Each case in which there is an actual reduction in DIB due to WC/PDB requires offset recomputation under the redet provision to determine if the redet ACE yields higher benefits payable after offset.

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  If offset is continuous on the account, i.e., there is never a month where all beneficiaries receive full DIB, redetermine the ACE in the third calendar year following the year offset is first imposed (i.e., benefits reduced), or reimposed if there is a break in offset.

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  Compute subsequent redeterminations of the ACE every third year thereafter as long as offset on the account is continuous.

EXAMPLE 1:

The above example illustrates that the first redet is due less than three full years from the first month offset is imposed. The first redet is due in January 2008, the third calendar year after 2005 because 2005 is the first year benefits are reduced due to WC/PDB offset.

EXAMPLE 2: Using the same family composition from the above Example 1, Example 2 below illustrates what happens when offset is not continuous for HB2 and HC1 (i.e., there is a break in offset of at least one month and HB2 and HC1 receive their full monthly benefit amount). The redet “clock” starts over:

A redet ACE applies if the triennial redetermination yields a higher amount payable after offset for any beneficiary on the account. If the redet applies, the redet increase is always effective in January of the redet year.

Use form SSA-3643, Offset Worksheet - Triennial Redetermination, to manually compute a redetermination of the ACE. The computation determines if a triennial redet applies (i.e., the redet ACE increases the benefits payable after offset in January of the redet year for any beneficiary on the account).

For instructions on using the SSA-3643, see DI 52170.015.

If the redet ACE applies, use the new redet ACE in subsequent offset calculations.

As part of the redet alert process, we reverify WC/PDB payments every three years. If the alert is generated for the correct year, ensure that the WC information/verification is current, as follows:

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  If WC/PDB information/verification is more than two years old, verify WC/PDB payments via direct contact, online access with State records, etc.

  EXCEPTION: Reverification is not required if the WC claim has been finally settled and the continuing offset is solely due to the proration of a previously verified lump sum settlement. For information on WC/PDB verification and permanent retention procedures, see DI 52145.001.

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  If the information/verification is not older than two years and there is no reason to question it, reverification is not required.

All redet alerts contain the legend: “(YEAR)-WC Redet and PCACS TOEL (S) – OFFSET WCREDET”. There are three types of redet alerts, Y, W, and Z. These codes are shown at the top of the redet alert.

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  Verify that a redet is potentially due. (For criteria that prohibit a redet, see DI 52150.080D. in this section.)

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  If the alert is erroneously generated, notify the BA/BTE to correct the MBR invalidity.

  NOTE: An erroneous alert is sometimes produced due to inconsistent or questionable data on the MBR (e.g., data fields ACE, PER PMT, WCPDBDET and WCPDBOFF). Corrections, other than adding a STOP date, normally require preparation of a new offset Datasheet.

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  Using current WC/PDB information, compute the triennial redetermination of the ACE via ICF, or Form SSA-3643 if a manual computation is necessary. A redet ACE may or may not yield an increase in benefits payable after offset.

If a manual computation is required for a family composition change and a triennial redet of the ACE, follow the calculation steps below. These steps are necessary to manually compute the actual amount payable after offset, effective with the month of the family composition change:

1. a. 

   Compute offset using the new number of beneficiaries (i.e., the new family composition) from the Offset First Considered Date on Form SSA-2455 “Offset Worksheet – Disability Insurance Benefits.” Use the WC/PDB rate effective the month of the family composition change. (See DI 52170.020 for completion of this form.)

   NOTE: This computation may change the Offset Effective Date (OED) to a different (though fictitious) date, as illustrated in Example 1 in this section. The fictitious OED and any offset computation results for the fictitious period are not posted to the MBR. However, if the fictitious period involves a redetermination of the ACE, the fictitious redet ACE is used in subsequent offset computations until replaced by a “real” redet ACE (i.e., an ACE based on the triennial schedule in effect prior to the family composition change). Therefore, a change in the WC/PDB rate after the family composition change (but before the next “real” triennial redet is due) is calculated using the “fictitious” ACE.

2. b. 

   Compute all triennial redets based on the Offset Effective Date (which may be a fictitious date - see NOTE above) on Form SSA-3643 using the new family composition. Any redets from this Offset Effective Date to the month before the month of the family composition change are “fictitious redets.”

3. c. 

   Add any applicable increases (e.g., COLAs) that may be due after each “fictitious” redet.

A redet is not applicable if offset (reduction in benefits) is not continuous for any reason, such as a break in offset due to a high ACE. However, these rules must be modified when there is change in the family composition, such as a subsequently entitled auxiliary with a DIB MOE after the date of the first potential redet. See following example.

We presume that if HC1 had been entitled in 04/1993, they would have been in partial offset effective 04/1993.

To determine rates payable for the family effective 01/1998 (HC1’s MOET), we must recompute offset retroactively to 04/1993 as though HC1 was entitled in 04/1993 (the month offset was first considered).

1. a. 

   The fictitious rates payable result in no offset for the NH for 04/1993-03/1994 and the NH’s benefits are offset effective 04/1994. HC1 is offset effective 04/1993 so this creates a fictitious Offset Effective Date of 04/1993. Therefore, a fictitious redet is computed for 01/1996, three calendar years after the new (but fictitious) 04/1993 Offset Effective Date.

2. b. 

   We must do a reconciliation of the future redet schedule between the prior family composition (NH only entitled) and the new family composition (NH and HC1 entitled) at the point the new family composition becomes effective (HC1 becomes entitled in 01/1998) to adhere to the every third year rule for redets. In this example, after the month of the family composition change (01/1998), any future redets are based on the year offset was actually first imposed (the actual offset effective date of 04/1994).

3. c. 

   The fictitious rates payable after offset for 04/1993-12/1997 are computed to determine the amount payable to the NH and HC1 beginning 01/1998, the date of the family composition change. Therefore, the amounts previously determined payable after offset for the NH for 04/1993-12/1997 (prior to HC1’s entitlement) do not change.Actual benefits are not offset for 04/1993 through 03/1994.

4. d. 

   The NH’s actual benefits are offset effective 04/1994. Therefore, as long as there is no break in offset from the actual Offset Effective Date (04/1994), actual redets are due in 01/1997, 01/2000, 01/2003, 01/2006, etc., at three-year intervals.

Use the fictitious Offset Effective Date of 04/1993 and the fictitious redet in 01/1996 only to compute the rates payable beginning 01/1998 (HC1’s MOET).

The ACE DATA output screen (WCAC) in ICF displays the fictitious redet ACE (01/96) as well as the actual redet ACEs (01/97, 01/00, 01/03, 01/06). The following illustrates the WCAC screen for this example:

The first two entries on this screen (04/93, 01/96) only apply to the fictitious computations (due to the family composition change) and therefore display the fictitious Offset Effective Date of 04/93 in the last column.