Workers’ Compensation and Social Security Disability Insurance—What you don’t know could hurt you!

Thursday, 07 April 2016 13: 27
Written by Joni B. Bailey


You might be wondering:  What should I do about Social Security Disability benefits while my worker's compensation claim is pending?

This is a very common question that I hear in my work as a Southern Illinois Social Security Disability representative.

If you have read any of the other posts on this blog, you will not be surprised to find out that the answer is not simple.

There are two main differences between Worker’s Compensation and Social Security Disability Insurance benefits:

The impairments considered:

  • Worker’s Compensation benefits only compensate a person for the injuries sustained at work.

  • Social Security Disability Insurance benefits compensate a person who cannot work in any job because of their overall health condition, not just one injury.

The jobs considered:

  • Worker’s Compensation insurance will compensate you if you cannot do the job you had when you got hurt even if there are other jobs you could do.

  • Social Security Disability Insurance benefits are only paid to you if there are NO jobs you can do with your impairments.

How do these differences impact a Social Security claim?

A Southern Illinois Social Security attorney will explain that these differences have a very big impact on the advice given to prospective clients.

Let’s look at some common scenarios:

“I am 40 years old. I got hurt at work last year. The company paid my medical bills, paid temporary total disability benefits for a few months, paid a lump sum settlement of about $15,000.00, and then told me they did not have any jobs I could perform with the restrictions my doctor* said I had. Now when I apply for other jobs and they find out I had a workplace injury, I can’t get hired. My doctor said I could do light work, but those jobs don’t pay as much as my last job; I can’t survive on minimum wage. So I thought I would apply for Social Security disability benefits.  Can you help me?”

The bad news is that Social Security is not likely to help in this situation if the worker can still perform light work and is less than 50 years old. The Social Security Administration assumes that this worker will either take a lower paying job or learn new skills and adapt to new workplace settings.

“I am 40 years old. I got hurt at work last year. My attorney in the workers compensation case hired a vocational expert to find a job for me that I could do within my doctor’s* work restrictions. The expert could not find any work in the area that I can perform. I received a large cash settlement and my attorney set up a Medicare Set-aside Agreement fund to pay for medical care in the future for the problems caused by my workplace injury. I thought it would apply for Social Security disability benefits. Can you help me?”

This client has a good chance of winning a favorable decision because there is expert evidence that the functional limitations eliminate jobs in the region.  This worker had a good attorney who knew to develop the vocational aspect of the case and protect the client in the future when surgeries or other medical treatment are necessary. 

*Read tips for interacting with your doctor here.

The next big question is when to file your Social Security disability claim.

I receive calls on a regular basis from people whose workers compensation attorneys tell them not to bother filing their Social Security disability claim because they are getting so much temporary total disability benefits that they will not receive Social Security benefits anyway. That is bad advice.

Waiting to file the Social Security disability claim can reduce the past-due benefits and delay the first Medicare eligibility month.

The first Social Security benefit month depends on two dates-- the onset date and the filing date.  The earliest benefit month will be 5 full months after the onset date but no earlier than 12 months before the filing date.  That means if you wait more than 17 months from your injury date you are losing benefit months.

While it is true that in many cases the temporary total disability (TTD) benefits will almost completely offset the monthly Social Security benefit, waiting more than 17 months to file the Social Security claim affects not only the monthly benefits but the first Medicare eligibility date.

A claimant who qualifies for Social Security Disability Insurance benefits also qualifies for Medicare coverage on the 24th month after the first benefit month. This means that the worker who waits too long to file the Social Security claim misses out on free Medicare part A coverage and very affordable Medicare part B coverage.

See also:  When Is The Right Time To Call An Attorney For Help With A Social Security Disability Insurance Claim?

Although every situation is unique, my general recommendation is to file your Social Security disability insurance claim before the 17th month after your injury date if you have not worked since the injury date.

Don’t forget to keep everyone informed about what is going on.

Failing to inform the Social Security Administration about Worker’s Compensation settlements or monthly benefits could result in a large overpayment.

  • You need to provide all the details about the worker's compensation case to the Social Security Administration when you file your claim and while the claim is pending. This is required.

  • And you need to keep your worker's compensation attorney up to date on the status of your Social Security claim. Winning your Social Security claim can help you get a higher award in the worker's compensation claim.

  • You also need to keep your Southern Illinois Disability attorney up to date on the status of your worker's compensation claim. If you are receiving Social Security benefits when your worker's compensation claim settles or your TTD benefits stop, you are required to let the Social Security Administration know. In these situations, your monthly benefits will increase in most cases where there was an offset of your Social Security monthly benefits due to the workers compensation benefits.

When you are dealing with workers compensation or Social Security disability benefits, you are gambling with your future livelihood. Before you decide who to hire to handle your case, take the time to ask around and get recommendations for a worker's compensation attorney or Social Security attorney who has a good reputation for taking good care of his or her clients.

Joni Beth Bailey is a Southern Illinois Social Security Disability attorney.

social security disability lawyer in murphysboro, il

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