If one or more auxiliaries are entitled on or before the first possible month of offset, and another auxiliary is subsequently entitled in a later month, the newly awarded auxiliary is entitled to share in any protected increases as if they were entitled in the first possible month of offset.

Protected increases in a prior period of DIB are not protected for a subsequent period of DIB. In such cases, compute offset for the new period of DIB as if it were an initial DIB claim; i.e., compute a new average current earnings (ACE) and total family benefits (TFB). This applies even if the new period of DIB begins the month after the prior period of DIB ends.

For expedited reinstatement (EXR) cases, see the “NOTE” in DI 52150.055C.2. in this section and DI 52160.001 - Expedited Reinstatements with WC/PDB.

Benefit increases that result from a recalculation of the primary insurance amount (PIA), a recomputation of the PIA, or a combined family maximum (CFM) are protected only if the increase is effective at least one month after the first possible month of offset. If the increase is effective retroactive to the first possible month of offset or earlier, recompute offset from the first possible month of offset.

A break in WC/PDB entitlement means the wage earner is not entitled to receive WC or PDB for a period of at least one month and, therefore, we must remove offset for the period of non-entitlement to WC or PDB.

Example:

• •

  A number holder (NH) has an industrial accident on 08/13/2006 that results in temporary total (TT) disability payments.

• •

  TT stops 07/23/2007 because the NH medically improves and returns to work on 07/24/2007. WC entitlement (based on the 08/03/2006 injury) ceases.

• •

  The NH suffers another on-the-job injury on 09/01/2007 and receives a new and separate WC award based on the new injury.

• •

  A new Offset First Considered date is established and offset is imposed again based on the new WC entitlement/award.

A break in WC/PDB offset (e.g., beneficiaries may be in and out of offset) can occur even when the number holder’s entitlement to WC/PDB is continuous. The following situations can result in a break in WC/PDB offset, but WC/PDB entitlement is continuous:

• •

  A break in WC/PDB payment occurs, and all payments are based on the same injury or illness (e.g., an interruption in WC/PDB payment pending a permanent disability rating, not because of a new and separate WC/PDB award). See DI 52150.055C.3. in this section.

• •

  The WC/PDB rate changes to a lower amount.

• •

  Excludable expenses preclude offset for at least one month.

• •

  A high ACE applies at least one month after the first possible month of offset.

• •

  Reverse offset applies at least one month after the DIB MOET and offset is later reimposed (for example, certain States' reverse offset ends at age 62 and DIB is then subject to offset at age 62 attainment). For breaks in WC/PDB offset due to reverse offset, see DI 52105.001.

EXAMPLE: The NH’s temporary WC payments stop pending a permanent disability rating for that injury/illness, (i.e., additional payments are contemplated). Offset is removed. WC payments later resume at a lower permanent rate that does not cause offset. The WC permanent rate increases and offset is re-imposed.

NOTE: T8 months constitute a break in offset except in expedited reinstatement (EXR) cases when, in rare instances, the T8 month equals the month of entitlement (MOET) of the EXR. As an example, the first DIB line on the MBR is a T8 benefit termination month (BTM) of 11/2004 (first month benefits are not payable for this period of disability), the second DIB line (for the EXR period) shows a disability award code (DAC) of “F”, and benefits are payable 11/2004 (EXR MOET of 11/2004).

A break in WC/PDB payment can occur when WC/PDB payments are based on one injury/illness claim. A break in WC/PDB payment results in a break in offset.

Example - break (interruption) in WC payments:

• •

  The number holder (NH) has an industrial accident in 2007, which results in temporary total (TT) disability payments.

• •

  The NH had a pre-existing medical condition not involving a work-related injury or illness.

• •

  TT stops November 23, 2008 because the carrier alleges any ongoing disability is not the result of the industrial accident. We remove offset.

• •

  The NH appeals the WC decision and WC payments begin again, effective with the date of the decision.

• •

  Offset is re-imposed effective with the date WC payments begin again.

• •

  There is an interruption in WC benefits for the same injury. The Offset First Considered date remains the same.

NOTE: Determining whether an interruption of WC/PDB payments is due to a break in WC/PDB entitlement or whether additional payments are contemplated depends upon the laws, regulations, policies, and procedures of individual States, and they vary from State to State (For State-specific WC procedures, see DI 52120.001 and for State-specific PDB procedures, see DI 52135.001). If WC/PDB entitlement is continuous, even though WC/PDB payments are stopped and resumed, increases are protected.

Because the TFB is higher than the 80%ACE, use the TFB amount to calculate offset (i.e., the TFB is the controlling factor when computing offset).

Because HA's MBA is not offset, they receive the full increase and their rate payable effective 12/2007 is $936.90. Each auxiliary receives $23.10 in 12/2007 after offset ($19.60 12/2006 + $3.50 12/2007 increase).

 

In 01/2008, HC3 becomes entitled and shares in the protected increase. To calculate the rate payable after offset in 01/2008:

HA is still not offset. Each of the four auxiliaries receives $17.30 after offset effective 01/2008 ($14.60 12/2006 + $2.70 12/2007 protected increase for four auxiliaries).

NOTE: If the ACE was the applicable limit in computing offset (rather than the TFB), the expedient in DI 52150.070C. can be used.

Compute the spouse's protected increases as though they were entitled in the first month of offset (02/2003). Assume total offset for the HB in 02/2003 (because HA is in partial offset effective 02/2003). Their benefit payable after offset in 12/2007 (their MOET) is $25.10, the amount of the protected increases from the first possible month of offset (02/2003) through their HB MOET (12/2007). (Assume the January 2006 triennial redetermination of the ACE did not yield an increase.)

Determine the amount payable to HB effective 12/2007 by calculating the protected increases as follows:

When computing the protected increases for a spouse entitled to a benefit reduced for age, use the same reduction factor (RF) for the first possible month of offset as the RF applicable for the spouse’s actual month of entitlement.

In Example #2 above, if HB is entitled in 12/2007 with a RF of 24, use the same RF of 24 in determining their fictitious MBA effective 02/2003 (the first possible month of offset). MBAs retroactive to 02/2003 are needed to establish all protected increases from the first possible month of offset to their actual HB MOET (12/2007), thereby determining the HB amount payable after offset effective 12/2007.

NOTE: The interactive computation facility (ICF) programs #31 and #32 cannot calculate offset for dual entitlement or technical entitlement situations. These computations must be done manually and input via OREO.

A spouse (HB) is entitled on their spouse's SSN effective 11/2003 (four years after their spouse's DIB MOET of 11/1999) and the HB is subject to WC offset on the spouse's DIB account. The HB is also entitled to retirement benefits on their own SSN effective 11/2003:

In this dual entitlement example, HB/A benefits must be reduced for age. The reduction factor (RF) for their RIB and spouse's benefit is 43 based on their age and MOET. Take into consideration any fictitious or actual REDETS that may apply.

When computing offset for HB, determine all protected benefit increases as though HB is entitled effective with the first possible month of offset (11/1999), and compute the “fictitious” MBAs for 11/1999-10/2003 (since HB isn’t really entitled until 11/2003) using the same RF (43). If HB was actually entitled in 1999, their ELY would be 1999. Therefore, the special 07/2001 COLA is included in their protected increases.

NOTE: ICF programs #31 and #32 cannot calculate a monthly benefit amount based on an RF of 43. To compute the reduced spouse’s rate effective 11/2003, use the WNPSC Tools Rate Computations - Click here.

You must de-convert the 11/2003 HB MBA (and their own RIB PIA) back to the first possible month of offset (11/1999). To determine HB’s protected increases for 12/2003 and 12/03, ICF de-converts the 11/2003 RIB PIA of $300.00 (based on an ELY of 1999) as follows:

 

The protected increases for 11/2003 and 12/2003 are calculated as follows:

 

To figure their protected increases effective with the 01/2004 PIA Recomp, ICF deconverts the 01/2004 RIB PIA of $314.00 (based on an ELY of 1999) as follows:

 

The protected increases effective 01/2004 are calculated as follows:

• •

  The WC monthly amount of $375.00 effective 11/1999 remains unchanged.

• •

  The spouse is not offset:

  ACE $1350.00 - $375.00 monthly WC = $975.00 payable after offset

  $975.00 payable - DIB PIA $950.00 11/1999 = $25.00 remainder (payable to HB)

• •

  Their total protected increases for 11/1999-11/2003 ($15.20) are added to the $25.00 remainder to compute the amount payable after offset for HB effective 11/2003 ($40.20), their date of entitlement to spouse’s benefits.

• •

  The protected increase for 12/2003 ($3.40) is added to compute the amount payable after offset to HB effective 12/2003 ($ 43.60).

• •

  The total protected increases for 11/1999-01/2004 ($18.00) are added to the $25.00 remainder to compute the amount payable after offset to HB effective 01/2004 ($ 43.00). (The 01/2004 recomputation increase in their own RIB PIA results in a lower amount payable after offset as a spouse (HB) effective 01/2004.)

HA entitled 07/1999; PIA 885.20, FMAX = 1327.80D

 

No recomps apply in this case.

 

100% ACE = 2388.00

 80% ACE = 1910.40

 

TFB will remain lower than 80% ACE for the entire entitlement period

 

WC Received = 340.57 Weekly (= 1475.80 per month)

 

HA will receive 434.60 after offset in 7/1999.

Protected increases are added in 12/1999, 12/2000, 07/2001, 12/2001;

MBA after offset in 12/01 is 512.80

 

Triennial redetermination in 01/2002 raised the 80% ACE to 2128.00; the redetermined HA rate was 652.20.

 

In 09/2002, HA's PIA is 963.40, and the table maximum is 1445.10D.

B2 and C1 become entitled. B2 is also entitled to their own HA, at a PIA of 465.30; a combined maximum of 1910.40 becomes effective.

 

The family rates are figured as if B2 and C1 were always entitled, but using the table maximum. The increase due to the combined maximum is treated as a protected increase:

 

To determine protected increases for B2 and C1 as of 01/02, we re-work the original 07/99 offset comp:

- HC1 benefit (adjusted for DMAX) = 221.30

- B2 is technically entitled, so that their LEMBA is effectively zero.

 

 

Protected increases to C1 total 19.50 due to COLA increases through 12/01.

 

B2 is still technically entitled, so they get no protected increases.

 

A's redetermined rate is 632.40, and C1 remains with the protected increases of 19.50.

 

The increase due to the CMAX is then treated as a protected increase:

 

 

 

We then deal with Parisi: