Can I Get Disability After Workers’ Comp Settlement?

Yes, you are still eligible to receive disability benefits after receiving a workers’ compensation settlement. These may include payments from many different public and private programs, but the most common is Social Security Disability (SSD) through the Social Security Administration (SSA).

Various types of benefits exist to help those who have become disabled, each with its own, sometimes confusing criteria and application requirements. Having an experienced law firm assist you with the process of receiving benefits can make it much less stressful. The attorneys of Pond Lehocky Giordano LLP take a look at what you need to know.

How a Workers’ Comp Settlement Affects Your SSD Eligibility

While a workers’ compensation settlement does not affect your eligibility for SSD, it may reduce the amount of your SSD monthly benefits. There may be an exception to this rule if you receive SSD as well as:

• State and local government benefits, provided that Social Security taxes were taken out of your paycheck
• SSI (Supplemental Security Income)
• VA (Veterans Administration) benefits

Our workers’ comp attorneys can review your individual circumstances, let you know which benefits you can claim, and estimate the amount for which you may be eligible.

When to File for Disability After Your Settlement

If you receive a workers’ compensation settlement and estimate that your injury will prevent you from working for at least one year (12 consecutive months), then you need to think about applying for SSD benefits. It’s important to understand, however, that workers’ comp eligibility does not automatically translate to SSD eligibility. The two programs operate according to their own rules and standards.

What Is the 80% Rule?

The 80% rule is a limit on how much money an individual can receive from both workers’ compensation and SSD. The combined benefits cannot exceed 80% of the recipient’s average gross monthly income (the amount of their earnings before the time the disabling condition began).

Will My SSD Benefits Be Reduced Due to Receiving Workers’ Comp?

If the combined total of workers’ comp and SSD does exceed 80% of your average gross monthly income, your SSD benefits will be reduced to comply with the 80% rule. However, some benefits, such as SSI, VA, and local and state benefits, will not affect SSD.

SSI may sound similar to SSD, but there are some important differences. SSD – also called Social Security Disability Insurance, or SSDI – is based on a beneficiary’s work history and whether they paid enough in Social Security taxes during their working years. Meanwhile, SSI is a needs-based program that is not tied to work history. 

SSI covers essentials for disabled persons, such as food and housing. It is possible to receive both SSD and SSI.

Do I Have to Report My Workers’ Comp Settlement to the SSA?

You are required to report your workers’ compensation settlement to the SSA. The SSA has no other way of knowing whether your total payments exceed the 80% rule. If you receive overpayments, you may be penalized and have to make repayments later.

Common Reasons Why an SSD Claim Is Denied

By some estimates, up to two-thirds of initial SSD applications are rejected, many for avoidable errors on the applicant’s part. These are a few common reasons SSD claims are denied:

• Missing or incomplete medical information: The SSA has to determine if an applicant meets its definition of “disabled,” and it cannot do so without adequate medical evidence. Outdated and incomplete records, or those that do not sufficiently describe how the condition affects the applicant’s ability to work, will hurt your application.
• Failing to qualify as “disabled”: Applicants should remember that every public and private disability program, from workers’ compensation to SSD, has its definition of what “disabled” means. To receive SSD, a condition must (1) prevent the applicant from engaging in substantial gainful activity, or SGA (a term related to their ability to earn a living), and (2) be expected to last at least 12 months or result in death.
• Paperwork errors: These may include anything from mistakes on the application to missing details such as treatment history. They also include inaccurate employment information, for example, listing incorrect employment dates. The SSA requires complete and correct information, so even a seemingly minor error can jeopardize the claim.
• Earning too much money: An individual who earns too much money, meaning they exceed the SSA’s substantial gainful activity (SGA) monthly limit ($1,620 for a non-blind individual), will likely be rejected. The SSA views this person as being capable of working and therefore not in need of disability benefits.
• Not appealing a prior denial: An applicant who is denied should appeal the denial instead of simply re-applying. An appeal should be filed within 60 days of a denial using one of several routes: reconsideration, ALJ (administrative law judge) hearing, Appeals Council review, and federal court review. Failing to exhaust these remedies could damage your claim.

When to Talk to a Disability Attorney About Your Workers’ Comp Claim

Most people would prefer not to allow a disability to keep them from working and living life as usual. But the time may come when you need to seek legal counsel. These are a few signs that the time may be now:

• Your employer or the workers’ comp insurer denies that the injury was work-related or happened on the job.
• Your employer or the insurer denies the severity of your injury.
• You’ve reported the injury promptly (we recommend immediately, or within 30 days at the latest) but your employer is dragging its feet with your claim.
• You are concerned that your disability, whether partial or total, will prevent you from working again.
• The workers’ comp insurer refuses to pay for doctor-recommended treatments.
• The insurer’s settlement offer doesn’t pay for all of your medical bills or cover all of your lost wages.
• You have a pre-existing condition, which means the insurer will likely reject your claim.
• The insurer rejects your claim.
• You plan to file for SSD.
• Your employer has retaliated or threatened to retaliate against you.
• You have a third-party claim for your injury (meaning, against someone besides your employer).

Talk to a Workers’ Compensation Lawyer for Answers About Your Claim

If you have experienced any of the above or other complications with your workers’ compensation claim, it’s time to reach out to us. We know that workers’ comp and Social Security disability benefits can be confusing, which is why we’re ready to put our considerable experience with these matters to work for you. Connect with us today to get started.