TN 56 (09-93)

SI 00830.235 Workers' Compensation

Citations:

Social Security Act as amended, section 1612(a)(2)(B);

20 CFR 416.1121(a), 416.1123(b)(3)

A. Introduction

Workers' compensation (WC) payments are awarded to an injured employee or his /her survivor(s) under Federal and State WC laws, such as the Longshoremen and Harbor Workers' Compensation Act. The payments may be made by a Federal or State agency, an insurance company, or an employer.

B. Policy

1. Income

a. General

The WC payment less any expenses incurred in getting the payment is unearned income.

b. Amounts Designated for Expenses by Authorizing or Paying Agency

Any portion of a WC award or payment that the authorizing or paying agency designates for medical expenses or legal or other expenses attributable to obtaining the WC award is not income (SI 00830.100). The expenses may be past, current, or future. The WC payments designated for such expenses may be received in a lump sum or as a continuing payment.

c. Other Amounts Claimed for Expenses

If an individual alleges having incurred expenses that exceed amounts designated for expenses as in b. above, or for which no amount was designated, the normal rules pertaining to the expenses of obtaining income apply (see SI 00830.100).

2. Resources

There is no resource exclusion that applies specifically to WC payments that have been deducted from income under b. or c. above. Normal resource rules apply to WC payments retained after the month of receipt.

C. Procedure

1. Checking for Possible WC Overpayment Withholding

Ask if any WC benefits are being withheld to recover an overpayment. If yes, see SI 00830.110.

2. Verifying WC Payments

If possible, use an award notice to verify WC payments. If such a notice is not available, use Form SSA-1709 (Request for Workers' Compensation Public Disability Benefit Information) to obtain information from the Federal or State agency, insurance company, or employer. (The address of the local Federal Employee's Compensation agency or the State Workers' Compensation Office should be in the local phone directory.)

3. Verifying Amounts Designated by Authorizing or Paying Agency

If the WC award notice includes monies designated for expenses listed in B.l.b. above, but does not specify the amount designated, contact the paying agency (i.e., the Federal or State agency, insurance company, or employer) to verify the amount of the WC award that is designated for such expenses.

4. Verifying Other Amounts Claimed for Expenses

Follow the instructions in SI 00830.100 C. to verify expenses that exceed the designated amounts or for which no amounts are designated.

5. Reopening Prior Determinations

a. Reopening

If a case comes to your attention where SSA previously counted as income any portion of a WC payment designated for any of the expenses listed in B.1.b. above, reopen and revise the earliest determination possible under the rules of administrative finality, unless there has been a subsequent decision by an ALJ or the AC on that issue.

Use the 2-year reopening rule, treating the determination as an error on the face of the evidence. Count the 2-year retroactive reopening period beginning with the date the error is brought to SSA's attention. (See SI 04070.010 to determine the date the error was brought to SSA's attention.)

b. Notices

If revising a prior determination results in an underpayment due:

  • Send the individual the manual notice (SSA-L8165) in E. below, then

  • Allow the automated notice to be released.

Fill in the following information on the notice prior to mailing it.

  • Office address

  • Office hours

  • Date

  • Claim number

  • Name and address

  • Field office manager's name and title

Also, see additional fill-ins in the body of the notice.

D. References

E. EXHIBIT

Form Letter to Precede Automated Notice — WC Income Amount Changes Because of
Tennant Court Case

 

SOCIAL SECURITY ADMINISTRATION

SUPPLEMENTAL SECURITY INCOME

IMPORTANT INFORMATION

 Office Address:
 Office Hours:
 Date:
 Claim Number:

 

Name

Address

City/State/Zip Code

 

We looked at your Supplemental Security Income (SSI) case again to see if we owe you money because of the Tennant court case. This case is about how we figure SSI eligibility and payment amount for some people who receive or did receive workers' compensation (WC) payments that include money paid to you for past, current, or future expenses related to the WC claim.

Our review showed that we had counted as unearned income the part of your WC payments that was paid to you for expenses related to your claim. Therefore, we refigured your SSI eligibility and payment amount without counting this income and found you are due   (1)   .

Because you are due   (2)   , we are sending you another letter soon telling you:

  • how much SSI you will get and for what months;

  • when to expect your SSI money;

  • the new amount of the WC benefit which we used to figure your SSI; and

  • what to do if you disagree with our decision about the amount we owe you.

     

SSA-L8165

 
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IF YOU HAVE ANY QUESTIONS

If you have any questions, you may call, write, or visit any Social Security office. If you call or visit our office, please have this letter with you and ask for   (3)   . The telephone number is (xxx) xxx-xxxx.

Also, if you plan to visit an office, you may call ahead to make an appointment. This will help us serve you more quickly when you arrive at the office.

  
 Manager's Name
Title
Fill-ins 
  
  1. Choice 1: SSI money

    Choice 2: more SSI money

     

  2. Choice 1: SSI money

    Choice 2: more SSI money

     

  3. Name of contact person

 

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0500830235
SI 00830.235 - Workers' Compensation - 06/18/2012
Batch run: 06/18/2012
Rev:06/18/2012