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indiana workmans comp laws

Social Security Disability & Workers’ Compensation

 

Sometimes, workers sustain a work injury that leaves them unable to return to their former job or a similar job. Since permanent total disability (PTD) benefits are not a guarantee for an injured worker who cannot return to his or her prior job or place of employment, these individuals might be forced to seek benefits elsewhere.

Consequently, social security disability (SSD) benefits may be pursued by the injured individual. This often leads to the question of whether SSD benefits will be reduced if the worker is also receiving TTD benefits from workers’ compensation. To determine if there will be a reduction in SSD benefits, a specific formula needs to be followed. Here is how you can determine whether your workers’ compensation benefits will affect drawing social security pay early due to a work-related disability:

  1. If the total of your combined monthly workers’ compensation and social security benefits (including what others in your household draw) exceeds 80% of your gross average earnings per month (average current earnings) prior to the disability, then your SSD benefits will be reduced so that you do not exceed this 80% level
    • Example: Donna draws $1,000 from SSD per month. Her husband draws $1,500 per month. Donna is also drawing $548 from workers’ compensation each month. Thus, benefits in this household total $3,048. Donna’s gross average earnings per month before she became disabled from a work accident was $3,500. Since 80% of $3,500 equals $2,800, the amount that Donna and her family draws from SSD will have to be reduced by $248 (the difference between $3,048 and $2,800) in order to meet the 80% requirement.
OR
 2. If your monthly social security disability pay alone is more than 80% of your gross average earnings per month prior to the disability, then your SSD benefits will be reduced so that the combination of drawing these events along with workers’ compensation benefits does not exceed the amount over 80% that you drew just through SSD income.
  • Example: Dennis draws $1,300 from SSD per month, while his son draws $300. In total, Dennis’ household receives $1,600 from SSD each month. This does not account for what Dennis earns from workers’ compensation. Dennis’ gross average earnings per month prior to the disability was $1,800. 80% of $1,800 equals $1,440. In this case, since the SSD benefits are more than the 80% requirement, the $1,600 will serve as the maximum standard of benefits level. Thus, the SSD benefits will be reduced so that the combination of this plus Dennis’ workers’ compensation benefits does not exceed $1,600.
On the other hand, workers’ compensation disability pay will not be part of the earnings that determine what you can get from social security disability when you do become eligible to draw it. In other words, if you had a work accident in 1992 and you received 11 weeks of temporary total disability pay that totaled $2,500, then the Social Security Administration will not recognize the $2,500 as part of your total earnings for 1992. This is because social security taxes are not taken out of workers’ compensation disability income.

What if I do not accept my PPI Rating?

 

It is important to note that the injured worker does not have to accept the worker’s compensation doctor’s permanent partial impairment (PPI) rating. YOUR RIGHT as an injured worker is to negotiate a higher settlement if you think the injury is serious enough that a second opinion from another specialist would likely result in a higher PPI rating.

Here are some things to consider when deciding if you should negotiate the PPI rating:

  1. Did my injury require surgery?
  2. Is my injury an aggravation of a pre-existing injury?
  3. Does the pain from the injury affect other areas of my body?

In this scenario, if you responded “yes” to the first or third question listed above, then negotiating might be a valid option for your claim. In the second question, after factoring out the old injury from the new injury, you may or may not be left with a higher rating to negotiate.

Rules of Thumb

Generally, if you are given two PPI ratings for the same injury from two different doctors, the settlement offered should be the difference (or average) of these two ratings.

On the other hand, if you are given two separate PPI ratings because you injured two different areas of your body as a result of the work accident, then the doctor will probably combine these impairments into one whole body impairment rating.

Hearings

If a dispute over a PPI settlement is not resolved between the parties involved, then the matter will be presented before a Judge. For all practical purposes, it is best if disputes over PPI ratings and settlements can be resolved without a hearing as each Judge rules differently in these matters. It is possible that the Judge will decide in favor of the lesser rating.