BASIC (09-08)

DI 52165.010 How to Complete the Workers’ Compensation/Public Disability Benefits (WC/PDB) Interactive Computations Facility (ICF) Screens

This section provides instructions for completing the screens for ICF functions #31, #32, and #34. Fields that are self-explanatory or explained fully in MSOM may not appear in this section.

A. Navigation of the ICF screens

The ICF screens use similar navigation functions as other PCOM data collection screens.

B. Help screens in ICF

The WC ICF help screens provide useful information about most fields that you need to complete and some that propagate. To access the help screens, position your cursor in the field you want more information about and press the F1 key. To exit the help screens, click “Enter" to cycle through all of the available screens or press the “F1” key.

C. WC/PDB offset screen guide

To assist users, additional information about certain ICF data entry, review and adjudication screens that are not included in MSOM are provided in this section. Click the screen you want more information about.

NOTE: MSOM contains information about all ICF screens and fields. It is the official source for providing a complete reference of systems data.

Data Entry Screens

WCMU – WC/PDB Offset Program

DI 52165.010C.1,
MSOM ICFT2 031.002

WCPA- Options

DI 52165.010C.2,
MSOM ICFT2 031.003

WCGI – General Information

DI 52165.010C.3,
MSOM ICFT2 031.006

WCSP – Spouse Data

DI 52165.010C.4,

MSOM ICFT2 031.009

WCCH - Child Data

DI 52165.010C.5,

MSOM ICFT2 031.010

WCCL – Claims

DI 52165.010C.6,
MSOM ICFT2 031.011

WCCD - Claim Data

DI 52165.010C.7,
MSOM ICFT2 031.012

WCEE - Periodic Payment Excludable Expenses

DI 52165.010C.8,
MSOM ICFT2 031.013

WCPP - Periodic Payments

DI 52165.010C.9,
MSOM ICFT2 031.014

WCLS – Lump Sum Data

DI 52165.010C.10,
MSOM ICFT2 031.015

   

Review and Adjudication Screens

WCDE - Computational Earnings

DI 52165.010C.11,
MSOM ICFT2 031.017

WCAC - ACE Data

DI 52165.010C.12,
MSOM ICFT2 032.003

WCWE – Lump Sum Proration Expenses Involved

DI 52165.010C.13,
MSOM ICFT2 036.004

WCGO - General Offset Data

DI 52165.010C.14,
MSOM ICFT2 032.006

WCAO - Account Data

DI 52165.010C.15,
MSOM ICFT2 032.007

WCPO - PIC Offset Data

DI 52165.010C.16,
MSOM ICFT2 032.008

WCNM - Notice Menu

DI 52165.010C.17,
MSOM ICFT2 033.002

WCEP - Enclosure Notice Block

DI 52165.010C.18,
MSOM ICFT2 033.003

WCDA - Adjudicate WC/PDB Claim

DI 52165.010C.20,
MSOM ICFT2 034.004

Required fields display in yellow within the ICF WC/PDB programs where the system default colors are used in PCOM.

1. WCMU

MSOM ICFT2 031.002

All fields are required. The system compares your inputs with the MBR. If an MBR does not exist, the comparison is to the Numident. All keyed information must match the MBR or Numident information before you can move to the next screen.

2. WCPA

MSOM ICFT2 031.003

The WCPA allows you to determine the time period for your input and the source, if any, to be used for propagation.

Enter the DIB Entitlement Start Date (MMYY)

Enter DIB DOE for the period that is being processed.

Start date for current action (MMYY)

If WC data is on the MBR and does not show the legend converted.

  • If WC/PDB began prior to DIB DOE, then input a date equal to the DIB DOE (Disability Date of Entitlement)

  • If payments began after DIB DOE, then input the date of change caused by the new information.

If WC/PDB data is not on the MBR or shows the legend converted.

  • Input the first date in which WC/PDB payments are being considered.

Is this computation for an A101/Manual award (Y/N)

Code this field with a “Y” if you will be completing an A101 or EF101. If not, leave it blank or answer “N”.

NOTE: If processing an A101, you must complete the ICF input prior to completion of the A101.

(A101 and WC/PDB DI 52155.025)

(EF101 and WC/PDB DI 52155.030)

This field will not be displayed if you are using ICF function #31.

Select (X) WC/PDB Records available for propagation.

The system will allow you to input an “X” next to any option that is available. If you can not place an “X” next to a record then the record does not exist for propagation. A Pre-adjudicate or Adjudicate record indicates the date they were created or “NIF”, if the record does not exist.

Your options include:

  • Pre-adjudicate record – a record that has been saved for future adjudication.

  • Adjudicate record – created by a prior claim or PE input.

  • T2 shared data.

  • No propagation.

NOTE: When you use propagated data, ICF will not consider any MBR changes or earnings changes that occurred after the prior datasheet was created.

Display Datasheet Query Menu for Print/View Options (Y/N)

This field is not required.

Enter a “Y”, if it is necessary to view prior datasheets before processing an action. A “Y” response bypasses the current screen and allows you to view or print prior records. Once the datasheet has been viewed, the WCPA screen is brought back into the path.

3. WCGI

MSOM ICFT2 031.006

The entries used on the WCGI screen dictates which screens will later appear in your path. Review all non-required fields carefully to determine if they apply. The (Y/N) fields that appear in white defaults to an “N” response if left blank.

Recomps after DIB Entitlement Start Date? (Y/N)

If “N”, a response is not required.

Indicate “Y”, if a recomputation is present on the MBR or to add a Recomp PIA. To determine if a Recomp has occurred, review the MBR for an increase in the PIA, effective with January of any year. For exceptions to a January effective date, see RS 00605.401B.1.

NOTE: A PIA decrease requires an OREO action.

Is Spouse Entitled? (Y/N)

Are Children Entitled? (Y/N)

Answer, “N” if a spouse or child(ren) are not involved

Answer, “Y” if a spouse or child (ren) have been entitled on the record, even if they are no longer entitled. The system will allow you to indicate the date of termination.

ACE Comp Needed? (Y/N)

The system needs an ACE to compute the offset. This information may have propagated. You have two options.

Answer “Y”. Let the system compute the ACE. You will need to enter the Divisor months. You must answer “Y” whenever there is a recomputation of the PIA.

Answer “N”. Enter the ACE and the Method.

NOTE: Unless you are certain the ACE you computed is correct, enter the divisor months and let the system compute the ACE.

Enter Original ACE 100%: 80%: Method

The calculated Ace and method used is located on the ACE line of the MBR or in MCS/EC. If you computed the ACE, you must also indicate the method used in the field below.

Enter dollar and cents amount in the 100% or 80% field, and

Indicate the Method used for the ACE computation.

High 1 (H1), High 5 (H5), AMW (AM)

This field is not completed if you choose to have ICF to compute the ACE.

NOTE: Useful Help screens available.

Divisor Months

This entry is mandatory if you answer “Y” to Ace Comp Needed. If you do not know the number of Divisor Months (DM) you can calculate them yourself or use the system to compute them.

NOTE: Divisor Months are used in the AMW ACE calculation so it is important that this number is correct.

  • System calculation

    1. If MCS/EC performed a computation then the Divisor Months will be shown on the PIA Calculation screen (DPIA) in the EC screen path.

    2. ICERS #23 from the Master File Query Menu (MFQM) can compute Divisor Months.

      1. Choose #4, Certified Earnings Record on the ICMN screen and press enter.

      2. Type the Date of Onset and Date of Filing on the ICIC screen and press enter.

      3. Choose “Y” to print a full record from the ICRS screen.

      4. The Divisor Months can be found in the Comp Data section at the end of your printout indicated by “DM: XXX”. Use the DM figure that was used for the PIA calculation in the OED.

    3. ICF function #24 may be the preferable method for cases involving multiple periods of disability. See MSOM ICFT2.024

  • Manual calculation - Use the divisor month help screen for an explanation of the manual calculation.

4. WCSP

MSOM ICFT2 031.009

All fields on the WCSP are found on the MBR. These fields might be propagated for you.

Delayed? (Y/N)

Delayed claimants are not common. They are included when dividing up the total base benefit payable to auxiliaries, but are not included in the Total Family Benefit until they are paid. If a Delayed Claimant exists, the HISTORY field for that claimant will show a Reason for Suspension or Termination (RFST) of DELYD.

Number of Credit Months

Credit Months can only apply if the spouse benefit is reduced for age. Credit Months are awarded for months, or partial months of non-payment. To determine if Credit Months apply, review the History segment of the MBR.

If all months are payable, then there are no Credit Months.

If there are months of non-payment see the link below to determine if Credit Months will apply.

See Requirements to earn Credit Months, RS 00615.482B.2.

5. WCCH

MSOM ICFT2 031.010

All fields on the WCCH are found on the MBR. These fields might be propagated for you.

Delayed? (Y/N)

Delayed claimants are not common. They are included when dividing up the total base benefit payable to auxiliaries, but are not included in the Total Family Benefit until they are paid. If a Delayed Claimant exists the HISTORY field for that claimant shows a Reason for Suspension or Termination (RFST) of DELYD.

6. WCCL

MSOM ICFT2 031.011

The WCCL screen allows you to input claim data for up to four separate WC claims.

Inj/Ill Date (MMDDYY)

The Injury/Illness is the injury date shown in the Workers’ Compensation/Public Disability claim. This is NOT necessarily the same as the DIB Date of Onset.

Type

Indicate the type of WC/PDB benefit received.

  1. (WC) Workers’ Compensation payments

    1. State WC

      WP = State WC payments

    2. Federal WC

      BL = Black Lung Benefits, Part C

      FC = Federal Employees Compensation Act

      HW = Longshore and Harbor Workers’ Compensation

  2. (PDB) Public Disability Benefits

    1. SG= State PDB only

    2. ML = Local PDB only

    3. FM = Federal PDB only

NOTE: Useful Help screens available.

Inj/Ill State

Input the two letter abbreviation for the state or political subdivision responsible for the WC payments. The field will be left blank for types BL, FC, FM, and HW.

NOTE: Useful Help screens available.

  • When the field is empty and “F1” is selected a list of valid state codes is provided.

  • When the field is completed with a valid state code and “F1” is selected, State specific instructions are provided.

Offset First Considered (MMYY)

This date is equal to the date that the NH was simultaneously entitled to both WC and DIB payments, with three exceptions.

  1. A break in offset exists due to a break in DIB entitlement or WC entitlement. (If a break in offset exists, use the first month that offset applies after the break.)

  2. There is more than one WC claim involving different injury dates.

  3. The input is for a complex case, such as a structured settlement.

NOTE: You cannot enter an OED prior to the injury date for the current claim.

NOTE: The “Start Date for Current Action” from the WCPA screen is often coded incorrectly as the “Offset First Considered” date on this screen. These dates may or may not be the same. For instructions on Start Date for Current Action, see DI 52165.010C.2. in this section.

Periodic Payments Involved?

Enter “Y” to bring the input screen into your path.

Lump Sum Payments Involved?

Enter “Y” to bring the input screen into your path.

7. WCCD – Claim Data

MSOM ICFT2 031.012

The WCCD screen requests additional information about each WC claim that is involved. If you have multiple WC claims, review the top portion of this screen to determine which WC claim you are processing.

WC/PDB Claim Pending? (Y/N)

“Y” indicates the Number Holder has filed for WC/PDB benefits and is waiting for a decision on the claim.

WC/PDB Appeal Pending? (Y/N)

“Y” indicates the Number Holder has already been awarded benefits, but has filed an appeal regarding the award.

Reverse Jurisdiction Involved? (Y/N)

If a Reverse Jurisdiction (RJ) or Reverse Offset agreement exists, the offset is performed by the State agency rather than SSA. This means that we pay the NH his or her full DIB and the State determines if any benefit adjustments are needed to the WC/PDB benefit.

ICF requires you to answer this question, if the State of injury has a Reverse Offset plan.

If you do not know whether Reverse Jurisdiction applies follow these steps:

  1. Consult the list of RJ States in DI 52105.001 or, leave the question blank and attempt to enter past the screen.

    • If you move to the next screen, Reverse Offset does not apply.

    • If you receive this message, “REVERSE JURISDICTION MAY APPLY, INDICATE IF RJ INVOLVED”, Proceed to step 2.

  2. You are working with a RJ State and need to determine if RJ applies for your input and how to code the input.

    • Refer to the procedures for your State, as they vary from state-to-state. For State specific POMS procedures, see DI 52120.001 and for PDB State specific procedures, see DI 52135.000.

    • Complete the start and/or stop date fields, using the State specific procedures and the instructions below.

    • If all WC ends and will be offset prior to the RJ Start date (periodic payments or a prorated lump sum), complete the field with an “N”. Answering “Y” may cause incorrect results.

If Yes,

Start (MM/YY)

The start date is the month that SSA will no longer reduce the NH’s benefit. SSA will pay the NH his or her full DIB.

NOTE: Review your payment output screens: The NH’s payment should not be reduced effective with the RJ start date month.

Stop (MM/YY)

The stop date is the month before the month that SSA begins to offset the NH’s benefit, after a period of Reverse Offset. You are not required to answer this question unless the State procedures require SSA to re-impose offset.

EXAMPLE: For Florida, RJ starts with the month of adjudication and ends with the month the NH attains age 62. If the NH attains age 62 in 03/2008, then we must input a stop date = 02/2008. Based on this, ICF will apply offset to the NH’s benefits effective with 03/2008 (the month of age 62 attainment).

Are Gross Amount Excludable Expenses from Periodic Payments Involved? (Y/N)

This field is not required. An answer of “Y” will cause the WCEE screen to come into the path. Excludable expenses for periodic payments can be coded on the WCEE or the WCPP screen.

  • If expenses are paid periodically corresponding to the periodic payments, answer “N” to this field or leave it blank. Enter the expenses on the WCPP screen.

  • It may be desirable to code the expenses on the WCPP screen, rather than the WCEE screen, due to the limitations of the WCEE screen.

  • However, if expenses are attributable to the first month of offset or a specific month of offset, it may be desirable to answer “Y” and code the expenses on the WCEE screen.

8. WCEE – Periodic Payment Excludable Expenses

MSOM ICFT2 031.013

Use caution on this screen. Expenses coded on the WCEE screen should not be coded on the WCPP screen. For additional cautions regarding excludable expense inputs, see DI 52150.050H.

The individual field inputs are self-explanatory, but it is important to understand the way in which the WCEE screen treats the expenses entered.

  • The WCEE is used for one-time expense deductions. The expense is excluded in a manner similar to a Method A Lump Sum proration. The system fully excludes the WC payments until the entire expense is accounted for.

    EXAMPLE: $1000 monthly WC. $8500 expense. The system excludes $1000 for the first 8 months and then $500 in the 9th month.

  • A start date is required. The system ignores the day and treats the expenses as if they start on the first of the month.

  • There is no need to code a stop date because it will be ignored by the system.

  • The expenses entered are fully deducted from the WC/PDB periodic payment amount until all of the expenses have been excluded.

9. WCPP – Periodic Payments

MSOM ICFT2 031.014

The WCPP screen allows you to code data for periodic payments. Start and Stop dates are day specific. The system automatically prorates any partial months of WC/PDB payments to calculate the monthly amount needed for offset. Most fields are self-explanatory and additional information is found in MSOM.

NOTE: Use caution on this screen. DO NOT code expenses on the WCPP screen to the WCEE screen. For additional expense cautions, see DI 52150.050G. and DI 52150.050H.

  • Avoid errors

    The values entered in “Periodic Payment Amount”, “Frequency”, and “Ongoing Expenses” need to correspond to one another. For instance, if you enter a frequency of weekly and enter the “Periodic Payment Amount” as a monthly dollar value your results will be incorrect.

  • Periods of non-payment

    The system will require you to code data for every day between the first and the last WC/PDB payment. If there is a portion of time prior to the last payment when WC/PDB benefits were not paid you need to enter $0.00 as the payment amount during that period.

  • Useful Help screens available

    For further discussion regarding entering excludable periodic expenses, see NEPSC WC Info Page (Select links for “Systems Issues” under the heading “Links to the WC Refresher Training Student Materials”).

10. WCLS – Lump Sum Award Data

MSOM ICFT2 031.015

The WCLS screen allows you to code data for a lump sum award. If expenses are involved, the system calculates and determines the most advantageous method of proration, using Method A, Method B, and Method C. You have the option to override the proration method if you disagree with the option selected by the system. If you override the system’s derived proration method, the basis for that decision must be annotated to the remarks screen, per DI 52150.060F.

NOTE: A large payment does not necessarily represent a lump sum. If a WC/PDB payment is made that represents back pay for prior periodic payments do not treat the payment as a lump sum. See DI 52150.035A.5. for more complete information. Enter these payments on the WCPP screen.

Useful links:

Lump Sum Start

  • Determining the correct start date can be complicated. Review the help screens to determine the correct start date. For more detailed information regarding the lump sum start date, see DI 52150.060D.2.

  • Useful Help screens available

Gross

Enter the total amount of the lump sum prior to any deduction for expenses.

Proof? (Y/N)

  • If “Y” is not coded, the lump sum information is ignored by the system and is not included in the offset computation.

  • Useful Help screens available.

Rate

     

Frequency

We consider offset for a Lump Sum, as if it will be distributed in periodic payments over an extended period of time. Use Rate and Frequency to specify the amount of money that will be offset each month.

  • Rate is the dollar value of the payment we count.

  • Frequency represents how often (monthly, weekly, etc) that the “Rate” is paid.

  • Useful Help screens available.

  • (Lump sum proration rate, see DI 52150.060E.3.

Excludable Expenses

            

Proof? (Y/N)

Input any expenses that can be excluded from the NH’s WC/PDB payment.

  • The system will calculate all three proration methods and display them for you later in the screen path.

  • “Y” must be coded in the proof column for the expenses to be included in the offset computation. The system ignores the expenses if proof is not received.

  • Useful Help screens available.

  • For excludable expenses, see DI 52150.050.

Amounts to be Deducted from Gross

This field is only for amounts intended to be deducted from the gross lump sum amount before the LS is prorated. This is not an excludable expense. Special deductions from a LS should be rare, and either specifically authorized in POMS or approved by a policy expert.

11. WCDE – Computational Earnings

MSOM ICFT2 031.017

The WCDE propagates earnings from the NH’s earnings record. You can overkey or add data if necessary. Changes made on this screen only affect your WC/PDB computation. This information will not update other SSA records.

Change the data in the following situations:

  • The NH has earnings over the statutory maximum (Maximum SSA taxable amount). These earnings will affect the High 1 and High 5 Ace computations.

  • Posted earnings are incorrect or missing. If earnings are missing or incorrect, verify that the PIA is correct.

NOTE: Earnings will be displayed in red for post-1977 years that show maximum FICA earnings. Check these earnings against the DEQY to determine if they are correct. For pre-1978 maximum earnings see DI 52170.035 for more information.

References

12. WCAC – ACE DATA

MSOM ICFT2 032.003

The WCAC screen displays computational information regarding the ACE. Review the information to determine if the figures are reasonable. You can not enter any information on this page, but you can access the help screens for most of the fields.

13. WCWE – Lump Sum Proration Expenses Involved

MSOM ICFT2 036.004

When a lump sum (LS) has excludable expenses, the WCWE screen comes into the path. The system displays the computation for all three LS methods and selects the method it determines is the most advantageous. If the amounts are equal, the selection defaults to method A.

The system calculates the most advantageous method without consideration for future events that may affect the proration. The following are examples of events occurring during the period of lump sum proration which may require you to override the method selected by system:

  • future termination of an auxiliary’s benefits

  • NH turns age 62

  • triennial redetermination

  • terminal illness may cause method A to be advantageous

If you choose a proration method different from the system determination, document your reason on the Remarks screen.

NOTE: Help screens are available.

14. WCGO – General Offset Data

MSOM ICFT2 032.006

The WCGO screen lists general offset information. Review the screen for accuracy.

  • “Account WC/PDB Data” at the top of the screen describes the effective and termination dates for the entire record.

  • “Individual WC/PDB Offset Data” at the bottom of the screen describes the start and stop dates of the offset as it affects each individual on the record. When multiple start and stop dates are involved only the most recent dates will be shown.

15. WCAO – Account Data

MSOM ICFT2 032.007

The WCAO displays a timeline of changes for the WC/PDB offset calculation. A separate line displays for any period that has a change in “Total Family Benefits”, “WC Only Amount”, and “Combined WC/PDB Amt”.

Before entering the next screen:

  • Review the changes from one line to the next.

  • Determine that each change is correct.

16. WCPO – PIC Offset Data

MSOM ICFT2 032.008

The WCPO screen displays changes as they affect each individual beneficiary on the record.

Before entering the next screen:

  • Review the amount of the “Combined Offset Amt” and the “Amt Payable After Offset” for each claimant.

  • Look over your results, checking to see if they seem reasonable. If you were expecting different results you may need to review some of the prior input screens.

  • Print this screen for reference. It will be helpful when you begin to prepare the claimant’s notice at the end of the screen path.

17. WCNM – Notice Menu

MSOM ICFT2 033.002

The WCNM screen is the first screen that addresses creating a notice.

  • For a pre-adjudicate action, you can bypass the notice coding.

  • For an adjudicate action, you must code additional information about the notice on the next screen (WCEP).

18. WCEP – Enclosure Notice Block

MSOM ICFT2 033.003

The WCEP screen allows you to prepare the notice for action. See ICF notices in DI 52165.030.

a. ICF notice data

The CR/CA/CTE is required to create the notice data for any WC/PDB ICF adjudicate input, regardless of whether it is a PE input, A101, or EF101.

b. Coding an ICF notice

Code the notice in the ENB field. The help screens in this section describe the necessary formatting for the ENB field.

Your options include:

  • Create a dictated paragraph

    A dictated paragraph is an explanation in your own words that describes the changes in the claimant’s benefits. It is preferable that the CR in the field office use this method of notice preparation due to their limited experience using MADCAP paragraphs.

    1. Type “C*AAA031”. This tells the system that you will produce a complete notice (C*) and you will insert dictated language (AAA031).

      NOTE: The ENB field should look like this – ENB: C*AAA031.

    2. Prepare the notice per instructions in DI 52165.030C.

  • Construct a table or chart

    To also insert a chart or table into the dictated notice to explain benefits (e.g. paid vs payable) use TBL019.

    NOTE: The ENB field should look like this – ENB: C*AAA031*TBL019.

  • Use WCP Paragraphs to Create a Notice

    For instructions when coding a notice in ICF using WCP paragraphs, see DI 52165.030.

    For cases involving an A101 or EF101, include in the ICF ENB any required non-WC/PDB claims paragraphs as well as all required WC/PDB “WCP” paragraphs (in this situation, code the paragraphs in the ICF ENB, not the A101/EF101 ENB. See DI 52155.035 – Initial Determination Workers’ Compensation/Public Disability Benefit (PDB) Notices.

c. When a notice is not created

  1. If the action taken does not require a notice, code the ENB field with “N”.

  2. If the PC needs to prepare a manual notice outside of the system because of space limitations on the Dictated Notice Language screen, code the ENB field with D.

d. References

19. WCAR – WC/PDB offset remarks screen

MSOM ICFT2 034.002

Remarks

Remarks displayed in this screen are informational only. Based on the remarks, you should decide what actions are necessary. For example, prepare a diary if the remark states that offset should be removed when the NH attains 62.

20. WCDA – Adjudicate WC/PDB Claim 4

MSOM ICFT2 034.004

On the WCDA screen, decide whether to process the action or save the action and process it in the future. Check for program limitations in DI 52165.020A.1. before adjudicating ICF #32.

NOTE: If Civil Service Public Disability Benefits are involved, see DI 52130.001 – Types of Federal Public Disability Benefit (PDB) Payments.

Adjudicate WC/PDB Claim? (Y/N)

“Y”

  • Post Entitlement input will transmit and attempt to effectuate the changes on the MBR.

  • A101 or EF101 input will save the WC/PDB data to be used by the PC when processing the award.

  • The datasheet will be locked and you will not be able to update it for two workdays.

“N”

Typing “N” will cancel the adjudicate action. Type “Y” in the following field to save as a pre-adjudicate record for future propagation. If you choose not to adjudicate the claim and fail to save the record as a pre-adjudicate record, all of the information will be discarded.

Special Instructions

Use this field to give additional information regarding your input. Examples include,

  • Input additional claim numbers for States that have both carrier and State claim numbers

  • Inform others where the documentation supporting your action has been stored.

  • If specifically required by POMS, such as when you used the LS Method A/B/C override or when you need to identify the system exception or limitation that required you to use OREO.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0452165010
DI 52165.010 - How to Complete the Workers' Compensation/Public Disability Benefits (WC/PDB) Interactive Computations Facility (ICF) Screens - 08/08/2012
Batch run: 08/08/2012
Rev:08/08/2012