SSR 79-20: TITLE II: INTERRUPTED WORKERS' COMPENSATION OFFSET
PURPOSE: To state the policy regarding the effect of interrupted workers' compensation (WC) offset on statutory increases in Social Security benefits and the requirement that the Social Security Administration be on "notice" of the receipt of WC payments.
CITATIONS (AUTHORITY): Social Security Act, sections 224(a)(2) and 224(a)(8); Regulations No. 4, sections 404.408(c)(2)(ii) and 404.408(i).
PERTINENT HISTORY: There is no statement of policy providing for the protection or lack of protection of statutory increases in Social Security benefits during a period of interruption in WC offset. Operational personnel have requested formalized policy which will enable them to be assured that cases involving the same set of facts are being processed uniformly.
POLICY DIRECTIVE STATEMENT: Where WC payments are interrupted in Disability Insurance Benefit cases because of a break in WC entitlement, offset will be reimposed beginning with the month after the month the Social Security Administration (SSA) receives notice of the new WC entitlement. In such cases, any statutory increases in Social Security benefits which became effective prior to the month offset is reimposed are not protected from the WC offset provisions of the Social Security Act. However, if WC entitlement is continuous, even though WC payments are stopped and resumed (e.g., temporary payments were stopped pending a permanent disability rating), Social Security statutory increases are protected from the first month of offset imposed.
The crucial determination to be made is whether the interruption in WC payments represents a "break in entitlement." Determining whether an interruption of WC payments is due to a break in WC entitlement or whether additional payments are contemplated depends upon the laws, regulations, policies, and procedures of individual States. These laws, regulations, policies, and procedures will vary from State to State. Questions regarding their effect in individual States should be referred to the Regional Attorney. Some examples of factors that may be relevant to whether there is or is not a break in WC entitlement in individual States are:
- Whether a new application is necessary to have WC payments resumed.
- Whether there is evidence of new accident or disease.
- Whether an appeal is necessary under State law before additional payments can be made.
- Whether the State WC agency automatically considers the claimant for additional payments without any further action on the part of the claimant.
An interruption preceding a second WC award, unrelated to the original WC award, is considered to be a break in entitlement. If offset is removed for a reason unrelated to the WC awards, such as a decrease in total family benefits, and later reimposed, benefit increases that become effective during the period of no offset are protected.