When imposing offset, use the WC rate(s) and period(s) determined by the payer to
be correct and payable, i.e., the rate that should have been paid rather than the
rate actually paid. This difference in rates can occur, for example, when the WC carrier
overpaid the beneficiary and subsequently reduced the WC rate to recover the overpayment.
Whether the carrier recovers the excess amount paid is irrelevant to the offset computation.
We impose offset based on the established WC rate that should have been paid.
For the 10-week period (05/01/2004 through 07/09/2004), NH received $400.00 per week
in temporary total WC.
Effective 07/10/2004, NH began to receive $300.00 per week in temporary partial WC.
In 12/2006, a hearing is held and it is determined that NH’s disability did not meet
the requirements for temporary total WC. The $300 payments should have started 05/01/2004
instead of 07/10/2004. This results in a $1,000 overpayment.
The WC proof indicates the WC carrier agreed to withhold $10 per week until the overpayment
recovery is completed – resulting in 100 weekly payments of $290 until the overpayment
is recovered. (The WC overpayment issue is between the carrier and the beneficiary.)
Therefore, code the ICF with a continuing WC rate of $300 per week for the period
05/01/2004 and continuing.
NH received a letter from the insurer converting NH’s TT benefits to PP benefits (at
a lower rate). The letter informed the NH that she was paid TT benefits from 04/28/2006
to 04/13/2008 and determined to be “Permanent & Stationary” beginning 02/05/2008.
The letter stated the insurer was asserting credit for the TT overpayment for 02/05/2008
to 04/13/2008 against permanent disability.
Code the ICF WC/PDB with the TT rate for 04/28/2006 through 02/04/2008 and the PP
rate for 02/05/2008 and continuing.