Do not offset if the WC/PDB is paid directly to the employer by the WC/PDB payer or turned over to the employer by the individual. Offset cannot be imposed while the worker does not actually have use of the WC/PDB payment. If only part of the WC/PDB is reimbursed to the employer, offset the portion received by the worker.

EXAMPLE 1: All WC paid to employer

A construction company pays weekly payments to injured workers and keeps their medical insurance active. When WC claims are approved, the weekly WC payments are paid directly to the employer. No offset applies because the employees do not receive the WC.

EXAMPLE 2: Employee has use of a portion of WC

The construction company in EXAMPLE 1 pays injured workers a maximum of $500 per week. When a welder receives the state maximum WC of $650, the employer holds back $500 and pays the welder $150. Since the welder has use of the $150 per week, that amount is offsettable.

If the NH has use of the WC/PDB, but entitlement to the WC/PDB payments causes a reduction in the payments from the employer, offset the full amount of the WC/PDB. This is not a reimbursement arrangement.

EXAMPLE: Bill receives weekly long term disability payments of $600 from an employer while their WC claim is pending. This is paid directly to Bill. When the WC claim is approved, Bill begins to receive $400 per week in WC, paid directly to them. The employer then reduces the temporary disability to $200 per week because Bill now receives WC. SSA offsets the entire $400 weekly WC payments.

Take the following actions to document WC/PDB:

1. 1. 

   Verify the WC/PDB amount.

2. 2. 

   Obtain proof of the amount of WC/PDB paid directly to or turned over to the employer.

To apply offset in initial claims situations:

1. 1. 

   Input the WC/PDB claim information (but not payment information) into the Modernized Claims System (MCS) or the Interactive Computation Facility (ICF) and show the claim as pending.

2. 2. 

   Annotate the WC payment amount and the relevant facts in Remarks in MCS or ICF and as a Special Message on the master beneficiary record (MBR).

3. 3. 

   Offset any portion of the WC/PDB payments that the individual has use of.

4. 4. 

   Develop the date the payments will no longer be turned over or paid to the employer.

5. 5. 

   Set an MCS diary for the processing center (PC) to recontact.

6. 6. 

   Advise the individual to notify SSA of any changes to the WC/PDB or the employer plan.

The PC will take the following actions:

Develop for any changes to the WC/PDB.

Verify that the employer no longer receives any of the WC/PDB.

If WC/PDB still paid to employer, develop an ending date. Set a diary for re-contact.

Offset any WC/PDB that the individual does not turn over to the employer.

Take the following actions when WC/PDB is paid directly to the employer:

1. 1. 

   Verify the WC/PDB amount via direct contact.

2. 2. 

   Contact the WC/PDB payer or the employer to verify the amount of WC/PDB paid to the employer.

3. 3. 

   Offset any WC/PDB that the individual is allowed to keep. If all WC/PDB is paid to the employer, do not enter WC/PDB into ICF.

4. 4. 

   Develop the date the payments will no longer be turned over or paid to the employer and set a diary for re-contact.

Take the following actions when WC/PDB is no longer paid to the employer:

1. 1. 

   Develop for any changes to the WC/PDB.

2. 2. 

   Verify that the employer no longer receives any of the WC/PDB.

3. 3. 

   Impose offset via ICF beginning with the first month the NH is allowed to keep any of the WC/PDB, unless the NH became disabled prior to 03/01/1981 or the month of entitlement is earlier than 09/1981. In that case, follow the procedure in DI 52170.040 - Notice Provisions – Pre 1981 Amendment Cases to determine the correct month to begin offset.