A worker injured on the job can sometimes qualify and receive Social Security Disability (SSDI) benefits in ADDITION to receiving workmans compensation benefits. The criteria for SSDI eligibility and workers comp are different, but more serious workplace injuries often wind up with a claimant getting both.
In a workmans comp case, you have to prove only that you were injured on the job, and have some residual problem in order to be entitled to a workers compensation benefit for permanent disability. In most instances, the injured worker returns to the work force, in the same capacity he held when injured. On the contrary, to be entitled to Social Security Disability (SSDI), you have to prove that you cannot work in ANY capacity before being entitled to benefits.
So in the typical workmans comp claim, Social Security Disability (SSDI) is not an issue, as you would not be entitled to it. But where a serious injury is involved—one where you will not be returning to any work, or where you will require future medical treatment after conclusion of your workmans compensation case, where you expect to apply for SSDI—Social Security will likely be involved.
In the normal legal course, the injured worker will first apply for workers compensation benefits then for SSDI benefits. When applying, it is essential that you explain to Social Security that you got hurt on the job and are receiving benefits (not doing so may constitute fraud). If SS finds you entitled to benefits, they will take into account your WC benefits and reduce, but not eliminate, your SSDI benefits. The result is always a net gain for you.
Your workers comp settlement must contain “spread” language at its conclusion, whereby, even if you receive a lump sum settlement today, Social Security will understand the lump sum as representing payments that accrue over a lifetime. “Spread” refers to your life expectancy, represented in months. So for example, if you receive $100,000 in a lump sum settlement, and you are 45-years-old, the settlement contract should read that your life expectancy according to US Life Tables, is 37 years (or whatever the actual figure is), which is 424 months. The $100,000 represents payment to you of $100,000/424= $235.85 month. It is this latter figure the Social Security Administration will take into account when reducing your SSDI benefits, generally by only a modest amount. Any attorney handling workers compensation cases should be familiar with this concept.
One other way in which the Social Security Administration is involved in a workers compensation case is where future medical expenses are anticipated. Social Security will not want to be saddled paying bills that should rightly be paid by workmans comp. So in an instance where an injured worker might be entitled to future Social Security Disability (SSDI) benefits, “set aside” language must be used in the settlement contract. This means that the Social Security Administration will inform the employer’s workers compensation insurance carrier of how much money must be set aside for payment of your future (work related) medical bills. This is for your ultimate protection because failure to include this language, and abiding by it, means that the Social Security Administration can insist that you pay the amount that should have been set aside before making further payments of your bills.
For example, if you had a work related back injury which required two surgeries, you continue to need medical treatment at the conclusion of your workmans comp case, and Social Security determines that $36,000 should be set aside for payment of your potential future medical treatment, at $3,000 a year, failure to abide by the set aside could mean that the Social Security Administration will refuse to pay $3,000 for you in any one year.
Understanding how workmans compensation and Social Security Disability (SSDI) benefits work together must be understood by your legal representative. The Chicago workers compensation attorneys at Lipkin & Apter have been forceful, effective advocates for their clients for years, and would be pleased to speak with you about representing you in your case. Contact Lipkin & Apter today for more information, or to set up a free consultation.