The MCS DISB screen asks if the number holder (NH) filed or intends to file a claim
for WC/PDB. This question must be answered completely. It is not sufficient to only
ask if the NH was injured on the job. This also applies when a paper SSA-16 application
is submitted. If a claim was or will be filed, ascertain the carrier and WC attorney
(if applicable) and document MCS (even if payment has not yet been made or if the
NH does not know the amount of the payment).
After identifying receipt of WC/PDB, ask the NH if the payment is reduced for any
medical expenses, attorney fees etc., that may be excluded from offset.
1. NH provides alleged WC/PDB rate
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Complete WC/PDB screens in MCS or obtain paper Form SSA-546 (Workers’ Compensation/Public
Disability Benefit Questionnaire).
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Obtain a signed paper Form SSA-1709 (Request for Workers’ Compensation/Public Disability
Benefit Information) from the NH if the NH is unable to provide evidence of the WC/PDB
benefit they allege.
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Verify WC/PDB payments from outside sources only if the NH cannot or will not provide
verification.
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If the NH is receiving WC but provides no proof and alleges no rate, impose offset
at the State maximum using the chart in DI 52150.045 - States’ Maximum WC Benefits Chart.
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Develop for proof of WC/PDB post-adjudicatively.
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Be sure to follow-up to determine if proof is eventually received.
3. NH not filing for WC/PDB
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Inform the NH that entitlement to WC/PDB may affect the amount of Social Security
disability insurance benefits payable to the NH and their family.
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Explain that, in attesting to the application, the NH is agreeing to the reporting
responsibilities if WC/PDB is paid in the future.
4. Discrepant WC/PDB answers
If the work-related question is answered “yes,” but the filing question is answered
“no”:
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Obtain an explanation from the NH or the employer.
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Determine if a claim will be filed if the NH has not filed a WC claim.
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Document MCS RPOC screen or the EF with the responses.
If the NH alleges sick pay but the impairment appears to be work-related, obtain verification/proof
from the employer to determine the true nature of the payments. Document the EF with
your findings.
If the WC/PDB was denied less than one year prior to the first possible month of offset
and no appeal was filed:
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Document MCS RPOC screen or the EF with the responses.
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Use the DIAR screen to record the reason for the denial.
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If the claim requires an A101 or EF101, annotate the reason for the WC/PDB denial
on the Remarks screen.