There are situations when WC/PDB entitlement terminates during the reverse offset
period and a new WC/PDB claim is awarded which is also paid under a reverse offset
plan, and there is at least one month of non-entitlement to WC/PDB between the two
awards. The period of non-entitlement to WC/PDB closes out one period of offset and
any subsequent WC/PDB award establishes an entire new period of offset, thereby requiring
a new offset first considered (OFC) date and a new TFB effective with the new WC/PDB
award. A new ACE may also be required if the previous ACE is not a High-1 ACE based
on earnings in the year of disability onset and the five years immediately preceding
the year of onset. See DI 52150.010C.3. for situations when the ACE can change.
If the new OFC date precedes the new beginning date of reverse offset, increases are
protected, as described in DI 52105.001G.2.a.
If the new OFC date and the new beginning date of reverse offset are the same month,
follow procedures in DI 52105.001G.2.b. regarding protected increases.
NOTE: If a CFM in effect during the previous reverse offset period still applies when the
subsequent reverse offset period (based on the new WC/PDB award) begins, the new TFB
will include the CFM auxiliary rates in effect with the new OFC date. If the CFM ceases,
the TFB must be refigured.
EXAMPLE - Multiple WC awards result in multiple periods of reverse offset: A worker receives permanent total WC from the state of Florida and is subsequently
awarded DIB effective April 2002. The DIB claim is adjudicated timely and reverse
offset applies beginning April 2002. A High 1 ACE applies. Although reverse offset
is effective with the DIB MOET and benefits are not reduced, MBR coding requires an
OFC date and TFB. The OFC date is equal to the DIB MOET and the TFB is based on the
monthly benefit amount effective in the DIB MOET.
In August 2005, WC terminates because the claimant has gone back to work and a WC
termination (STOP) date is coded on the MBR.
In October 2005, the claimant sustains another on-the-job injury and receives a new
WC award effective with the date of injury. Reverse offset again applies (effective
October 2005). Although DIB is not offset, a new OFC date of October 2005 and a new
TFB based on the October 2005 monthly benefit amount are established. The High-1 ACE
remains the same. The claimant attains age 62 in May 2007, WC payments continue, and
reverse offset terminates at age 62 attainment. Offset is imposed effective May 2007.
The SSA COLA increases from April 2002 through April 2007 and a January 2006 PIA recomputation
are not protected. Any SSA benefit increases from May 2007 are protected from offset.