How Does Workers’ Compensation Affect SSDI Benefits?

How Does Workers’ Compensation Affect SSDI Benefits?

Receiving compensation for Social Security disability is possible if you meet the requirements, regardless of whether you have already received a Workers’ Comp settlement. Your Workers’ Compensation settlement amount can have an impact on the Social Security disability benefits you receive. If the Workers’ Comp settlement amount is high, your Social Security Disability award could be reduced.  Your settlement and the disability benefits must be less than 80% of your average current earnings when combined, or the excess amount will be reduced from your benefits. The earnings calculation is done by the U.S. Social Security Administration.

Social security cards. social security disability after workers' comp settlement

Workers’ Compensation and Social Security Disability

Understanding the difference between workers’ compensation and disability benefits is crucial if you have suffered a work-related injury. Both programs offer financial assistance to cover medical bills and living expenses, but they are not the same, nor interchangeable. As an injured worker, you should know how each program works to apply for the benefits that will best suit your situation.

Understanding Workers’ Comp Settlements

Workers in Illinois are entitled to benefits through the Workers’ Compensation program for work-related injuries or illnesses. Employers must carry Workers’ Compensation insurance, and workers must have sustained an injury on the job to file a claim. Compensation covers medical expenses and lost wages, paid either as a lump sum or monthly payments. State laws govern these programs, which can differ in insurance providers, compensable injuries, and benefit levels.

There are four types of workers’ compensation benefits. These are wage replacement benefits, rehabilitation benefits, medical care benefits, and wrongful death benefits.

Social Security Disability

Social Security Disability Insurance (SSDI) is a program that provides benefits to disabled workers and their dependents. To qualify for benefits, workers must have paid Social Security taxes on their earnings. SSDI offers a way to replace some lost income for those who can no longer work due to a disability.

What Are the Differences Between Workers’ Comp and SSDI Benefits?

There are two main benefit programs available to injured workers in the United States: Workers’ Compensation and Social Security disability benefits. However, there are significant differences between the two programs and different eligibility requirements. A lawyer well versed in injury cases can review your claim to help you navigate which program may be right for you, or if you may be able to receive benefits through both programs.

Workers’ Compensation benefits are available from the start of the worker’s employment, while Social Security disability benefits require a minimum work record. Workers’ Compensation benefits aim to aid workers in their recovery from injuries, while Social Security benefits are intended for individuals who are permanently disabled and left unable to work.

Workers’ Compensation benefits cover job-related disabilities only, while Social Security disability benefits are for long-term impairments that prevent employment, regardless of the cause. Workers’ Compensation provides disability benefits for both short-term and long-term, partial or total disabilities. Social Security, however, only provides benefits for workers who have been diagnosed with a physical or mental impairment that is anticipated to last at least a year.

Post-Settlement Social Security Disability Considerations

Can you get workers’ comp and disability? If you are an injured worker with a disability and meet the eligibility criteria for Social Security Disability benefits, you may be eligible to receive both Social Security Disability benefits and workers’ compensation. Any SSDI benefits that an injured worker may receive can be impacted by the workers’ compensation settlement amount.

Does Workers’ Compensation Affect SSDI Benefits?

Your monthly SSDI benefits, which also include benefits for your family members, can be combined with any workers’ compensation or other public disability payment you may receive. If the total amount of these benefits together exceeds 80% of your average current earnings, the excess amount would be deducted from your Social Security benefit.

Eligibility Requirements for SSDI Benefits

To be eligible for Social Security Disability Insurance (SSDI) benefits, two requirements must be met. The first requirement is that the job you were employed at when you got injured must have Social Security coverage. The second requirement is that your medical condition needs to meet the Social Security’s definition of disability.

Not only must you meet the eligibility criteria, you must also have accumulated enough work credits. The number of credits required depends on your age and work history. Generally, you need to earn 40 credits, with 20 of them earned within the last decade leading up to your disability. However, younger workers may not need as many credits. Social Security work credits are based on your yearly wages or self-employment income, with a maximum of 4 credits awarded per year. A social security disability lawyer to help you understand this requirement and help you determine how many work credits you require.

The Social Security program has its own definition of disability, which differs from other programs. It only provides compensation for total disability and doesn’t offer any benefits for partial disability or short-term disability, unlike workers’ compensation.

To qualify for disability benefits, your medical condition must prevent you from working or engaging in substantial gainful activity (SGA). You must also be unable to perform your previous job or adjust to other forms of work due to your condition. Lastly, the medical condition should be expected to last for at least a year or lead to death.

To determine if you’re eligible for disability benefits, the Social Security Administration (SSA) considers various factors. These include whether you are working after your disability, the severity of your condition, whether your condition is found on a pre-determined list of disabling conditions, or whether you can return to any form of past work. It also considers if there is any other form of employment that you can engage in.

Potential Challenges for SSDI Eligibility

Knowing the common challenges of applying for Social Security disability benefits is critical for success. Awareness of these challenges helps avoid them and increases chances of getting financial support for the disabled who cannot work.

Complying With Doctor’s Orders

Failing to comply with doctors’ orders is a common challenge faced by disability benefits applicants. The SSA reviews medical records to assess your condition and whether you are following doctor-recommended treatment plans. Not adhering to the treatment paths recommended by medical professionals can raise a red flag to the SSA.

Cooperation With Requests Made by the Social Security Agency (SSA)

The SSA may request additional medical records, even if you’ve already submitted some. It’s crucial to comply promptly, as failure to do so may lead to application denial. Take these requests seriously and respond promptly.

Demonstrating the Severity of Your Disability

To qualify for benefits, your disability must be severe enough to prevent you from working for at least a year. It’s important to provide adequate proof of the severity of your disability to avoid having benefits denied.

Proving That You are Unable to Work

One of the biggest challenges in applying for benefits is proving that you are unable to work. This is an essential step in getting approved for benefits, but it can be difficult, especially depending on your disability and occupation. While some income is allowed during the application process, it must be within the permitted amount, or your claim may be denied.

Strategies to Maximize SSDI Benefits After a Workers’ Comp Settlement

Your workers’ compensation settlement and Social Security Disability benefits cannot exceed 80% of your earnings. When negotiating the terms of the settlement, it’s recommended to have a lawyer who can request that specific language is included in the settlement agreement:

  • Certain expenses can be excluded from your workers’ comp settlement when calculating the amount of your workers’ comp and SSDI benefits added together.
  • The portion intended for attorney fees/litigation costs, medical expenses, future care, surgeries, rehab, adaptive equipment, home health care, or vocational rehabilitation expenses should be specified in the settlement amount to offset SSDI benefits.
  • Lump-sum settlements can spread compensation payments over your entire working life, rather than a short period, reducing the amount chargeable in any single month and offsetting your SSDI payment less substantially.
  • If you are 62 years old, opting for retirement benefits can be beneficial because your Social Security retirement benefits will not be offset by the lump sum worker’s comp settlement.

Gathering the required medical documentation can be tedious, time-consuming, and challenging, especially for someone who is ill. However, medical documentation is crucial in establishing the severity and extent of your symptoms and how they affect your ability to work. A social security disability lawyer can help you gather all the necessary documentation, to make a strong application as well as word your workers’ comp settlement correctly, to maximize your benefits.

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David W. Martay

David W. Martay, a partner at Martay Law Office in Chicago, IL, is a top-rated workers’ compensation lawyer who represents injured employees throughout the state. Known as a highly-skilled advocate for his clients, David has recovered millions for victims of workplace accidents.

Years of Experience: More than 25 years
Illinois Registration Status: Active

Bar Admissions: Illinois State Bar Association

author-bio-image author-bio-image
David W. Martay

David W. Martay, a partner at Martay Law Office in Chicago, IL, is a top-rated workers’ compensation lawyer who represents injured employees throughout the state. Known as a highly-skilled advocate for his clients, David has recovered millions for victims of workplace accidents.

Years of Experience: More than 25 years
Illinois Registration Status: Active

Bar Admissions: Illinois State Bar Association