If you qualify for workers’ compensation and have a permanent disability, you may be able to receive benefits from more than one source. Many injured workers do not realize that there is additional help available after a disabling accident or are unsure about how to file. A workers’ compensation attorney may be able to help you navigate multiple compensation claims and ensure that your paperwork is filed correctly, on time, and in the right order.
Should your claim be denied, we may be able to file an appeal, negotiate with the insurance company, and even represent you in court if necessary.
Can You Apply for SSDI and Workers’ Comp at the Same Time?
If you receive a workers’ comp settlement, it does not impact your ability to file for SSDI. Many injured workers are facing permanent changes to their health, bodies, and lifestyles after an accident. In this case, you may qualify for both SSDI and workers comp; however, the total settlement number you receive from a workers’ comp claim will impact how much you can receive from Social Security disability payments.
For this reason, we usually advise our clients to wait until their workers’ compensation case is concluded before filing for SSDI. When negotiating a workers’ compensation claim, our firm will attempt to maximize the amount that you can receive from the insurance company by including calculated future expected costs for your medical care. This might involve ongoing prescriptions, medications, physical therapy, occupational therapy, home health aides, and other projected future expenses associated with your accident.
Your SSDI payments can be reduced by the final number of your workers’ comp claim; likewise, the insurance company can be let off the hook for an amount that they owe if SSDI is expected to fund the difference.
What Is a Clincher Agreement?
One powerful tool in a workers’ compensation attorney’s arsenal is the ability to negotiate for a clincher agreement (also known as a compromise settlement agreement). Projected future costs are one of the main drivers in insurance company settlements. Often, how much you receive from a case hinges upon your attorney’s ability to project future compensation you will require, as well as appropriately account for past costs, including your pain and suffering.
With a clincher agreement, a workers’ comp firm might agree to waive your future rights to negotiate for covered costs under the Workers’ Compensation Act to receive a higher settlement number upfront from the insurance company during the claim.
A clincher agreement may or may not be to your advantage. However, having the ability to negotiate with one can help you receive the maximum outcome from your workers’ comp claim. For this reason, an experienced law firm will likely advise that you wait to file for SSDI until your workers’ comp claim is concluded.
What Is the “Offset Rule”?
Under the 1965 Social Security Amendments, SSDI or “disability” payments are reduced when a worker is also eligible to receive ongoing or lump sum workers’ compensation payments. The combined total earnings should not surpass 80% of a worker’s average current earnings. This is known as the offset rule.
Essentially, one source of benefits “offsets” the other so that an injured worker cannot receive more than they were earning through their original employment. The figure is capped at 80% of the average current earnings, which is calculated based on a worker’s average monthly wage, or average monthly earnings in the calendar year of highest earnings from covered employment during the 5 years (ending with the year in which disability began).
How Do You Know if You Qualify for Social Security Disability?
In general, almost all workers are covered by workers’ compensation insurance from day 1 of their employment. Exceptions to coverage do exist, but the length of employment at a certain job or company is not one of them. However, to qualify for Social Security disability, a worker must have worked long enough to have earned a certain amount of Social Security work credits.
What Is the 20/40 Rule?
Under the 20/40 Rule, most workers must have earned 40 credits, 20 of which were earned in the last 10 years ending with the year that the disabling event, accident, or illness occurred. Younger workers may be admitted without the full amount of 40 credits under certain circumstances. The amount that the average worker earns in Social Security credits varies by employment, and it also changes year to year under federal guidelines.
Consider this example: in 2025, earning $1,810 in wages or self-employment income per quarter will earn a worker 1 credit under SSA rules. Therefore by earning $7,240 in one year, a worker has earned 4 credits in 2025, which is generally the minimum qualifying rate annually.
Besides earning enough credits through prior employment or self-employed wages, a worker must also meet the federal criteria for disability. This includes a list of covered impairments as well as certain “compassionate exceptions”, and the ability to answer no to the following questions:
- Are you currently working and earning more than $1,620 in average monthly earnings? (Or $2,700 in average monthly earnings for the blind.)
- Can you perform basic work-related activities like sitting, standing, walking, and remembering, for at least 12 consecutive months?
- Can you do the work you performed prior to the injury or disabling event?
- Can you do any other kind of work with your existing skills, education, age, medical diagnosis, and past work experience?
Disability vs. Retirement Benefits
One common source of confusion to clear up: Social Security disability benefits are different from Social Security retirement benefits. The amount that you receive from a workers’ compensation settlement has no bearing on how much you eventually receive from Social Security when you retire. SSDI is a different pool of funding entirely than Social Security retirement benefits.
How Do You File a Workers’ Compensation Claim?
To file a successful workers’ compensation claim, it is advisable to do the following.
Seek Medical Care
Do not wait to go to the doctor if you have been injured at work. Your employer must provide a list of covered doctors under the workers’ compensation insurance. However, some accidents require emergency attention.
Go to the doctor right away if you have been hurt. Waiting to be seen can not only be detrimental to your health, but it may also reduce your future claim amount if the insurance company can argue that an aggravating condition or secondary accident worsened your outcome in the time before you received an official diagnosis.
Report the Incident to Your Supervisor
Speaking to your coworkers is not enough to file a workers’ compensation claim. Your employer must fill out certain documentation and submit the claim to their insurance company. Speak to HR and/or your supervisor as soon as possible after a workplace accident.
Document the Accident as Much as Possible
You may be able to ask your coworkers for eyewitness accounts that support your claim. If you work in a warehouse, for a rideshare company, or other routinely monitored areas there may also be video footage of your accident.
Fill out a First Report of Injury Form
For some state workers’ comp reporting requirements, your employer may ask you to fill out a First Report of Injury form to file with their claim.
Consult with a Workers’ Comp Attorney
When in doubt about any stage of filing, or if you have been denied or offered insufficient benefits from a workers’ comp claim, contact an attorney for a consultation. Your employer must file on your behalf. If they have told you they do not offer workers’ compensation insurance or that you do not qualify, speak with an attorney immediately.
What Do You Do if Your Claim Is Approved for Less than You Thought?
Once your employer has filed your workers’ comp claim you should receive a follow-up that your claim has been reviewed and was either approved or denied. If you receive too small an offer for your injury, contact a workers’ comp attorney. You may be able to negotiate to receive additional benefits, a lump sum payment, or a larger structured settlement.
Pond Lehocky can file your appeal within the appropriate timeline and build up a compelling case for compensation. We know what amounts are standard from insurers, what kinds of evidence to include, and when to say no to a low-ball offer and go to trial.
What Do You Do if a Claim Is Denied?
If your claim has been denied outright, talk to an attorney. You may have additional options available to you under workers’ compensation laws, such as the right to request reconsideration or the right to review under the state workers’ compensation board.
An insurance denial is not necessarily the end of the road to receiving benefits; however, many workers never know how to file an appeal. Working with a law firm not only ensures that your claim is heard but also that it is structured with as much support as possible for adequate compensation after an injury.
Let a Workers’ Compensation Lawyer Help You with Your Claim
The offices of Pond Lehocky handle workers comp claims in all 50 states. With our in-depth knowledge of workers’ rights, Social Security disability, and employment compensation law, Pond Lehocky is a preeminent source of legal guidance. Our attorneys have won millions for our clients throughout the U.S.
With over 250 years of combined experience and a track record of over 100,000 successful cases, our expert workers’ compensation attorneys are more than qualified to represent you. To schedule a free, no-obligation consultation with our legal team, call or fill out our contact form today.
