically the measurable amount of permanent disability that you are left with after all corrective care has been rendered.

It has always been my suggestion to have a SS/WC expert represent anyone injured at work when the injury results in a total disability determination from the SSA. As this may qualify you for what's called the second injury fund which last for the duration of the total disability. This is in combination with your SS benefits. To summarize your SS benefits may be about 70% of your working wage. The second injury fund is the average weekly wage I think they call this figure your ACE. This is the amount of compensation your will get minus your SS benefit which is called the offset.

I do hope that you have filed for benefits for your minor children as the family benefit is appox 1/2 of what your benefits are from SS. In other words filing for the kids will get you a 50% increase in your SS benefits.

What I think has you concerned is and there is some truth to this, the SS deals with all 50 states and for some reason if you are getting WC they automatically deduct this from your SS benefit which is precisely the exact opposite way it should be done in NJ????? As I said its difficult for many SSA reps to answer correctly a SS based question, as I have called on 1 issue 5 times and got 5 completely different answers, and that is very frustrating.

The JUDGE does have the final say in all settlements!!! What is considered is your recovery, the results of your surgery(s) and a few other things that we will talk over when we are in direct contact.

Considering you have SS now I'm sure you can find a way to make ends meet as things must have been worst when you were MMI and without SS??

Honestly it takes a true expert in WC/SS to navigate this but I have seen many cases of total disability due to work injury in Nj and do have a real good idea of how this works, if I am unsure on a point I will say so, as then you have a precise question to ask your legal expert. The NJ WC court works extremely slow, but as I tell all who are in rotation to have their case heard the reason there is such a back log is that the court wants you to have the court time needed to present your case effectively, and just like the ones before you also will be afforded the time to make your case to get all the benefits due to you. Needless to say there are just that many cases to be heard in WC court.

When we are in direct contact I can be more blunt and straight forward as to the questions that concern you most. I have been right where you are but was a single guy, but the WC system did what I call the squeeze play. This is when they take so much time that years without any income cost a claimant to lose everything they have worked for, waiting for a day in court. Or until their SS claim is approved which takes on the average 24 months. 24 months in NJ without an income, well you can figure out that 1? The other choice is to return to work even if you feel you may cause more injury to self, but many will do so to save what they have earned over the years, and I feel that this is done purposely just to see if the claimant will sacrifice everything to show they are too disabled to work. Because those who cant work will not no matter what the financial circumstances are, because the million dollar question is "Is the claimant disabled from working?? I think calling this maneuver the "squeeze play" is very appropriate, but I would think with todays high tech world there must be a better ways for the injured worker to get the benefits due. However until our law makers choose to side with working class America, and not be so "employer friendly" when WC is concerned, and if they would just honor the promise noted in the "Injured Worker Manifesto" we would not be going through all this hardship just to spare some employers a break on WC premiums.

I'll be waiting for your reply to my email and we can also talk about this post in detail. Its important to remember that you are not alone and many have faced just what you are and have done OK in the end, just deal with one day at a time and when you understand whats going to happen it will make it easier to sleep at night, as for me not knowing was very disturbing and that's in part why I have become an advocate for injured workers specifically those who have been left totally disabled due to their work injuries. Again I would like to thank you for your words in the private message as it is a nice feeling to be appreciated for caring about others who have been forced into a situation that I know is so unfair to those hurt doing a job they love, just to provide for the ones they love most!!

BUG

PS Until we chat the best I can say is I feel you have a better shot at keeping your home than just "a little hope" OK but this is said very premature as I dont have details about your case, but can surmise by what you have stated here in this post. Hang tough I am sure they call you Catgirl because you are a survivor just as a feline would be?? I am also a kitty lover with a few buddies here of the feline species.

[ilaw61]

I was told by my lawyer that I can collect all my SSD and workers comp benifits

[DH's better half]

The name of the clause you need in the W/C settlement is "Utica Mohawk":

Utica-Mohawk Agreement


Claimant requests the Commission approves the allocation of the proposed settlement as follows:

1. $XX,XXX.XX as attorney fees and $X,XXX.XX as costs; a total of $XX,XXX.XX.
2. $XXX,XXX.XX in compromise settlement of disputed past and future compensation benefits at the rate of $XX.XX per week for a period of 1,470.51 weeks (claimant's life expectancy), commencing October 11, 2007 as interpreted by the South Carolina Supreme Court in the decision of Orr v. Utica-Mohawk Mills, 227 SC 226, 87 SE 2d 589 (1955).
3. It is not the intention of the employers/carrier or Claimant to shift responsibility for paying future medical expenses related to this claim to the Federal government. As an integral part of this agreement defendants agree claimant is entitled to causally related medical care which would tend to lessen claimant’s disability.

I hereby approve the allocation of settlement proceeds set forth above and hereby order that this allocation be followed.

SIGNED:
X

Another version:
The parties agree the payment of $________________.00 represents payment of all future medical expenses and wage loss/indemnity claims payable to the Claimant for the rest of his or her natural life. Attorney's fees in the amount of $_________.00 are being deducted. No portion of this settlement is being specifically attributed to future medical expense. Accordingly, the Claimant will therefore net the sum of $__________.00 as payment for wage loss/indemnity benefits for the rest of his or her natural life. The Claimant is ________ (___) years old (born ________, 19___), and his remaining life expectancy is _____ years or ____ months (pursuant to the Center for Disease Control (CDC) Table 1 (All American Table), United States Life Tables, 2004. NVSR Volume 56, Number 9. 40 pp. (PHS) 2008-1120. (online version)). Therefore, even though the above amount is being paid in a lump sum, for the purpose of determining any offset by the Social Security Administration on account of the Claimant's receipt of this worker's compensation settlement, the Claimant's net payment of future wage loss/indemnity benefits in the lump sum of $______.00 over ___ months amounts to an equivalent monthly payment of $______ per month ($_____.00 divided by ___ months = $_____ per month). The commencement date represents the first day following the last payment of workers' compensation wage loss/indemnity benefits. The offset rate stated herein is set forth specifically to comply with the Social Security Administration's POMS Section DI - 52001.555 © (4). See Sanfilippo v. Barnhart, 325 F.3d 391 (3d Circuit 2003).

[Catgirl]

I think I might actually understand what you wrote. Now in layman's terms, tell me if i am getting this.
Let's say I am awarded 100,000.
The first part is a deduction of attorney's fees.
The rest is divided by months/years using my life expetectancy.
For arguments sake, lets say it came out to 500.00 a month for the rest of my life.
Social Security then deducts that from the 80% rule of my salary.
If 80% rule allowed me 3000 a month, they would deduct that 500 from WC and reduce my 3000 to 2500.
(I did not use real calculations I just plugged in "for example numbers")

Also for the person who said their attorney told them could collect both WC and SS, that would be true if you were over the 80% rule from SS based on what you were recieving from workers comp.
In my personal situation, my workers comp exceeded my SS and that is why I could only collect in the summer or when I would be MMI and my benefits would terminate.

[bugmann]

I was reading up on this impressive agreement issued under the US court of Appeals but this is in regards to a PA WC claim. I believe there are many differences in PA-NJ WC rules, as far as settlements go. In one version of this agreement it states payment for future medical THIS CAN ONLY APPLY TO PA WC not NJ, as you are not going to get lifetime medical in NJ, NJWC only covers care up till you are MMI, in general.

However if there is in existence any kind of "mohawk" agreements valid in NJ I am unaware of them. You basically hit the nail on the head with your first post, "It going to be up to the Judge ultimately", as well as the skill of your attorney to know all there is to know about disability settlements,and there are MANY. Now if we knew all their secrets we would be the experts making boo coo bucks a year. For sure there are many factors to consider in answering this question, some are unknown even to you.

Just hang in there and hopefully this will all draw to a livable conclusion. I would not consider this agreement valid in Nj.I could not find the phrase at all in the states WC laws or rules, but I really didn't not in depth search it once I learned it was in regards to a PA WC case.

BUG

[Catgirl]

Thanks Bug, by the way I have things to tell you what's been going on, but I will send that to you in a private email.
Just as another note, that "ahem new attorney" that's been busting your chops and has nothing but negative things to say, I hope that never derails you from helping those of us who APPRECIATE your time and VALUABLE advice you give on here.
Excuse the language, but he's an ass, and really doesn't get what these boards are all about. The layman helping the layman.
If others read this, my advise is to be proactive in your own cases. I believe most attorney's are good (and very busy), but sometimes pieces of information don't always get relayed. Learn from others, read, read, read, do your homework and ask questions.
Feel good all!!

[bugmann]

OK After some more looking into this Utica-Mohawk Agreement issue it appears to also serve a few other states, but I am unfamiliar with these states WC rules. I really dont think this type of agreement will play any part in your settlement. I was reading your interpretation of how you understood this to effect you and here is what I see in conflict with the total disability cases I am aware of in NJ. How this normally settles is your damages (comp for your permanent disability,"rating") is your settlement check.This is non taxable.This should conclude your WC case, but this case settles last.

First you are awarded your total disability award from SS. Then the State determines 80% your av weekly wage If eligible for 2nd Injury Fund the SS benefit is deducted from your 80% and the remaining balance is paid to you bi-weekly as 2nd Injury benefits. This is not WC benefits!! From your settlement of % of permanent disability the legal fees are taken, and you are issued a final WC settlement from this. Also there are situations where some of your legal fees are paid by the employer and State.

I wish I was aware of what the SS rep had told you as it sounds real close to what I understand as you can collect your SS continuously once awarded. I would run what you were told by this SS rep to your lawyer or just wait for his/her direction on how you are to precede.

Sure there can be agreements between the parties providing the action is lawful under NJWC, and if the Judge signs off on it. It is my understanding that the WC settlement comes a few years after the SS award and if you are on SSDI will have no impact as SSD is based on work history not need as with the case of SSI. However there is also a way to word your award so that it will NOT effect SSI but it is a little different than how the SSD is handled.. I do think this Utica-Mohawk Agreement is for States such as PA who provide medical AND TTD for the duration of the claimants disability. In NJ both the medical and the TTD end at MMI. For this I feel this specific agreement is invalid in a state like NJ.

That was a very interesting post and I can see where one could feel this indeed would apply, but just not with NJ. I hope I have made more clear what I was saying earlier, as I was on short time, but couldn't get it off my mind till it was vented more thoroughly.
BUG

[DH's better half]

'Utica-Mohawk' is used to minimize the offset of Social Security benefits, it has NOTHING to do with the W/C state. If you read the agreement, it specifically states it applies to Social Security.


The parties agree the payment of $________________.00 represents payment of all future medical expenses and wage loss/indemnity claims payable to the Claimant for the rest of his or her natural life. Attorney's fees in the amount of $_________.00 are being deducted. No portion of this settlement is being specifically attributed to future medical expense. Accordingly, the Claimant will therefore net the sum of $__________.00 as payment for wage loss/indemnity benefits for the rest of his or her natural life. The Claimant is ________ (___) years old (born ________, 19___), and his remaining life expectancy is _____ years or ____ months (pursuant to the Center for Disease Control (CDC) Table 1 (All American Table), United States Life Tables, 2004. NVSR Volume 56, Number 9. 40 pp. (PHS) 2008-1120. (online version)). Therefore, even though the above amount is being paid in a lump sum, for the purpose of determining any offset by the Social Security Administration on account of the Claimant's receipt of this worker's compensation settlement, the Claimant's net payment of future wage loss/indemnity benefits in the lump sum of $______.00 over ___ months amounts to an equivalent monthly payment of $______ per month ($_____.00 divided by ___ months = $_____ per month). The commencement date represents the first day following the last payment of workers' compensation wage loss/indemnity benefits. The offset rate stated herein is set forth specifically to comply with the Social Security Administration's POMS Section DI - 52001.555 © (4). See Sanfilippo v. Barnhart, 325 F.3d 391 (3d Circuit 2003).