DI 52150.025 Workers’ Compensation/Public Disability Benefit (WC/PDB) Offset Ending Date
Offset ends with the earliest month one of these events occurs:
Number holder (NH) attains age 62 (1965 Amendments) or 65 (1981 Amendments);
NH attains age 65 prior to December 19, 2015 ( 1981 Amendments); or
NH attains full retirement age (FRA) effective December 19, 2015 or later (2015 Amendments) see DI 52101.005;
WC/PDB offset does not apply due to a recognized reverse offset plan per DI 52105.001;
Lump Sum proration ends;
Periodic WC/PDB ends (payments cease and no lump sum settlement involved);
Social Security DIB benefits terminate; or
Worker elects reduced retirement insurance benefits (RIB). See DI 52150.030 regarding RIB.
A. Offset ends because of attainment of age 62—Workers Comp Non-MEGACAP Alert Code F
If the DIB onset is prior to 03/01/81 OR the MOET is prior to 09/81, the last possible month of offset is the month prior to attainment of age 62. The Non-Megacap Code-F alert is generated in the Processing Center (PC) at age 61 years, 11 months. See SM 00619.056 regarding the alert.
The benefit authorizer/benefit technical examiner (BA/BTE) receives the alert.
If proof of age is established, the BA/BTE uses MACADE to annotate the WC/PDB offset stop date and removes offset.
If proof of age is not established, the BA/BTE routes the case to a claims authorizer/claims technical examiner (CA/CTE) to develop proof of age.
B. RETAP selection for WC/PDB offset stop date
RETAP uses information on the MBR to determine that WC/PDB offset should be removed. A RETAP selection processes offset removal for the following types of cases.
1. Attainment of age 65
If the DIB onset is 03/01/81 or later AND the MOET is 9/81 or later, the last possible month of offset is the month prior to attainment of age 65.
NOTE: Full Retirement Age (FRA) now extends past age 65, but WC/PDB offset is removed at age 65.
2. Attainment of FRA — December 19, 2015 or later
Effective December 19, 2015 or later, the offset termination date extends from Age 65 and continues until FRA. See the 2015 Amendment in DI 52101.005. The amendment affects individual who attain Age 65 on December 19, 2015 or later.
3. Reverse jurisdiction starts
Certain States have reverse offset plans that begin in a month later than the first possible month of offset. When the reverse offset plan begins, WC/PDB offset is removed. The start date of the reverse offset depends on the State where the injury or illness occurred. See DI 52105.001 and the references for Florida, New Jersey, and Washington in that section.
4. Lump sum (LS) proration ends
The selection is sent to Title 2 Redesign (T2R) for processing.
If T2R cannot process the action to completion, an exception is produced in the PC.
C. Offset ends when WC/PDB payments stop
When the NH reports WC/PDB payments have ended, obtain verification that the case is closed and no further payments or awards are expected. For instructions regarding obtaining verification, see DI 52145.001.
If the NH requests full benefits be paid until WC/PDB payment resumes or until proof is received that no more payments will be made, take the following actions:
Obtain the request in writing. It should include a statement acknowledging potential overpayment and the repayment requirement.
Obtain verification of the last date of payment.
Verify that the NH did not receive a lump sum (LS) settlement.
Post a special message to the MBR regarding the request and repayment statement. Indicate in the message whether the repayment statement is in the Claims File User Interface (CFUI).
Route all WC/PDB documentation for permanent retention. For instructions regarding retention, see DI 52145.001.
Establish a diary control. For establishing diary control in the FO, see DI 52140.001H., and for PC diaries, see DI 52140.010D.
After the necessary documentation is received, process the WC/PDB end date.
In MCS, enter the end date on the WC/PDB Periodic Payments (WPPR) screen. For coding information, see MSOM COMMON 001.005.
If processing the end date as a post-entitlement event, enter payment information on the WC/PDB Offset-Periodic Payments (WCPP) screen in ICF #32 or #34. For coding information, see MSOM ICFT2 031.014.