DI 52155.020 Disability Claims with a Prior Period of Disability with Workers' Compensation/Public Disability Benefit (WC/PDB)
If the number holder (NH) has multiple periods of disability, consider WC/PDB offset for every period of entitlement. Reimposing offset from a prior period of disability cannot be processed through MCS EC. These cases require A101 or EF101 processing.
A. New period of disability insurance benefits (DIB)
For every new period of DIB determine:
Obtain current documentation of changes in payment and new claim information.
B. WC/PDB benefits paid in the prior period of DIB have ended
If periodic payments and/or lump sum (LS) proration end prior to new date of entitlement (DOE), WC/PDB offset (based on the prior WC/PDB claim) does not apply in the new period of DIB.
C. The only WC/PDB claim is based on injury or illness after prior period of DIB ended
Determine all factors of offset from the new period of DIB.
D. WC/PDB periodic payments continue from prior period of DIB
Redetermine the first possible month of offset for a new period of DIB. For an explanation of the first possible month of offset, see DI 52150.020.
Establish a new Total Family Benefit (TFB) based on the new period of entitlement. For complete information about the TFB, see DI 52150.005.
Establish a new Average Current Earnings (ACE) based on the year of onset of the new DIB period. For instructions on determining the ACE, see DI 52150.010.
Use the year in which WC/PDB offset is imposed in the new period of DIB to determine the year of a triennial redetermination of the ACE. For rules on triennial redetermination of the ACE, see DI 52150.080.
E. WC/PDB LS proration continues from prior period of DIB
If LS proration will continue past the new date of entitlement (DOE),
NOTE: Provisional payments and expedited reinstatement (EXR) awards do not represent a new period of disability. See DI 52160.001 for EXR awards involving WC/PDB offset.