How Does Workers Comp Affect Social Security Benefits?

If you were hurt on the job, you should know that your worker's comp benefits can effect your SSDI benefits.You can collect both only if you are eligible for each type of benefit. You must prove your disability to the Social Security Administration by having your condition on a list or based on your age, work experience, skill level, and physical or mental limitations. You cannot work any job, no matter how easy or effortless.

Workers' compensation can be received if you prove you were injured on the job, but there is a limit to how much money in benefits you can receive from both at the same time. People cannot receive more than 80% of their average earnings from both benefits. The Virginia Workers' Compensation Board (WCB) will decrease the benefits given to a claimant to reach the 80% limit instead of having Social Security.

This is because Virginia is a reverse offset state. Social Security would decrease their benefits if the claimant resided in an offset state.

Calculating Average Current Earnings

There are three methods that the SSA uses to calculate a claimant’s average current earnings. They can use average monthly wage to determine benefit sums, the average of the top five profitable months of the year called the “high five” method, or at the most profitable year called the “high one” method.

Here is an example if you are still confused about the 80% rule. If a claimant of SSDI benefits earns $6000 every month, then no more than 80% of the monthly income can be comprised of SSDI benefits and workers’ compensation. $4800 is 80% of the monthly income for the claimant, so he/she cannot earn more than that from the coinciding benefits.

Does Medicare Offset Workers’ Compensation Medical Benefits?

Medicare will always provide secondary financial, medical assistance to those that have insurance already, according to the Medicare Secondary Payment (MSP) Act. This means that Medicare will take care of any medical expenses that the claimant's insurance could not cover. If the injury is work related, then the employer's workers' compensation insurer is in charge of covering as much of the cost as possible.

If a workers' compensation settlement has medical benefits incorporated into it, then Medicare will ask for those benefits to be reserved for medical expenses (note that this can end a worker's right to receive future benefits from workers' compensation). This allows Medicare to continue being a secondary financial help to medical expenses.

The American Bar Association has asked Congress to pass laws clarifying this issue due to the uncertainty it poses to workers. Workers affected by injury can learn more about these issues by speaking with an experienced attorney. BenGlassLaw can help teach you more about and guide you through worker's compensation, Medicare, and Social Security disability.

Ben Glass
Ben Glass is a nationally recognized Virginia injury, medical malpractice, and long-term disability attorney