PROGRAM OPERATIONS MANUAL SYSTEMPart DI – Disability InsuranceChapter 521 – Workers' Compensation/Public Disability Benefit (WC/PDB) OffsetSubchapter 70 – Manual Computations for Workers' Compensation/Public Disability Benefit (WC/PDB) OffsetTransmittal No. 2, 06/05/2020
This is a Quick Action Transmittal (QAT). These revisions do not change or introduce new policy or procedure. They are minor changes for increase clarity in the instructions to complete the subject form.
Summary of Changes
DI 52170.010 Form SSA-2455 (Offset Worksheet-Disability Insurance Benefits)
E. Completing the SSA-2455
E.2.b. - added "for which the computation is applicable."
E.2.d. - added "in the first possible month of offset,"
E.2.e.. - added "Do not enter an amount less than zero."
Use the SSA-2455 to compute the amount of workers’ compensation/public disability benefits (WC/PDB) offset. You may use the e2455+, a new tool for calculating amounts payable after WC/PDB offset, instead of the paper Form SSA-2455. The e2455+ can propagate offset rates into OREO (see DI 52165.020).
Complete a paper SSA-2455 only when you cannot use an Interactive Computations Facility (ICF) program or e2455+ due to systems limitations. For more information, see DI 52145.015 – Retention of Workers’ Compensation/Public Disability Benefits (WC/PDB) Proofs.
Click here for an example.
If the SSA-2455 cannot be stored or recorded in the Modernized Claims System (MCS), Modernized SSI Claims System (MSSICS), or the ICF, fax the form into the Non-Disability Repository for Evidentiary Documents (NDRED) or the electronic disability (eDIB) folder, as appropriate.
NOTE: If processing center (PC) action is required, the FO will also fax the form to the PC’s paperless fax number.
Prepare a separate SSA-2455 for each month there is a change in the following:
Total family benefits (TFB)
Average current earnings (ACE).
EXCEPTION : Use Form SSA-2454 in DI 52170.020 for WC/PDB rate changes occurring after a triennial redetermination.
Enter the worker’s Social Security number on each SSA-2455.
Enter the period of time for which the computation is applicable, (e.g., 06/1995 – 05/1997, 07/1996 only, 06/1998 on).
Enter the DIB month of entitlement (MOET).
Enter the first month offset was considered or imposed, whichever is earlier. For more information, see DI 52150.020 – Workers’ Compensation/Public Disability Benefits (WC/PDB) Offset Effective Date (OED).
Enter each beneficiary's benefit amount in the first possible month of offset. Add all the benefit amounts and enter the sum for the TFB. For more information, see DI 52150.005 – Total Family Benefits (TFB).
Enter the 100 percent ACE rounded down to the nearest dollar. Use unindexed covered earnings. Check the appropriate block to identify the highest ACE. Show the year and earnings used if a High-1 ACE is used. For information on ACE, see DI 52150.010 – Average Current Earnings (ACE).
NOTE: The ACE shown on the MCS Remarks screen is the 80 percent ACE.
Multiply the 100 percent ACE by 0.8.
This part of the form establishes a base rate for all beneficiaries. The total Social Security disability benefits payable in the first month of offset plus the monthly WC/PDB cannot exceed the applicable limit (the higher of the 80 percent ACE or TFB (total family benefits).
Subtract the monthly WC/PDB from the applicable limit to find the total benefits payable to the family in the first possible month of offset.
Pay the number holder first and any excess is distributed among the auxiliaries.
Enter the highest of the TFB or the 80 percent ACE. For determining the applicable limit, see DI
Enter the monthly WC/PDB rate for which the computation is applicable. Round the monthly amount down to the next lower dime. Indicate if the amount has been verified (by checking the verified block). (For example, $578.58 would be rounded down to $578.50.) If not verified, obtain verification. See DI 52150.035 - Determining the WC/PDB Amount.
Subtract the monthly WC/PDB from the applicable limit and enter the amount. Do not enter an amount less than zero.
If this amount is equal to or higher than the number holder's monthly benefit amount (MBA), the number holder receives the full MBA.
If this amount is higher than the TFB, do not offset and do not complete the rest of the form. Annotate the MBR with the OFT code OP (Offset Postponed).
If this amount is less than the number holder's MBA, this is the amount payable to the number holder in the first possible month of offset. (i.e., total offset applies to the auxiliaries.)
Enter the PIA in the first possible month of offset, unless reduced for age. If so, enter the reduced DIB.
Subtract the number holder’s MBA (Part 2 D.) from the total benefits after offset (Part 2 C.) and enter the amount. Do not enter an amount less than zero.
Enter the number of auxiliaries entitled for the months shown in the period covered by the worksheet, including delayed auxiliaries and any auxiliary whose payment is marked “Do Not Certify”. (This will protect the benefits payable to auxiliaries not yet certified for payment.) NOTE: Recalculate the offset whenever there is a change in the number of auxiliaries.
Divide the amount payable to auxiliaries (Part 2 E.) by the number of auxiliaries (Part 2 F.), if the auxiliaries' benefit amounts before offset are equal. See DI 52170.025 - Rounding Rules for Offset Computations.
Distribute this amount proportionately if the auxiliaries' benefit amounts before offset (i.e., amounts used in the TFB) are not equal, (e.g., a reduced or dually-entitled spouse and 3 children or an HB6 or an HB9 is involved).
Apply the following formula to distribute the amounts payable after offset:
Benefits payable to all auxiliaries after offset (Part 2 E.);
Multiplied by the auxiliary benefits before offset; then
Divided by the total of the auxiliary amounts used to compute TFB.
1. Total benefits payable to all auxiliaries after offset = $150.00
2. HB MBA = $120.00
HC1 MBA = $160.00
3. Total Auxiliary benefits used to compute TFB = $280.00
HB $150.00 X $120.00 = $64.20 (rounded down - MOE after 6/82)
HC1 $150.00 X $160.00 = $85.70
Enter the auxiliaries symbols (BICs).
Enter the month and year of each increase.
Enter each increase that is effective after the first possible month of offset.
Show the number holder's increase under “HA”.
If the auxiliaries' increases are equal, use one column to show the auxiliary rates. For example, if the BICs on record are HA, C1, C2 and C3, label one column HA and label one column C1, C2, C3. NOTE: Do not combine the auxiliary amounts.
Use the remaining columns if the auxiliaries' increases are not equal.
NOTE: Protected increases are increases that are not subject to offset by a recomputation or SSA cost-of-living increase. See DI 52150.055 to determine protected increases.
Enter the amount payable after offset to the number holder (from Part 2 C. or 2 D.) and to each auxiliary (from Part 2 G.).
Add each column.
Sign and date the form. Then, scan or fax into the claims folder.
Use the reverse side of the SSA-2455 to manually prorate a lump sum settlement and to document calculations involving mid-month WC/PDB rate changes. See manual proration instructions for SSA-2455 in DI 52170.030.