Hello, Not sure if this is correct place to post this or not so Admins please feel free to re-locate.
This is complicated (for me at least) so it will be kind of long winded, and I know that to get good answers I need to explain as much as I can, sorry
Facts:
The state I worked in only has a SSA approved Workers Compensation (WC) Reverse Offset for Permanent Total Disability (PTD).
The company I worked for is "Self Insured for WC" meaning they have a Third Party Administrator (TPA) to handle WC claims.
They also had a private pension plan so no Social Security (FICA) was paid in the last few years therefore my ACE is very low resulting in a low SSDI benefit.
In the first week of May 2014 I had an on the job injury in a "no-fault" state.
Supervisor was on site and notified of accident and injury when it occurred.
6 days later I was hospitalized in ICU with internal liver injuries and Sepsis for a period of 21 days.
The accident caused lesions on my liver which resulted in my body becoming sepsis.
I was then sent home with 2 liver drain bags and a picc line (for 6 weeks of antibiotic home infusion) due to whole body sepsis which affected/damaged almost everything in my body.
My employer did not file a WC claim until end of June 2014, 3 weeks after I was released to go home from hospital, almost 7/8 weeks after accident.
On the first day of being off from work (6 days post accident) they put me on FMLA (12 weeks) (instead of WC) and paid me bi-weekly until my accrued sick time, leave time and accumulated K Time (unpaid overtime) were used up, then I was terminated in Oct 2014 for not having the minimum required sick time balance.
My doctor(s) had indicated to them (WC) in Sept 2014 that I would never be able to work again without extensive medical and physical rehabilitation due to the damage caused by the sepsis to my system.
The whole time the above was going on the TPA were stalling saying that they could not make a determination to approve or disapprove my claim because they had not yet received all of my medical records.
This went on for almost a year until I realized that they were just stalling until the deadline for filing a 1008 would expire and I would lose my WC rights and they would no longer be liable.
I then hired a WC attorney (with no Social Security experience). And he started the legal process which protected my WC rights.
In June 2014 (after my sick,leave and K-time ran out) I applied for SSI and SSDI and was approved which after the 5 month delay started my SSDI income Jan 2015.
I only received SSI for 1 month, Jan 2014.
I am still drawing SSDI and am not scheduled for a review until 2022.
Still no decision on my WC case except that they had "controverted" it pending investigation.
In May 2015 I received a Indemnity check covering from the date of the accident (May 2014) until Jan 2015 and (2) 1002's, both were dated the same day, (1) starting my WC benefits and (1) stopping them.
They paid indemnity benefits but not any of the medical bills or the ongoing associated related complications.
My attorney stated that because the check was for lost wages/ periodic payments and represented a time frame prior to my receiving SSDI that I need not report it to SSA, So I did not.
(I used that money to catch mortgage and other bills up and to repay loans from family and friends)
After jumping through all the hoops for the TPA's including (2) second medical opinions and numerous tests they are still fighting it, even though their own doctors concur with all my Dr's as to my condition and current status which is Temporary Total Disabled (TTD).
Which means the employer cannot take a reverse offset but SSA can.
I have just been informed that they are going to send me checks for my out of pocket Mileage expenses, Pharmacy Expenses, and their underpayment for the incorrect Average Weekly Wage (AWW) on the initial check, and Indemnity Payments(lost wages) from Jan 2015 thru Oct 2015, (but not to up to current date).
My WC attorney says there will never be a full and final or a settlement on my case due to the cost of what a Medical Set Aside (MSA) (would be in excess of 7 figures).
We are scheduled to go to trial in less than a month (for the 6th time) and I am wondering if this check is a Trojan horse.
I cannot afford to hire another attorney at this time for the SSDI questions I have so I am reaching out here for some guidance.
I hope I have not left out any pertinent information, so ask me if I have and I will try to clarify any questions.
I am trying to determine how best to handle this and what effect this will have on my SSDI.
So...
Here are a few of my Questions:
Should I have reported the first check (for May 2014 - Jan 2015) That I received in May?
(I know I need to report the 2nd indemnity check because it represents monies received while getting SSDI.)
Since these indemnity checks represent periodic payments and not a lump sum (LS) and since I have no settlement or court documents to submit to SSA, How do I report it (or them)?
Any thoughts on:
We are scheduled to go to trial in less than a month (for the 6th time) and I am wondering if this check is a Trojan horse?
Will I be subject to an offset?
If so How to figure it?
How else could this affect my SSDI?
(Which I do not want because SSDI is regular and guaranteed whereas WC has been known to "misplace" checks.)
When I get some answers to these questions I am sure I will have more and will ask them then,
Thanks.
This is complicated (for me at least) so it will be kind of long winded, and I know that to get good answers I need to explain as much as I can, sorry
Facts:
The state I worked in only has a SSA approved Workers Compensation (WC) Reverse Offset for Permanent Total Disability (PTD).
The company I worked for is "Self Insured for WC" meaning they have a Third Party Administrator (TPA) to handle WC claims.
They also had a private pension plan so no Social Security (FICA) was paid in the last few years therefore my ACE is very low resulting in a low SSDI benefit.
In the first week of May 2014 I had an on the job injury in a "no-fault" state.
Supervisor was on site and notified of accident and injury when it occurred.
6 days later I was hospitalized in ICU with internal liver injuries and Sepsis for a period of 21 days.
The accident caused lesions on my liver which resulted in my body becoming sepsis.
I was then sent home with 2 liver drain bags and a picc line (for 6 weeks of antibiotic home infusion) due to whole body sepsis which affected/damaged almost everything in my body.
My employer did not file a WC claim until end of June 2014, 3 weeks after I was released to go home from hospital, almost 7/8 weeks after accident.
On the first day of being off from work (6 days post accident) they put me on FMLA (12 weeks) (instead of WC) and paid me bi-weekly until my accrued sick time, leave time and accumulated K Time (unpaid overtime) were used up, then I was terminated in Oct 2014 for not having the minimum required sick time balance.
My doctor(s) had indicated to them (WC) in Sept 2014 that I would never be able to work again without extensive medical and physical rehabilitation due to the damage caused by the sepsis to my system.
The whole time the above was going on the TPA were stalling saying that they could not make a determination to approve or disapprove my claim because they had not yet received all of my medical records.
This went on for almost a year until I realized that they were just stalling until the deadline for filing a 1008 would expire and I would lose my WC rights and they would no longer be liable.
I then hired a WC attorney (with no Social Security experience). And he started the legal process which protected my WC rights.
In June 2014 (after my sick,leave and K-time ran out) I applied for SSI and SSDI and was approved which after the 5 month delay started my SSDI income Jan 2015.
I only received SSI for 1 month, Jan 2014.
I am still drawing SSDI and am not scheduled for a review until 2022.
Still no decision on my WC case except that they had "controverted" it pending investigation.
In May 2015 I received a Indemnity check covering from the date of the accident (May 2014) until Jan 2015 and (2) 1002's, both were dated the same day, (1) starting my WC benefits and (1) stopping them.
They paid indemnity benefits but not any of the medical bills or the ongoing associated related complications.
My attorney stated that because the check was for lost wages/ periodic payments and represented a time frame prior to my receiving SSDI that I need not report it to SSA, So I did not.
(I used that money to catch mortgage and other bills up and to repay loans from family and friends)
After jumping through all the hoops for the TPA's including (2) second medical opinions and numerous tests they are still fighting it, even though their own doctors concur with all my Dr's as to my condition and current status which is Temporary Total Disabled (TTD).
Which means the employer cannot take a reverse offset but SSA can.
I have just been informed that they are going to send me checks for my out of pocket Mileage expenses, Pharmacy Expenses, and their underpayment for the incorrect Average Weekly Wage (AWW) on the initial check, and Indemnity Payments(lost wages) from Jan 2015 thru Oct 2015, (but not to up to current date).
My WC attorney says there will never be a full and final or a settlement on my case due to the cost of what a Medical Set Aside (MSA) (would be in excess of 7 figures).
We are scheduled to go to trial in less than a month (for the 6th time) and I am wondering if this check is a Trojan horse.
I cannot afford to hire another attorney at this time for the SSDI questions I have so I am reaching out here for some guidance.
I hope I have not left out any pertinent information, so ask me if I have and I will try to clarify any questions.
I am trying to determine how best to handle this and what effect this will have on my SSDI.
So...
Here are a few of my Questions:
Should I have reported the first check (for May 2014 - Jan 2015) That I received in May?
(I know I need to report the 2nd indemnity check because it represents monies received while getting SSDI.)
Since these indemnity checks represent periodic payments and not a lump sum (LS) and since I have no settlement or court documents to submit to SSA, How do I report it (or them)?
Any thoughts on:
We are scheduled to go to trial in less than a month (for the 6th time) and I am wondering if this check is a Trojan horse?
Will I be subject to an offset?
If so How to figure it?
How else could this affect my SSDI?
(Which I do not want because SSDI is regular and guaranteed whereas WC has been known to "misplace" checks.)
When I get some answers to these questions I am sure I will have more and will ask them then,
Thanks.
Social Security Issues: SSDI + Workers Comp + SSDI Offset Confusion
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