BASIC (09-08)

Workers’ Compensation/Public Disability Benefit (WC/PDB) offset can be imposed on a number holder (NH) and his family until the NH attains age 65 before December 19, 2015. Effective December 19, 2015 or later, WC offset termination now extends from age 65 to full retirement age (FRA). See 2015 Amendment in DI 52101.005. When the NH becomes eligible for RIB, the NH should consider the option to file for RIB.

A. Processing Center (PC)

The Workers Comp Megacap Alert Code G is generated when the NH is 61 years and 9 months old and WC/PDB offset is involved. The criteria for selection is outlined in SM 00619.057. The PC claims authorizer/claims technical examiner (CA/CTE) receives the alert.

1. Compare the amount payable to the family under RIB entitlement to the current disability insurance benefit (DIB) after offset.

• If only the NH is entitled, calculate the reduced RIB amount and compare to the current benefit after offset. For computation instructions, see RS 00615.110.

• Consider that the RIB primary insurance amount (PIA) and DIB PIA may be different.

• If auxiliaries are also entitled, consider possible increase based on the table maximum as opposed to the disability maximum. For information regarding applying the family maximum, see RS 00615.730.

• Consider the effect of RIB entitlement on certain State public disability benefits (PDB). For State PDB information, see DI 52135.001.

2. Develop a RIB claim

Develop the RIB claim, if RIB entitlement could be advantageous.

• Contact the NH directly by telephone and make a RIB appointment with the servicing field office (FO). (For use of the appointment system, see MSOM APPTS 001.001); or

• Send a PCACS Request for Field Office Assistance to the servicing FO. Instruct the FO to secure a RIB application as explained in DI 52150.030 B. For instructions on making a request for assistance, see MSOM PCACS 009.005.

B. FO action

1. NH filing a DIB claim

Consider the possibility of RIB entitlement to avoid WC/PDB offset of DIB when adjudicating a DIB claim if the NH is at least within four months of age 62 attainment or older.

2. Request for assistance from the PC to develop a RIB claim

Compare the amount payable to the family under RIB entitlement to the current DIB after offset. See DI 52150.030A.1. in this section.

3. Issues to consider when interviewing the NH

• Discuss with the NH the results of the comparison of DIB benefit after offset and the reduced RIB amount, as well as benefits due the entire family.

• The NH remains technically entitled to DIB while receiving RIB benefits.

• Medicare entitlement continues based on DIB entitlement factors, if it is advantageous.

• An adjustment to the RIB reduction (ARF) is completed when the NH attains full retirement age (FRA). For information about the ARF, see RS 00615.482.

• Many States offset WC/PDB payments when the NH elects to receive RIB. For State-specific information, see DI 52120.001. Advise the NH to contact the entity making the WC/PDB payments to determine if this makes the RIB option disadvantageous.

4. Obtain a RIB claim if RIB option is advantageous

The RIB application represents a new type of entitlement and regular retroactivity rules apply to the RIB month of entitlement. If the RIB option is advantageous:

• Adjudicate the RIB claim. Because the NH has simultaneous DIB entitlement, A101 processing is required. Include a request on the BCRN of the A101 for the PC to establish a diary code 018. Provide instructions that a diary is required for the month of FRA attainment to process the ARF increase, as explained in RS 00615.482C.

• Advise the NH to continue to report changes in WC/PDB payments. Include MADCAP paragraph WCP032 on the BCRN screen of the A101. WCP032 reminds the NH to report changes in WC/PDB.

5. NH chooses not to file for RIB

If the NH chooses not to file for RIB, document the discussion and the reason for not filing on the EVID screen in shared processes. For instructions on completion of EVID, see GN 00301.288.

C. Change in election based on a decrease in WC/PDB payment

If the NH elected RIB and a subsequent decrease in WC/PDB appears to make the DIB benefit more advantageous:

1. Obtain proof of the payment change.

2. Determine if DIB benefits after the change in offset are higher than the RIB benefit currently being paid.

A NH can request a change back to DIB entitlement with a signed request. For subsequent changes in election, see RS 00615.110.

Because the NH continues to be entitled to both DIB and RIB, there is no restriction on the month of election for a change in benefits.

D. DIB election at age 65

For NHs born 01/02/1938 or later, full retirement age (FRA) is later than age 65, but WC/PDB offset still terminates at age 65 before December 19, 2015.

Effective December 19, 2015 or later, WC offset termination now extends from age 65 to FRA.

NOTE: Since WC offset now continues to FRA for individuals attaining age 65 on December 19, 2015 or later, there will be no need for the comparison (reduced RIB to higher DIB) See 2015 amendment in DI 52101.005.

A RETAP alert, “NH Age 65-Dev DIB Election”, generates in the PC when:

• NH is age 64 and 9 months;

• Concurrently entitled to DIB and RIB but elected reduced RIB; AND

• WC/PDB offset applied to the DIB.

For the RETAP alert, see SM 00619.096 .

The claims authorizer (CA) determines if DIB is advantageous. For information regarding the NH’s election, see RS 00615.110.

If DIB is advantageous, contact the NH to offer the option of electing DIB payment at age 65.

E. References

• DI 52101.005 — Social Security Amendments with Workers’ Compensation/Public Disability Benefits (WC/PDB) Offset Provisions