BASIC (09-08)

DI 52150.070 How Changes in Family Composition Affect Workers' Compensation/Public Disability Benefits (WC/PDB) Offset

The original offset computation may not involve the family maximum. However, the addition or deletion of a beneficiary may cause the total family benefits (TFB) to become the applicable limit for offset or cease to be the applicable limit for offset.

A. Composition change

When the family composition changes, recompute offset as though the new number of beneficiaries was on the rolls for the first month offset was imposed or considered.

B. Benefit computation

Compute new rates using:

  • The same average current earnings (ACE) applicable in the first possible month of offset; and

  • The TFB determined for the new number of beneficiaries that would have been subject to offset in the first possible month of offset.

C. Application of the processing expedient

Primary use of the expedient is for post-adjudicative situations (e.g., Post Entitlement Online System (POS) exceptions) in the processing centers (PCs). Field offices (FOs) ordinarily use direct input.

1. When to use the expedient

Compute the benefits payable to the new number of beneficiaries using the expedient below only if the case meets all of the following conditions:

  • The ACE is the applicable limit and remains the same both before and after the change;

  • The family maximum is payable both before and after the change; and

  • The auxiliaries receive equal shares of the maximum.

If the case meets all of these conditions, the total amount payable remains the same. Redistribute the amount payable among the new number of auxiliaries. This expedient redistributes amounts payable to auxiliaries even when protected increases are involved.

The BA/BTE may use this expedient and use the WC Benefit Results screen (MPAO) to update the MBR data without having to refer the case to a CA/CTE for a new datasheet.

2. When not to use the expedient

Do not use the expedient if, in the month of the family composition change, there is any other event that requires recomputing offset from the first month of offset (e.g., WC rate change).

NOTE: ICF does not employ the expedient so the ICF computation may differ slightly due to rounding. Do not change the offset unless there is another reason for refiguring the computation (e.g., WC/PDB rate change).

D. Example

In this situation, the 80% ACE is the applicable limit in the initial computation of offset. Compute 03/2007 offset as follows:

PIA – 03/2007

$655.40

MAX

$794.30

HB2, HC1, HC2

$ 46.30 (each)

TFB

$794.30

80% ACE

$880.00

WC

$593.30

  

80% ACE

$880.00

Monthly WC

- 593.30

HA Payable

$286.70

HB2, HC2, HC1 Payable

$ 0.00

HB2, HC1, and HC2 are in total offset, each having offset of $46.30. A COLA is due 12/07.

PIA – 12/2007

$670.40

MAX

$812.50

HB2, HC1, HC2

$ 47.30 (each)

TFB

$794.30

80% ACE

$880.00

WC

$593.30

  

12/2007

 

HA Payable

$301.70

HB2, HC2, HC1 Payable

$ 1.00

$670.40 minus $655.40 = $15.00 protected increase due HA.

$ 47.30 minus $ 46.30 = $ 1.00 protected increase due auxiliaries.

HA Payable

Auxiliary Payable

$ 286.70

$ 0.00

+ 15.00

+ 1.00

$ 301.70

$ 1.00

HC2 terminates leaving two remaining entitled auxiliaries 06/2008.

If T2 is unable to process the termination and adjustment, a manual adjustment credit and award data entry (MACADE) action is required in the PC.

Because the ACE remains the applicable limit, the maximum is payable both before and after the auxiliary termination and equal shares of the maximum remain payable to the remaining auxiliaries, so use of the expedient would be acceptable in this situation. The BA/BTE would redistribute the amount after offset that was payable in 05/2008 to the remaining auxiliaries.

$3.00 divided by 2 yields $1.50 each due HB2 and HC1 after offset effective 06/2008

If T2 is able to process the termination action to completion, it recalculates the offset as follows:

Redistribute the MAX.

$ 794.30

$ 812.50

$142.10

($ 71.00 each)

- 655.40

- 670.40

- 138.90

(- 69.40 each)

$ 138.90

$ 142.10

$ 3.20

($ 1.60 each)

Despite the fact that there are now only two auxiliaries, only the $3.20 protected increase is payable to the auxiliaries.

$3.20 divided by the 2 remaining auxiliaries yields $1.60 payable to HB2 and HC1.

PIA – 12/2007

$670.40

MAX

$812.50

HB2, HC1

$ 47.30 (each)

TFB

$794.30

80% ACE

$880.00

WC

$593.30

  

06/2008

 

HA Payable

$301.70

HB2, HC1 Payable

$ 1.60

Although the two methods yield results that differ by $.10, either result is acceptable under the equivalency rules found in RS 00601.010 - Equivalency and Tolerance Rules

E. References

  • SM 00880.261 - Function 11 Propagation of WC/PDB Data to MACADE Screens

  • SM 00880.262 - The Special Instructions Screen


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0452150070
DI 52150.070 - How Changes in Family Composition Affect Workers' Compensation/Public Disability Benefits (WC/PDB) Offset - 06/28/2013
Batch run: 06/28/2013
Rev:06/28/2013