If you are disabled, you may be entitled to disability benefits through multiple benefit programs. Before applying for disability benefits from multiple programs, it is important to know how benefit programs interact and how each applying for one benefit may affect your eligibility for another for other benefits. Knowing what is available to you and when you should apply for these benefits is crucial. Seeking the advice of an attorney experienced in navigating multiple benefits programs will help you through the complicated process and help you get the best financial result.
Social Security Disability, Workers’ Compensation, Long Term Disability and Veterans’ Administration benefits are the most routinely sought by disabled individuals. We have highlighted some of the most important interactions to be aware of when applying for these benefits.
Workers’ Compensation Benefits and Social Security Disability
If you are receiving workers’ compensation benefits, you may also be entitled to Social Security Disability benefits (SSDI). The two programs are completely separate and the guidelines used by each to determine disability are very different. Workers’ compensation programs vary by state, but in general, you are considered disabled if you are no longer capable of performing the job you were doing when you were injured. The Social Security Administration’s definition of being disabled is broader and the requirements more rigorous. To qualify for SSDI you must be found totally disabled from performing any of the past work you have done and unable to perform work in any field in which you could be reasonably retrained to work.
For example: A certified nurses’ assistant (CNA) injures her low back while lifting a patient and now cannot perform the heavy physical requirements of her pre-injury position; she would likely be considered disabled by workers’ compensation standards. Under the requirements for SSDI, it may be determined that while the CNA cannot work as a CNA, she has the residual functional capacity to do less physical work such as being a receptionist, a companion or housekeeper, and so she would not be considered disabled.
If you are receiving workers’ compensation benefits and then are awarded SSDI, the total amount of the combined benefits you receive cannot exceed 80 percent of your average current monthly earnings before you became disabled. Your workers’ compensation benefits act as your “primary” benefit and then SSDI will supplement your income up to the 80 percent maximum, but no more than your full SSDI benefit rate.
For example: Your average monthly earnings before you became disabled as determined by Social Security was $4,000 per month. You are presently receiving $2,400 per month in workers’ compensation benefits. Your maximum SSDI benefit rate per month is $1,800. Because the combined total of the potential benefits ($4,200) exceeds 80 percent of your average monthly earnings ($3,200), your SSDI benefits would be reduced to $800 per month. If your workers’ compensation benefits are reduced, you would report the change to Social Security and your SSDI benefits can be increased.
There are advantages and disadvantages regarding when you apply for SSDI while receiving workers’ compensation benefits. The timing of your applications may affect your future medical benefits and a potential lump sum settlement of your workers’ compensation claim. If you plan on receiving both benefits, it would be well advised to seek the advice of an attorney that has experience with both workers’ compensation and SSDI claims.
Long Term Disability and Social Security Disability
If you are receiving private long term disability benefits you may also be entitled to SSDI. The definition of disability and the medical evidence required to meet the disability requirements differ among private insurance carriers and will be very different from requirements of the Social Security Administration.
The amount of SSDI monthly benefits you are entitled to receive if found disabled are not affected by your private long term disability payments. On the other hand, with private insurance, your long term disability benefits are defined contractually and the insurer may be entitled to an offset for any SSDI benefits you receive. In fact, many insurers require you to apply for SSDI benefits for just this reason, and failure to apply for SSDI could result in termination of your long term disability coverage.
The long term disability insurers often offer to assist you with your SSDI claim as it benefits them financially. If you are receiving $3,000 per month in long term disability and are awarded $2,000 in SSDI per month, the long term disability plan will begin paying you only $1,000 per month. If you receive back due benefits from SSDI, the long term disability insurer will seek reimbursement for the same $2,000 per month offset retroactively from any back SSDI benefits you receive.
Long term disability does not provide medical benefits coverage so it is important to apply for SSDI benefits to become Medicare eligible. In order to be entitled to Medicare, you must be disabled for two years. The SSDI process can be lengthy and onerous but is extremely important to undertake if you need affordable medical coverage under Medicare.
You should consult with an attorney experienced in Social Security Disability to advise you through the SSDI application process. Keep in mind, although your disability insurer may offer assistance with obtaining SSDI, you may actually never meet a representative until the day of a hearing. It may be beneficial to seek counsel from an attorney that is located in your local area so that you can meet with them from the onset of your claim.
Veterans Administration benefits and Social Security Disability
If you are receiving Veterans Administration (VA) benefits you may also be entitled to SSDI. The definition of disability and the medical evidence required to meet the disability requirements for VA disability differs from those of the Social Security Administration.
The SSDI monthly benefits you are entitled to receive if found disabled are not affected by your VA disability benefits. You are entitled to receive both concurrently without any reduction or offset between the two agencies.
Up until March 27, 2017, Social Security considered whether an individual was receiving VA disability benefits and gave it great weight in the review process of determining an applicant’s disability. For applications filed on or after March 27, 2017, VA disability decisions are considered “ inherently neither valuable nor persuasive to us”. The intent of Social Security was to make it clear that it is never appropriate to “credit as true” any medical opinion. Revisions to Rules Regarding the Evaluation of Medical Evidence in the Federal Register (82 FR 5844). While Social Security will consider VA medical records in their determinations, the VA disability determination by itself will not guarantee an award of SSDI benefits.
If you have questions regarding your entitlement to Social Security Disability, assistance in applying for benefits or filing an appeal of a denial of benefits, please contact Linay L. Haubert at 215-345-8888 or firstname.lastname@example.org. As a registered nurse, I also have the medical knowledge and experience to navigate your claim through the rigorous medical requirements of the disability application and appeal process. Our attorneys see clients in both our Bucks County and Montgomery offices and have the knowledge and experience in all facets of disability issues.
The information above is general: we recommend that you consult an attorney regarding your specific circumstances. The content of this information is not meant to be considered as legal advice or a substitute for legal representation.