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  1. #1
    Join Date
    Mar 2007
    Posts
    9

    Question Awarded Social Security Disability, but Will Not Receive Monthy Checks

    My workers compensation claim was made in the State of: California
    I just received a notice of award saying they approved my application for disability benefits. The rate is $396.70 beginning November 2004. but I will not receive regular monthly checks at this time.. Then it goes on to say we are reducing your monthly social security checks beginning november 2004 which is the first month you were entiltled to both social security disability and worker's compensation payments. Then it says you are entitled to hospital insurance under medicare beginning November 2006, and you are entitled to medical insurance under medicare beginning April 2009 and they will send me my medicare card. Then it says they will continue to bill me for my medicare part B premium... my question is what does all this mean?? I got injured at work on 12/11/2003 and I am receiving worker's comp benefits. I am totally temporary disabled and have not been made P&S yet. I am 43 years old and I am struggling as it is just living on workers comp alone. How am I suppose to pay for this part B premium?? I do have a worker's comp attorney can anyone tell me if there is anything I can do about this? do I need to hire a disability advocate?? any advice or suggestions would be greatley appreciated.

  2. #2
    Join Date
    Jul 2008
    Location
    California
    Posts
    1,898

    Default Re: Awarded Social Security Disability, but Will Not Receive Monthy Checks

    Hi Female trucker,

    Social security will do an offset of your disability payments, because you are receiveing WC payments. Social security will not allow payments over 80% of your pre-injury income, so they will be decreasing your SSDI payments because you are also receiving WC. However, if your WC payments are lowered, or stop, make sure you let SS know and they will increase your payments.

    Also, let your WC attorney know that you are receiveing SSDI, as this may affect how your claim is resolved. Your AA must protect medicare interests during settlement.

    In work comp, you make something like 60% of your pre injury income. SSDI may pay you the difference, up to 80% of your pre-injury income.

    You will get a medicare card, and a small amount will be deducted from your SSDI checks, for the part B premium.

    Your income will increase, with these SSDI payments, AND you will have medicare insurance. This is a good thing.

    It sounds like you will be getting a nice backpay check, if they backdated your payments from 2004.

    If you have any questions, you can make an appointment at your local SS office, or call them. All of this is very confusing, I know.

  3. #3
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Awarded Social Security Disability, but Will Not Receive Monthy Checks

    There should be a reason provided why you are not going to be receiving the benefits now...and an explanation of any retro payment you are to receive.

    The 'small' amount for Medicare Part B is $96.40/mo. That is traditionally deducted from your SSDI check/deposit....if your full benefit amount is not enough to cover that, then if you wish to have the Part B Medicare, you'll have to pay seperately...
    Everyone who reaches normal retirement age is eligible for Medicare... who pays for Part A is dependant upon the deductions/taxes paid while working..some people are eligible for state retirement, but are still eligible for Medicare even though not SSA. Part A premiums are about $435/mo, you won't be billed for that...

    my question is what does all this mean??
    Means at some time you applied for SSA/SSDI/SSI benefits, and have been finally awarded your entitlement. Based on your qulaifying wages/points, your benefit has been determined....and adjusted. And now, you are Medicare eligible... so if you have non industrial medical needs, you are covered for those expenses.

    You'll receive more information soon. When you access treatment under your Medicare coverage, be sure there are no billings for the work related injury.

    You can also look for a Medicare Advantage program... that could reduce or wipe out any share of cost for Medicare treatment... an HMO/PPO or the like. Depending on your county of residence there could be little or no additional premium for this Information is available at www.cms.gov

    This also means there are additional considerations when it comes time to settle the comp claim...SSA/SSDI has a tendency to change things a bit.

  4. #4
    Join Date
    May 2007
    Location
    Calif
    Posts
    483

    Default Re: Awarded Social Security Disability, but Will Not Receive Monthy Checks

    First off congrats on your award from SSA.....I can tell you it was a definite benefit to us especially when the Medicare kicked in.

    I just happend to check our bank account and found a sizable sum deposited, and then about a week later received a similar letter. Our letter did not give any figures so I had to contact SSA to find out what all this meant. Then about 45-60 days later we got a 2nd letter informing us of the monthly benefit, and when it was to be deposited. .....either way it provided additional income above WC....to the 80% rule.

    If you filed for SSA and continued in the appeal process then your date is based on that application....for us we applied, was denied and then re-applied receiving acceptance on the 2nd application....so we lost some benefits.....

    It sounds as though you continued to persue your original application and was granted an award based on that.

    SSA grants a COLA increase on your SSDI benefit, should same be warranted around the beginning of each year.

    You will be receiving a large packet from SSA about Medicare benefits, and since you have IP access, start researching now....just go to the SSA web site here: http://www.ssa.gov/mediinfo.htm

    to check your options on Medicare coverage go here: http://www.medicare.gov/

    There is a lot of information to check out with regard to the type of insurance plan that best fits your needs.......

    Just remember that you can not change your Medicare Coverage until this December......so initially you are in just the plain Medicare Part A/B coverage and this coverage is accepted by most physicians/hospitals etc.
    from this coverage [when the enrollment period begins] you can then select to keep the regular medicare coverage and pay for supplemental coverage [PPO] or select an HMO/PFFS....

    We took the HMO because it reduced our out of pocket costs and included RX coverage [Part D] at no additional cost......so far the HMO has worked well for us......your situation may be different....

    We found the SSA reps to be very helpful in the initial stage, so by all means contact them if you have questions about when you will begin to receive benefits, what the inital SSDI monthly payment would have been, and what is the amount being taken as the offset. Your payment will be issued based on your birth date.......

    2nd Wednesday of the month - birth date between 1st -10th
    3rd Wednesday of the month - birth date between 11th - 20th
    4th Wednesday of the month - birth date between 21st - 31st

    RW......

  5. #5
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Awarded Social Security Disability, but Will Not Receive Monthy Checks

    Your payment will be issued based on your birth date.......

    2nd Wednesday of the month - birth date between 1st -10th
    3rd Wednesday of the month - birth date between 11th - 20th
    4th Wednesday of the month - birth date between 21st
    For some reason SSA keeps changing the payment criteria.
    Not all receipients are payed/deposited on Wednesday... mine comes on the 3rd of the month... if the 3rd is on Sat/Sun, or Holiday... the deposit is made on the Friday before. (Never later than the 3rd...)

    Just remember that you can not change your Medicare Coverage until this December......so initially you are in just the plain Medicare Part A/B coverage and this coverage is accepted by most physicians/hospitals etc.
    from this coverage [when the enrollment period begins] you can then select to keep the regular medicare coverage and pay for supplemental coverage [PPO] or select an HMO/PFFS....
    On the initial Medicare eligibility... you are free to assign your Medicare benefits in any month, any time...only after the first period, does the open enrollment come into play. If you move from one county to another, or state/state... you would certainly be permitted to change your coverage selection. Don't have to wait for the open enrollment period.

    A booklet "Medicare and You'' will arrive shortly after you Medicare card. You can also access benefit information, and do a 'search' by zip code on line at http://www.medicare.gov/...follow the links and all kinds of information is available.

    You can get password assignment from www.ssa.gov. Once you fill in the information requested, a password will be sent to you in the mail.

    We took the HMO because it reduced our out of pocket costs and included RX coverage [Part D] at no additional cost......
    Unfortunately not all HMO/PPFS plans include Part D drug coverage at no cost... Medicare Advantage plans are contracted by County...not all Counties have the same plans available... (have NO idea why this is, you'd think Medicare is Medicare regardless of where you live). In some Counties, there can be a monthly premium for the same policy/coverage.

    It's very important to review the options on Medicare you may be eligible for...once the plan is selected, it is there for the year... plan eligibility can vary based on your participation in Part D drugs... and whether you have accessed this through Medicare, or a IC providing the Part D as part of a HMO/PPO plan.

  6. #6
    Join Date
    May 2007
    Location
    Calif
    Posts
    483

    Default Re: Awarded Social Security Disability, but Will Not Receive Monthy Checks

    For some reason SSA keeps changing the payment criteria.
    Not all receipients are payed/deposited on Wednesday... mine comes on the 3rd of the month... if the 3rd is on Sat/Sun, or Holiday... the deposit is made on the Friday before. (Never later than the 3rd...)
    To determine when your check may be deposited you can check this site from SSA here: https://www.socialsecurity.gov/pubs/calendar.htm
    actually it is only the beneficiaries receiving benefits prior to May 1997 that receive their check on the 3rd of the month or thereabouts, anyone after 1997 is subject to the table provided in the link.

    On the initial Medicare eligibility... you are free to assign your Medicare benefits in any month, any time...only after the first period, does the open enrollment come into play. If you move from one county to another, or state/state... you would certainly be permitted to change your coverage selection. Don't have to wait for the open enrollment period.
    there are two kinds of enrollment general and special...... this link will explain both to you: http://www.medicare.gov/MedicareElig...ollment#TabTop

    General enrollment runs from Jan 1 thru March 31 this is where you can sign up for part B, if you did not request it with your initial application.

    If you didnít take Medicare Part B when you were first eligible because you or your spouse were working and had group health plan coverage through your or your spouseís employer or union, you can sign up for Medicare Part B during a Special Enrollment Period. You can sign up:
    • Anytime you are still covered by the employer or union group health plan through your or your spouseís current or active employment, or
    • During the 8 months following the month the employer or union group health plan coverage ends, or when the employment ends (whichever is first).
    If you are disabled and working (or you have coverage from a working family member), the Special Enrollment Period rules also apply.

    SSA may have changed some of their requirements because when my husband received his initial award and the SSA packet came with his SSA card we were informed that we had to wait till the general period to select a plan, until then he was covered under straight medicare, both A and B, so I would contact SSA for clarification that is specific to your particular situation.....

    Lots of good info on the SSA site, CMS cite, and here http://www.medicare.gov/default.asp

    RW.....

  7. #7
    Join Date
    Mar 2007
    Posts
    9

    Question Re: Awarded Social Security Disability, but Will Not Receive Monthy Checks

    Thank you for taking the time to read and reply to my post it is most appreciated. See this is the thing on my Notice of Award letter where it says Your Benefits all it says is:

    Beginning Date Benefit Amount Reason

    November 2004 $396.70 Entitlement began
    December 2004 $ 10.70 Cost of living Adjus
    December 2005 $ 27.40 Cost of living Adjus
    December 2006 $ 41.30 Cost of living Adjus
    December 2007 $ 51.30 Cost of living Adjus
    December 2008 $ 77.20 Cost of living Adjus

    I did receive my Medicare card today and it says:

    HOSPITAL (PART A) EFFECTIVE DATE 11/01/2006
    MEDICAL (PART B) EFFECTIVE DATE 04/01/2009

    is this why I don't get any checks???

    When I was working I was making around $1,900.00 before taxes
    and I get $547.70 every two weeks on Worker's Comp.

    Does that sound right? I did notify my Worker's Comp attorney that I was approved and faxed her a copy of the letter. Have not heard anything from her yet. Will this screw with my Worker's Comp Settlement??

    I went to every link that was suggested by you guys and I did learn a little bit but, not enough to understand yet..

  8. #8
    Join Date
    May 2007
    Location
    Calif
    Posts
    483

    Default Re: Awarded Social Security Disability, but Will Not Receive Monthy Checks

    When SSA determines your award they look at your ACE before injury. Then they consider what you are receiving from WC, be it TTD/TPD or PD.
    You cannot receive more than 80% from all sources when the DI award is granted.

    Your pre injury income was 1900.00 per month x 12 = 22,800 yr
    22,800 x 80% = 18,240 yr divide that by 12 = 1520.00 per month

    1520.00 per month is the cap from all sources to meet the 80%
    1095.40 from WC [547.70 every 2 weeks]
    424.60 is the difference [this is the sum that SSA could pay up to]

    SSA is saying your monthly DI benefit is 396.70 in 2004, and then each preceeding year you were entitled to a COLA increase, so each year you add the amount noted to the initial award, and then subtract the cost of the Medicare premium Part B......

    I would contact SSA to determine based on what you have explained why you are not receiving any back pay or a monthly payment at this point. It could be that SSA needs time to figure out what exactly they owe you in back pay before the issue the check.

    Your award letter should have a name on it and a contact telephone number.....start there......

    hope this helps you somewhat.....RW....

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