Workers’ Compensation provides financial support for employees injured on the job, covering medical expenses and partial wage replacement. SSDI, on the other hand, is a federal program for individuals with disabilities that prevent them from working, regardless of where the injury occurred.

When you receive WC benefits, the Social Security Administration (SSA) applies “offset rules,” which could reduce your SSDI payments. By law, the combined amount from both benefits cannot exceed 80% of your average pre-disability earnings. If it does, your SSDI payment will be reduced. This offset often surprises applicants who are unaware of how the two programs interact.

Filing a WC claim can directly impact your SSDI application in several ways. The medical evidence used to support your WC claim must align with the requirements for SSDI. While WC focuses on work-related injuries, SSDI requires proof that your disability prevents you from performing any substantial gainful activity (SGA). Discrepancies in medical records between the two claims can raise red flags for the SSA.

When receiving both Workers’ Compensation and Social Security Disability Insurance (SSDI) benefits, the 80% rule is a key factor in determining your SSDI payment amount. This rule ensures that the total amount you receive from these two programs does not exceed 80% of your average pre-disability earnings, also known as your average current earnings (ACE). If the combined benefits surpass this threshold, your SSDI payments will be reduced.

It’s important to note that the SSA calculates the offset based on gross amounts, not after-tax income. Once you stop collecting those benefits and the SSA no longer considers that you’re collecting, your SSA payment will revert back to the appropriate amount paid – because you won’t be at the 80% anymore.

To avoid complications, ensure your medical documentation is consistent across both claims. This involves coordinating with your healthcare providers to clearly outline the severity of your condition and how it affects your ability to work in any capacity.

It is also important to keep SSA updated about your earnings and other benefits that you’re receiving so that they keep your information current and don’t over/under pay you. When dealing with Workers’ Compensation, submitting a Compromise and Release (C&R) agreement—one of the primary settlement documents in a workers’ comp case—can provide the SSA with all the details they need. This includes the exact amount you were paid and the timeline of those payments, allowing the SSA to calculate your benefits accurately and ensure you’re receiving what you’re entitled to under the law.

The SSA is typically aware of any Workers’ Compensation claims, even if they weren’t mentioned on your SSDI application. While it’s always important to be truthful and disclose all relevant details, failing to provide the C&R agreement can lead to miscalculations in your benefits. This oversight could result in an underpayment, leaving you without the full financial support you deserve. Proper documentation is key to avoiding these issues and ensuring a smooth benefits process.

Seeking legal guidance with Casa de la Justicia can be an essential approach when dealing with the complexities of overlapping Workers’ Compensation and SSDI claims. Our experienced attorney can help you evaluate your situation to determine whether you also qualify for SSDI benefits. Ensuring your applications are aligned and comply with SSA regulations. Proper planning can minimize the risk of delays or denials while maximizing the benefits you receive.