Pennsylvania Worker's Compensation - Help For Injured Pennsylvania Workers

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  1. #1
    Join Date
    Apr 2009
    Posts
    11

    Default Settlement and SSD

    I am finally seeing the light at the end of the tunnel, I hope. Injured in PA in 2008 at work, back surgery, collected wage benefits until return to work in 2009. Could only work 3 months, dr took me back out of work and recommended I apply for SSD. I did apply, primarily because WC insurance carrier refused to pay me wage benefits, no reason given, they just wouldn't do it. Even when their IME doc declared me totally unable to work. (amazing)

    I am now in the settlement stage of things and collecting SSD. I realize that if I had forced the weekly wage benefits due and collected those, that there would be an offset in my SSD benefits. In my case, it would negate all of my SSD benefits. If that happens, any months that I am not eligible for SSD also do not count toward my Medicare two-year waiting period. This is a huge deal for me, I need that Medicare in February of 2011. I have searched this site and many others and read everything I could find but I'm still missing the information I need.

    Is there any way to structure a lump sum settlement so that it does not affect my SSD? If I can avoid that, I can also avoid the Medicare issue. I realize there may have to be a Medicare set-aside also.

    Again, thank you so much for being here. I would have, no doubt, made some bad decisions through ignorance if this site was not here.

  2. #2
    Join Date
    Dec 2007
    Location
    Tunkhannock, PA
    Posts
    1,101

    Default Re: Settlement and SSD

    There is language to spread out the lump sum over your life expectancy. Your lawyer should have it. If you are not represented, and I will not give my opinion regarding entering into a settlement without representation, the lawyer for the IC will know it. All you have to do is ask them.
    Timothy D. Belt, Esquire
    Helping injured workers in Northeast Pennsylvania.
    belt-law@belt-law.com
    www.belt-law.com

    DISCLAIMER: This post is intended as general information applicable only to the state of Pennsylvania. The information given is based strictly upon the facts provided. This post is not intended to create an attorney client relationship, or to provide any specific guarantee of confidentiality.

  3. #3
    Join Date
    Apr 2009
    Posts
    11

    Default Re: Settlement and SSD

    Thank you once again. I am represented but he is in the Bahamas on vacation. I have nothing I can do to really keep my mind busy so I tend to worry and worry about these things. Thank you for the peace of mind.

  4. #4
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Settlement and SSD

    any months that I am not eligible for SSD also do not count toward my Medicare two-year waiting period. This is a huge deal for me, I need that Medicare in February of 2011. I have searched this site and many others and read everything I could find but I'm still missing the information I need.
    I'm curious where you are getting the info that months you do not receive SSDI due to an offset, those months would negatively affect your Medicare eligibility. (?) You become Medicare eligible 24 months after the date of your SSDI DOE/Date Of Eligibility, which is 5 months after the DOO/Date Of Onset of your disability. And, Medicare can extend up to 39 months after SSDI benefits end. The point is, being actually paid benefits during the delay period should not have any affect on your Medicare eligibility.

    The language you are looking for is called "Hartman", SSA can and will help you with this. Basically, the WC indemnity lump sum is calculated/defined as what you would receive had to continued with weekly payments. This provides for a calculation of your average weekly pre injury wages to the 80% rule so as to minimuze any offset SSA may apply to your SSDI.

    You should think very, very carefully about closing the medical coverage in your comp claim. And IF you opt for a C&R and close out the medical and indemnity, consider a Structured Settlement, where annuities would fund a WCMSA and non Medicare allocations of the future medical needs. Once the MSA money is exhausted, you will incur out of pocket costs when Medicare picks up the cost of your treatment.

    A C&R is always in the best interests of the ER/IC...not so in the interests of the IW.
    I think you have a lot more to consider here than just the language to prorate your indemnity award.

    BTW... If you receive money in a settlement that reimburses you for any wage loss/TTD that you should have received for the same periods you rec'd SSDI, those months will be subject to the offset per the 80% rule. Watch how any C&R settlement language is used, and the allocations.

  5. #5
    Join Date
    Apr 2009
    Posts
    11

    Default Re: Settlement and SSD

    I talked to the Soc Sec Admin and was told that any month that I did not quality for SSD due to the offset for other income (the WC benefits) would not count toward my 24 month waiting period for Medicare.

    I'm looking for a way to minimize that settlement impact on my SSD and, in effect, my eligibility for Medicare.

  6. #6
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Settlement and SSD

    I would ask them what they base that opinion on.... What do you do with the months there has been an overpayment and SSA stops your monthly payment until the overpayment is satisfied..? No money, no Medicare entitlement?
    SSA views WC benefits as though your full SSA/SSDI entitlement were being paid. That's why there is the possibility of the amount on a SSA1099 may be taxable...and IW's have difficulty seperating the numbers... it appears a portion of their WC benefits are being taxed, when in fact they aren't.

    There are three dates involved here... DOO/Date Of Onset, DOE/Date Of Entitlement, and DOA/Date Of Award (which is the date a decision is made to grant/award your benefits. That could be a year or more from the DOE) DOE is 5 months post DOO.

    I do not believe the 24 month waiting period for Medicare eligibilty starts/stops. You are Medicare eligible 24 months from your DOI/Date Of Entitlement. And, when/if your SSD were to stop at some point, due to gainful employment, your Medicare benefits could/would continue for an additonal 39 months. Even though no benefits were paid.

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