Identify the possibility that a PDB is based on covered service using information in the claims file, including:
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A “yes” response to the question 4 “Do the PDBs meet the covered service exclusion?”
on the WPCL screen in Modernized Claims Screen (MCS), or
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•
Look for non-covered wages on the Detail Earnings Query (DEQY) or for details of the
number holder’s (NH's) work history on the SSA-3368-BK (Disability Report-Adult) and/or
SSA-3369-BK (Work History Report). See OS 15020.375 for SSA-3368 and OS 15020.380
for SSA-3369, or
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A “yes” response to question 4 on the SSA-546 (Workers’ Compensation/Public Disability
Questionnaire).
Develop each case individually because work histories and dates of covered service
will vary.
NOTE: If the PDB plan is based on one period of service to establish eligibility and a
different period of service to compute the amount of the PDB, either period can exclude
the PDB from offset if at least 85 percent of the period used is covered. (See DI 52125.010H Example 3 below.) In these situations:
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Evaluate the first period of service. If the 85 percent test is met, the PDB is excluded
from offset.
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If the first period of service does not satisfy the 85 percent test, look at the second
period of service.
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If the second period of service (evaluated on its own and without regard to the first
period) satisfies the 85 percent test, the PDB is excluded from offset.
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•
If the second period also does not satisfy the 85 percent test (i.e., neither period
satisfies the 85 percent test), the PDB is offset.