Offset: Workers’ Compensation and Public Disability Benefit

October 6, 2018

There is a number of offsets which could reduce social security payments, including:
(1) Windfall Elimination Provision (WEP), (2) Government Pension Offset (GPO), (3) Workers’ Compensation and Public Disability Benefit and (4) Treasury Offset Program (TOP).

Workers’ compensation is a state-mandated insurance program that provides benefits to employees who suffer job-related injuries and illnesses. The benefits are paid for by employers or paid by government agencies (e.g. Public Disability Benefits, PDB: California State Disability Insurance (SDI or CASDI)).

The insurance provides five basic benefits:

  • Medical care;
  • Temporary disability benefits: Payments to compensate for lost wages;
  • Permanent disability benefits: Payments if you don’t recover completely;
  • Supplemental job displacement benefits: Vouchers to help pay for retraining or skill enhancement if you don’t recover completely and don’t return to work for your employer;
  • Death benefits: Payments to your spouse, children or other dependents if you die from a job injury or illness.

If you receive Social Security disability benefits, the amount receive will be offset by workers’ compensation.

Social Security figures your average current earnings in one of three ways:

  • method 1. The Average Monthly Wage Formula: Social Security uses your average monthly wages to calculate your disability benefit amount.
  • method 2. The High-Five Formula: Social Security uses the average monthly wages from your five highest-paid consecutive calendar years.
  • method 3. The High-One Formula: Social Security uses the average monthly wages from the your single highest-paid calendar year during the previous five years.

The High-One formula is used in the vast majority of cases, although Social Security will use whichever method is most favorable to you.
In Social Security terms, an individual’s pre-disability income is referred to as his/her “average current earnings” (or “ACE”). 42 U.S.C. 424a(a) provides three methods of calculating an individual’s ACE:

  • method 1 by computing the “average monthly wage”, a figure which is computed primarily (but with some additional considerations) by dividing the total of all wages and self-employment income by the number of months in the span of time over which the wages and self-employment income were earned;
  • method 2 by computing 1/60th of the total of wages and self-employment income for 5 consecutive calendar years after 1950 for which such wages and self-employment income were highest;
  • method 3 by computing 1/12th of the total of wages and self-employment income for the calendar year in which the individual had the highest such wages and income during the period consisting of the calendar year in which he/she became disabled and the 5 years preceding that year.

Using one of these three methods (the one which generates the highest number), the Social Security Administration calculates the individual’s ACE, reduces the ACE by 20%, and then compares the resulting amount to the sum total of the individual’s monthly workers’ compensation payment plus his/her monthly Social Security disability entitlement. Where the ACE (after reduction by 20%) is less than the sum total of the disability payments, a dollar-for-dollar offset will be applied to the overage.

Reduction of SSDI. First Social Security calculates 80% of the average current earnings (or uses 100% of the total family benefit, if that is higher) to come up with the applicable limit. Then it adds the monthly SSDI benefit to the monthly worker’s compensation benefit. If the benefit total exceeds the applicable limit, Social Security will reduce SSDI until it reaches the applicable limit.

Case #1. Social Security award’s letter dated 10/10/20×8 [disabled 4/29/20×6, 5mos: M-J-J-A-S, month of entitlement (MOE): 10/20X6]
We found that you became disabled under our rules on April 29, 20×6. To qualify for disability benefits, you must be disabled for five full calendar months in a row. The first month you are entitled to benefits is Oct 20×6. What we will pay and When. $317.80 10/29/20×8; due for 12/20×6 through 9/20×8. Monthly benefits $53.40, see computation follows:














Offset: Treasury Offset Program (TOP)

October 4, 2018

There is a number of offsets which could reduce social security payments, including:
(1) Windfall Elimination Provision (WEP), (2) Government Pension Offset (GPO), (3) Workers’ Compensation and Public Disability Benefit and (4) Treasury Offset Program (TOP).

What is the Treasury Offset Program (TOP)?

The Treasury Offset Program (TOP) is an agency established to maintain and collect debts under applicable laws, and is administered by the Bureau of the Fiscal Service’s Debt Management Services. TOP is a centralized offset program that collects delinquent debts owed to federal and state agencies.

If you owe certain governmental agencies any amount of money greater than $25, that governmental agency will submit this debt to TOP. TOP maintains the debt information in its database and informs the SSA of debts you may owe. For example, let’s say you are awarded monthly disability benefits, but it is discovered that you owe past-due taxes to the IRS. TOP will maintain that debt information, notify the SSA of the debt owed, and legally intercept some of your monthly benefits until the debt is fully satisfied.

SSA 3288 Consent for Release of Information

September 30, 2018

Consent for Release of Information, Form SSA-3288.


September 30, 2018

Benefits Planning Query (BPQY), Form SSA-2459

The Benefits Planning Query (BPQY) is part of the Social Security Administration’s (SSA) efforts to inform Social Security Disability Insurance (SSDI) beneficiaries and Supplemental Security Income (SSI) recipients about their disability benefits and the use of the work incentives.

  • Cash Benefits – For both SSDI and SSI shows the Type of Benefit, Current Status, Statutory Blindness, Date of Entitlement, Full Amount, Net Amount, Others Paid on This Record, Total Family Cash Benefit, Overpayment Balance, and Monthly Amount Withheld.
  • Health Insurance – Shows Medicare or Medicaid eligibility, and for Medicare (both Part A Hospital and Part B Medical) the date of coverage, premium amounts, and State Premium Buy-In.
  • Medical Reviews – For both SSDI and SSI, shows the Next Scheduled Medical Review, the Medical Re-Exam Schedule, and if deferred due to the Ticket to Work Program.
  • Representation – For both SSDI and SSI, indicates whether you currently have a Representative Payee or Authorized Representative.
  • SSDI Work Activity – Shows Trial Work Period months start date, end date, and months used, month of cessation, and current SGA level.
  • SSI Work Exclusions – Identifies any of the SSI work incentives that exclude earned income, with dates and dollar amounts, including Blind Work Expenses (BWE), Impairment Related Work
  • Expenses (IRWE), Student Earned Income Exclusions (SEIE), and PASS Exclusion.
  • Recent Earnings on Record – Shows all lifetime yearly work earnings from wages and self-employment, as well as monthly earnings for the most recent two years.

Who would request this planning tool and how it is used?

  • This form is generally requested by Employment Networks (ENs) and the State Vocational Rehabilitation (VR) agencies.
  • It is used to verify:
    • The type and amount of Social Security disability benefits(s) received;
    • Medicare and medicaid information; and
    • Information about past work and work incentive usage.

To obtain a copy of BPQY, either call Social Security Administration or contact us.

  • Two signed Consent for Release of Information, Form SSA-3288, must be submitted to Social Security if the BPQY will be sent to anyone other than the beneficiary and/or representative payee.
  • The SSA-3288s should be pre-filled with recommended language for release of Social Security and Internal Revenue Service records – refer to BPQY handbook.


Compassionate Allowance Conditions

August 27, 2018

Social Security has added five new Compassionate Allowance conditions:

  • Fibrolamellar Cancer,
  • Megacystis Microcolon Intestinal Hypoperistalsis Syndrome (MMIHS),
  • Megalencephaly Capillary Malformation Syndrome (MCAP),
  • Superficial Siderosis of the Central Nervous System, and
  • Tetrasomy

This list has grown to a total of 233 conditions.

For additional information about the program, , please goto>

Electronic Records- NUMI- MBR- SSID

October 30, 2017

SSA Electronic Records

  • NUMI or Numident (Numerical Identification System) contains an abstract of the information contained in an application for a United States Social Security number (Form SS-5).
  • MBR (Master Beneficiary Record) – stores the date of entitlement, the monthly cash benefit amount, Medicare data and other pertinent SSDI financial data.
  • SSID (Supplemental Security Income Display) – SSI program data, with a complete record of the cash benefits paid, scheduled medical review dates, and other work incentives used for both
  • SSI cash benefits and Medicaid. The SSID record provides a monthly listing of estimated or verified earnings.
  • DEQY (Detailed Earnings Query)
  • SEQY (Summary Earnings Query) – stores the annual earnings as reported by employers and self-employed individuals to the IRS and to SSA.
  • DCF (Disability Control File) – stores the number of Trial Work Period Months used, Medical Re-exam dates and other decisions about work activity and medical recovery.

Representative Payee

September 30, 2017

A representative payee is a person or an organization. We appoint a payee to receive the Social Security or SSI benefits for anyone who can’t manage or direct the management of his or her benefits. . A payee’s main duties are to use the benefits to pay for the current and future needs of the beneficiary, and properly save any benefits not needed to meet current needs. A payee must also keep records of expenses. When we request a report, a payee must provide an accounting to us of how he or she used or saved the benefits.

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Medicaid – Overview

July 29, 2017


As mentioned above, most SSI disabled recipients receive Medicaid coverage for their health expenses. Medicaid was established in 1965 as a joint federal/state program to provide medical coverage to the needy. States administer the program and, within federal guidelines, establish their own eligibility standards, types and levels of services, and rates of payment. Since the establishment of the SSI program in 1974, most SSI recipients have been eligible for Medicaid benefits, although in some states SSI is not a specific eligibility category. However, most SSI recipients in those states qualify for Medicaid under another eligibility category.

In some states, a Medicaid “buy-in” is available for certain categories of disabled individuals. The buy-in permits them to enroll in Medicaid even though they would not otherwise qualify because of income or resource considerations. The states may require the individual to share the cost of Medicaid by paying a premium or through some other cost-sharing arrangement, although these arrangements are generally assessed on a sliding scale based on income.

The federal government pays a percentage of total state Medicaid expenses. The federal percentage is determined by a formula based on state per capita income, with higher-income states receiving a smaller federal contribution rate. The federal contribution cannot be lower than 50 percent or higher than 83 percent. States may impose deductibles, copayments, or both for some services. And, as mentioned above, some categories of persons eligible for a Medicaid buy-in pay part or all of the cost of the coverage. For persons eligible for both Medicare and Medicaid, Medicare is the primary payer and Medicaid supplements payments.


Medicare Overview

July 29, 2017


Social Security beneficiaries receiving benefits based on their own disability are entitled to Medicare benefits beginning in the 25th month of entitlement. Medicare was implemented in 1966, providing medical benefits to complement the monetary benefits of Social Security retirees. In 1973, Medicare benefits were extended to disabled workers after a 24-month waiting period. Medicare is funded mainly through Hospital Insurance payroll contributions; additional sources of funding include general revenues, premiums, and a portion of the income taxes collected on Social Security benefits.

Until recently, Medicare had two parts: Part A (Hospital Insurance) and Part B (Supplementary Medical Insurance). In 1997, a third part, Part C, was added to Medicare, known as Medicare Advantage. Part C offers beneficiaries options for participating in private-sector health plans. In 2003, a fourth part, Part D, offering prescription drug coverage was added and Part B was modified. Part D was implemented in 2006. Modifications to Part B will take effect in 2007.

Part A, Hospital Insurance (HI), covers the cost of in-patient hospital care and is generally provided free to persons eligible for Medicare. It is paid out of the HI trust fund. There are deductibles and copayments under HI.
Part B, Supplementary Medical Insurance (SMI), covers doctors and other services. It requires a premium, which for most people is equivalent to 25 percent of the average expenditure for the aged for this coverage ($88.50 per month in 2006), to be paid by the beneficiary or on the beneficiary’s behalf. The balance comes from the Treasury as general revenue contributions. SMI also requires deductibles and coinsurance payments. Beginning in 2007, under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, beneficiaries with higher modified adjusted gross income ($80,000 or more for individuals, $160,000 or more for married couples) will pay a higher monthly premium based on a sliding scale that will be phased in over 3 years.
Part C, Medicare Advantage, expands beneficiaries’ options for participation in private-sector health care plans. Coverage and cost vary by plan. Part C receives funding from the HI and SMI trust funds and beneficiary premiums.
Part D, Prescription Coverage, became effective on January 1, 2006. Beneficiaries pay a premium that varies by income level and involves deductibles and copayments. The Part D subsidy benefit is also available to assist low-income beneficiaries who meet certain income and resource requirements.

Medicaid: 1634 states and Section 206(b) states

July 1, 2017

There are two primary governmental medical programs: (1) Federal medicare and (2) state medicaid. Beneficiaries receiving Supplemental Security Income (SSI) residing in “1634” states are categorical eligible and are automatically enrolled in medicaid. These individual do not need to apply for medicaid benefits separately.

The section 206(b) states have opted to use more restrictive criterias in determining medicaid eligibility. For beneficiary residing in “209(b)” states must separately apply for medicaid.


1634 209(b) SSI 1634 209(b) SSI
Alabama 1634 Montana 1634
Alaska SSI Nebraska SSI
Arizona 1634 Nevada SSI
Arkansas 1634 New Hampshire 209(b)
California 1634 New Jersey 1634
Colorado 1634 New Mexico 1634
Connecticut 209(b) New York 1634
Delaware 1634 North Carolina 1634
Dist of Columbia N Mariana Islands SSI
Florida 1634 North Dakota 209(b)
Georgia 1634 Ohio 1634
Hawaii 209(b) Oklahoma 209(b)
Idaho SSI Oregon SSI
Illinois 209(b) Pennsylvania 1634
Indiana 1634 Rhode Island 1634
Iowa 1634 South Carolina 1634
Kansas SSI South Dakota 1634
Kentucky 1634 Tennessee 1634
Louisiana 1634 Texas 1634
Maine 1634 Utah SSI
Maryland 1634 Vermont 1634
Massachusetts 1634 Virginia 209(b)
Michigan 1634 Washington 1634
Minnesota 209(b) West Virginia 1634
Mississippi 1634 Wisconsin 1634
Missouri 209(b) Wyoming 1634


1634:  States Automatically Grant Medicaid With SSI Disability.

209(b): The States with Their Own Medicaid Eligibility Criteria.