NL 00720.395:
Workers' Compensation (WCP)
Effective Dates: 09/13/2017 - Present- Effective Dates: 01/31/2018 - Present
- TN 8 (09-17)
- NL 00720.395 Workers' Compensation (WCP)
- WCP001 NUMBERHOLDER EXPRESSED INTENT TO FILE FOR WORKERS' COMPENSATION, ANOTHER DISABILITY PAYMENT OR BOTH (J59)
- (Requested)
- Caption: Information About Other Disability Benefits
- We learned that (1) to file a claim for workers' compensation and/or public disability benefit. If (2) these payments, we may have to reduce (3) Social Security benefits.
- At that time, (4) may have to pay back any Social Security benefits that (5) not due. If (6) a claim, please tell us the decision made on the claim right away.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: Number Holder's full name plans
- Choice 2: you plan
- Fill-in (2) - Systems Generated
- Choice 1: you receive
- Choice 2: he receives
- Choice 3: she receives
- Fill-in (3) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Choice 4: your and your family's
- Choice 5: his and his family's
- Choice 6: her and her family's
- Fill-in (4) - Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- Choice 4: you and your family
- Choice 5: he and his family
- Choice 6: she and her family
- Fill-in (5) - Systems Generated
- Choice 1: you were
- Choice 2: he was
- Choice 3: she was
- Choice 4: you and your family were
- Choice 5: he and his family were
- Choice 6: she and her family were
- Fill-in (6) - Systems Generated
- Choice 1: you file
- Choice 2: he files
- Choice 3: she files
- WCP003 DEFINITION OF WORKERS' COMPENSATION OFFSET (J48)
- (Requested)
- Caption: Information About Other Disability Benefits
- We have to consider workers' compensation and/or public disability payments when we figure a Social Security benefit. The following will explain how these payments affect Social Security benefits. For more information, please read the enclosed pamphlet, "How Workers' Compensation and Other Disability Payments May Affect Your Social Security Benefit."
- WCP004 NUMBERHOLDER RECEIVING WORKERS' COMPENSATION OR OTHER DISABILITY PAYMENTS - NO OFFSET (J44)
- (Requested)
- Caption: Your Benefits
(1) present (2) payments of (3) do not affect (4) Social Security benefits.- (1) present (2) payments of (3) do not affect (4) Social Security benefits.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: NH Name possessive
- Choice 2: Your
- Fill-in (2) - Requested As A One Position Alpha Character
- Choice 1: (A) workers' compensation
- Choice 2: (B) public disability
- Choice 3: (C) workers' compensation and public disability
- Fill-in (3) - Requested As A Money Amount in Format $$$$$.¢¢
- Amount
- Fill-in (4) - Systems Generated
- Choice 1: his
- Choice 2: her
- Choice 3: your
- Choice 4: his and his family's
- Choice 5: her and her family's
- Choice 6: your and your family's
- WCP005 WORKERS' COMPENSATION/PUBLIC DISABILITY BENEFIT - OFFSET DETERMINED BY AVERAGE CURRENT EARNINGS (ACE) (J37)
- (Requested)
- Caption: Your Benefits
- The pamphlet explains how we reduce (1) Social Security disability benefits. We add the money (2) would receive from us and from (3) . When this total adds up to more than 80 percent of (4) average currently monthly earnings, we reduce (5) Social Security disability benefits. We found that 80 percent of (6) average currently monthly earnings is (7) .
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: your
- Choice 2: you and your family's
- Choice 3: your family's
- Choice 4: number holder's name possessive
- Choice 5: number holder's name and his family's
- Choice 6: number holder's name and her family's
- Choice 7: number holder's name possessive plus family's
- Fill-in (2) - Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- Choice 4: you and your family's
- Choice 5: he and his family's
- Choice 6: she and her family's
- Fill-in (3) - Requested As A One Position Alpha Character
- Choice 1: (A) workers' compensation
- Choice 2: (B) public disability benefit payments
- Choice 3: (C) workers' compensation and public disability benefit payments
- Fill-in (4) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (5) - Systems Generated
- Choice 1: your
- Choice 2: you and your family's
- Choice 3: your family's
- Choice 4: her
- Choice 5: his
- Choice 6: her and her family's
- Choice 7: his and his family
- Choice 8: her family's
- Choice 9: his family's
- Fill-in (6) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (7) Requested As A Money Amount
- Earning amount
- WCP008 WORKERS' COMPENSATION OR OTHER DISABILITY CLAIM PENDING AUXILIARY ONLY (J30)
- (Requested)
- Caption: Information About Other Disability Benefits
- If (1) receives workers' compensation and/or public disability payments, we may have to reduce (2) Social Security benefits. At that time, we may also have to recover any money that should not have been paid.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: Number holder's name
- Fill-in (2) - Systems Generated
- Choice 1: Full name possessive
- Choice 2: your
- WCP009 NUMBERHOLDER APPEALING WORKERS' COMPENSATION DECISION - NUMBERHOLDER ONLY (J38)
- (Requested)
- Caption: Your Responsibilities
We will not reduce (1) benefit because of (2) payments until (3) a decision on (4) appeal of the claim. Please let us know the decision on the appeal right away. At that time, (5) may have to pay back any Social Security benefits that (6) not due.- We will not reduce (1) benefit because of (2) payments until (3) a decision on (4) appeal of the claim. Please let us know the decision on the appeal right away. At that time, (5) may have to pay back any Social Security benefits that (6) not due.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: Number holder's full name possessive
- Choice 2: your
- Fill-in (2) - Requested As A One Position Alpha Character
- Choice 1: (A) workers' compensation
- Choice 2: (B) public disability benefit
- Choice 3: (C) workers' compensation and public disability benefit
- Fill-in (3) - Systems Generated
- Choice 1: you receive
- Choice 2: he receives
- Choice 3: she receives
- Fill-in (4) Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (5) Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- Fill-in (6) Systems Generated
- Choice 1: you were
- Choice 2: he was
- Choice 3: she was
- WCP010 TOTAL OR PARTIAL WORKERS' COMPENSATION OFFSET NUMBERHOLDER ONLY (J21)
- (Requested)
- Caption: Your Benefits
- We have to take into account (1) (2) of (3) (4) (5) when we figure (6) Social Security benefits. Due to this payment, we are (7) (8) benefits.
- NOTE: ENB coding for Fill-in 5, choice 2: MM/YYYY-THROUGH-MM/YYYY. For example, 09/2014-THROUGH-11/2014.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: your
- Choice 2: Number Holder's Name possessive
- Fill-in (2) - Requested As A One Position Alpha Character
- Choice 1: (A) workers' compensation payment
- Choice 2: (B) public disability payment
- Choice 3: (C) workers' compensation and public disability payments
- Fill-in (3) - Requested As A Money Amount in Format $$$$$.¢¢ Amount (Workers' Compensation or Public Disability Benefit or combined)
Fill-in (4) - Requested As A One Position Alpha Character- Fill-in (4) - System Generated
Choice 1: (A) beginning- Choice 1: beginning
Choice 2: (B) for- Choice 2: for
- Fill-in (5) - Requested As Date In Formats Shown Below
- Choice 1: MM/CCYY
- Choice 2: MM/CCYY through MM/CCYY
- Fill-in (6) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (7) Requested As A One Position Alpha Character
- Choice 1: (A) withholding
- Choice 2: (B) reducing
- Fill-in (8) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- WCP012 OFFSET IMPOSED FIRST MONTH NUMBERHOLDER RECEIVES DISABILITY INSURANCE BENEFITS AND WORKERS' COMPENSATION, OTHER DISABILITY PAYMENT OR BOTH (J19)
- (Requested)
- Caption: Your Benefits
- We are (1) (2) monthly payment beginning (3) . This is the first month when (4) entitled to Social Security disability benefits and (5) payments.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: withholding
- Choice 2: reducing
- Fill-in (2) - Systems Generated
- Choice 1: Beneficiary's Name Possessive
- Choice 2: your
- Fill-in (3) - Requested As A Date In Format Shown Below
- Choice 1: MM/CCYY (first month of offset)
- Fill-in (4) - Systems Generated
- Choice 1: he is
- Choice 2: she is
- Choice 3: you are
- Fill-in (5) - Systems Generated
- Choice 1: workers' compensation
- Choice 2: public disability
- Choice 3: both workers' compensation and public disability
- WCP013 CHANGE IN REDUCTION OF WORKERS' COMPENSATION BENEFITS (BECAUSE OF CHANGE IN STATE LAW) (J85)
- (Requested
- Caption: Your Benefits
- Beginning (1) , we are paying (2) a Social Security benefit that is not reduced due to (3) payments. This is because of a change caused by the State law which provides for the reduction of these payments to persons who receive Social Security disability benefits.
- Fill-in values:
- Fill-in (1) - Requested As A Date In Format Shown Below
- Choice 1: MM/CCYY
- Fill-in (2) - Systems Generated
- Choice 1: Number holder's name
- Choice 2: you
- Fill-in (3) - Requested As A One Position Alpha Character
- Choice 1: (A) workers' compensation
- Choice 2: (B) public disability
- Choice 3: (C) workers' compensation and public disability
- WCP015 INCREASE IN BENEFITS DUE TO A REDETERMINATION (J31)
- (Requested)
- Caption: Your Benefits
- Based on (1) (2) , every 3 years we check to see if an increase in the national earnings level affects the amount of (3) monthly Social Security benefit. When we checked (4) monthly benefit amount, we found that (5) g due more money.
- NOTE : IF W/C is Offset Postponed (O/S), do not request WCP015. This will generate a systems bad.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: Beneficiary's Last Name possessive
- Choice 2: your
- Fill-in (2) - Systems Generated
- Choice 1: workers' compensation
- Choice 2: public disability
- Choice 3: workers' compensation and public disability
- Fill-in (3) - Systems Generated
- Choice 1: his
- Choice 2: her
- Choice 3: your
- Fill-in (4) - Systems Generated
- Choice 1: his
- Choice 2: her
- Choice 3: your
- Fill-in (5) - Systems Generated
- Choice 1: he is
- Choice 2: she is
- Choice 3: you are
- WCP017 INCREASE IN BENEFITS AFTER WORKERS' COMPENSATION - OFFSET FIRST IMPOSED (J32)
- (Requested)
- Caption: Your Benefits
(1) benefits were increased beginning (2) (3) (4) (5) not reduced because of (6) payments.- (1) benefits were increased beginning (2) (3) (4) (5) not reduced because of (6) payments.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: Beneficiary name possessive
- Choice 2: Number holder's first name possessive
- Choice 3: Beneficiary given and last name possessive
- Choice 4: Your
- Choice 5: Beneficiary given possessive
- Fill-in (2) - Requested As A Date In Format Shown Below
- Choice 1: MM/CCYY or MM/CCYY through MM/CCYY or MM/CCYY and MM/CCYY
- Fill-in (3) - Systems Generated
- Choice 1: null
- Choice 2: null
- Fill-in (4) - Systems Generated
- Choice 1: null
- Choice 2: null
- Fill-in (5) - Systems Generated
- Choice 1: This increase was
- Choice 2: These increases were
- Fill-in (6) - Systems Generated
- Choice 1: workers' compensation
- Choice 2: public disability
- Choice 3: workers compensation and public disability
- WCP018 REMOVAL OF OFFSET WORKERS' COMPENSATION OR OTHER DISABILITY PAYMENTS TERMINATED (J27)
- (Requested)
- Caption: Your Benefits
- We do not reduce benefits once (1) payments have stopped. Therefore, we are paying benefits at the full rate beginning (2) . Please let us know right away if (3) workers' compensation and/or other public disability payments again.
- Fill-in values:
- Fill-in (1) - Requested As A One Position Alpha Character
- Choice 1: (A) workers' compensation
- Choice 2: (B) public disability
- Choice 3: (C) workers' compensation and public disability
- Fill-in (2) - Requested As A Date In Format Shown Below
- Choice 1: MM/CCYY
- Fill-in (3) - Systems Generated
- Choice 1: Number holder's name receives
- Choice 2: you receive
- WCP019 REMOVAL OF OFFSET NUMBERHOLDER AGE 62 OR 65 (J28) – (BORN 12/19/1950 OR EARLIER)
- (Requested)
- Caption: Your Benefits
- Beginning (1) , we are not reducing (2) benefit because of (3) payments. We do not reduce benefits for months when the disabled worker is age (4) or over.
- Fill-in values:
- Fill-in (1) - Requested As A Date In Format Shown Below
- Choice 1: MM/CCYY number holder attains age 62 or 65
- Fill-in (2) - Systems Generated
- Choice 1: Number holder's name possessive
- Choice 2: Number holder's first name possessive (NOT USED BY MADCAP)
- Choice 3: Beneficiary given and last name possessive
- Choice 4: Your
- Fill-in (3) - Requested As A One Position Alpha Character
- Choice 1: (A) workers' compensation
- Choice 2: (B) public disability
- Choice 3: (C) workers' compensation and public disability
- Fill-in (4) - Requested As A One Position Alpha Character
- Choice 1: (A) 62
- Choice 2: (B) 65
- WCP021 POSSIBLE EXCLUDABLE EXPENSES WORKERS' COMPENSATION (J33)
- (Requested)
- Caption: Information About Other Disability Benefits
- If (1) had expenses related to (2) claim for (3) payments, please give us proof that (4) paid these expenses. These expenses may include medical, legal, or other related expenses. We may be able to deduct some of these expenses when we figure (5) Social Security benefits.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: Number holder's name
- Choice 2: you
- Fill-in (2) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (3) - Requested As A One Position Alpha Character
- Choice 1: (A) workers' compensation
- Choice 2: (B) workers' compensation and public disability benefit
- Choice 3: (C) public disability benefit
- Fill-in (4) - Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- Fill-in (5) - Systems Generated
- Choice 1: your and your family's
- Choice 2: number holder's name possessive
- Choice 3: your family's
- Choice 4: your
- Choice 5: Number holder's name possessive + and his family's
- Choice 6: Number holder's name possessive + and her family's
- Choice 7: Number holder's name possessive + family's
- WCP026 BENEFICIARY NO LONGER ENTITLED TO BENEFITS (J80)
- (Requested)
- Caption: Your Benefits
- We changed (1) monthly benefit to (2) beginning (3) because benefits to another entitled person stopped. When we figured (4) benefit, we had to take into account (5) (6) payments.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: Beneficiary's name possessive
- Choice 2: your
- Fill-in (2) - Requested As A Money Amount In Format $$$$$.¢¢
- Choice 1: Amount
- Fill-in (3) - Requested As A Date In Format Shown Below
- Choice 1: MM/CCYY
- Fill-in (4) - Systems Generated
- Choice 1: his
- Choice 2: her
- Choice 3: your
- Fill-in (5) - Systems Generated
- Choice 1: NH Name possessive
- Fill-in (6) - Systems Generated
- Choice 1: workers' compensation
- Choice 2: public disability
- Choice 3: workers' compensation and public disability
- WCP028 BENEFITS OFFSET NUMBERHOLDER MAY FILE FOR REDUCED RIB (J20) – (BORN 12/19/1950 OR EARLIER)
- WCP028
- (Requested)
- Caption: Things To Remember
- We may continue to reduce or withhold (1) disability benefits until (2) age 65. We must take this action because of (3) (4) payments. (5) payments do not affect retirement benefits. (6) may be eligible for retirement benefits at age 62. To apply, please get in touch with us three months before (7) age 62.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: your
- Choice 2: your and your family's
- Choice 3: Number holder's name possessive
- Choice 4: your family's
- Choice 5: Number holder's name possessive and his family's
- Choice 6: Number holder's name possessive and her family's
- Choice 7: Beneficiary full name possessive plus family's
- Fill-in (2) - Systems Generated
- Choice 1: you reach
- Choice 2: he reaches
- Choice 3: she reaches
- Fill-in (3) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (4) - Requested As A One Position Alpha Character
- Choice 1: (A) workers' compensation
- Choice 2: (B) workers' compensation and public disability benefit
- Choice 3: (C) public disability benefit
- Fill-in (5) - Requested As A One Position Alpha Character
- Choice 1: (A) Workers' compensation
- Choice 2: (B) Workers' compensation and public disability benefit
- Choice 3: (C) Public disability benefit
- Fill-in (6) - Systems Generated
- Choice 1: You
- Choice 2: He
- Choice 3: She
- Fill-in (7) - Systems Generated
- Choice 1: you reach
- Choice 2: he reaches
- Choice 3: she reaches
- WCP029 WORKERS' COMPENSATION OR OTHER DISABILITY CLAIM PENDING - NUMBERHOLDER ONLY (J29)
- (Requested)
- Caption: Your Responsibilities
- If (1) workers' compensation and/or public disability benefit payments, we may have to reduce (2) Social Security benefits.
- At that time, (3) may also have to pay back any Social Security benefits that (4) not due. Please let us know the decision on the claim right way.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: Number holder's full name receives
- Choice 2: you receive
- Fill-in (2) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (3) - Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- Fill-in (4) - Systems Generated
- Choice 1: you were
- Choice 2: he was
- Choice 3: she was
- WCP032 ALL LETTERS INVOLVING RECEIPT OF WORKERS' COMPENSATION OR OTHER DISABILITY PAYMENTS NUMBERHOLDER (J43)
- (Systems Generated)
- Caption: Your Responsibilities
- Please let us know right away about any:
- * Changes in (1) workers' compensation or public disability benefit payments
- * Lump-sum award(s) (2)
* Other payments (3) that increase or decrease (4) workers' compensation or public disability benefit payments- * Other payments (3) that increase or decrease (4) workers' compensation or public disability benefit payments
- Fill-in values:
- Fill-in (1) Systems Generated
- Choice 1: Beneficiary full name possessive
- Choice 2: your
- Fill-in (2) Systems Generate
- Choice 1: you receive
- Choice 2: he receives
- Choice 3: she receives
- Fill-in (3) Systems Generated
- Choice 1: you receive
- Choice 2: he receives
- Choice 3: she receives
- Fill-in (4) Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- WCP048 TOTAL OR PARTIAL OFFSET - AUXILIARY ONLY (J22)
- (Requested)
- Caption: Your Benefits
- We have to take into account (1) (2) payments when we figure (3) Social Security benefits. Because of these payments, we are (4) the benefits (5) due (6) (7) .
- NOTE: If the Technician input a date for Fill-in 7 the word “through” will be generated. If the technician selects “A” for null then the notice will end after Fill-in 6.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: Name of Numberholder (possessive)
- Choice 2: your
- Fill-in (2) - Systems Generated
- Choice 1: workers' compensation
- Choice 2: public disability
- Choice 3: workers' compensation and public disability
- Fill-in (3) - Systems Generated
- Choice 1: your
- Choice 2: Auxiliary name possessive
- Fill-in (4) - Requested As A One Position Alpha Character
- Choice 1: (A) withholding
- Choice 2: (B) reducing
- Fill-in (5) - Systems Generated
- Choice 1: you are
- Choice 2: he is
- Choice 3: she is
- Fill-in (6) - Requested As A Date In Format Shown Below
- MM/CCYY
- Fill-in (7) - Requested As A Date In Format Shown Below
- Choice 1: Null
- Choice 2: Through
- WCP049 AMOUNT OF BENEFIT RECEIVED AFTER OFFSET (J23)
- (Requested)
- Caption: Your Benefits
- Benefit Amount Beginning Date Reason
(1) (2) (3) g- (1) (2) (3) g
- NOTE : This Universal Text Identifier is flexible, to allow multiple repetitions of the three fill-ins. This allows it to be used once, and provide as many benefit amount, dates and reasons as are needed to explain the action, or twice with the benefit amount, date and reason. When there is more than one row of data to display under the headers in the chart, WCP059 is automatically generated. An example of how to input this in the ENB screen is:
- C*WCP049,500.00,09/2010,A,530.00,01/2011,C. (This method invokes WCP059, beginning with the second entry.) OR
- WCP049,500.00,05/2013,I*WCP049,530.00,06/2013,A.
- Fill-in values:
- Fill-in (1) - Requested As A Money Amount In Format $$$$$.¢¢
- Benefit Amount
- Fill-in (2) - Requested As A Date In Format Shown Below
- MM/CCYY
- Fill-in (3) - Requested As An One Position Alpha Character
- Choice 1 (A): Entitlement began
- Choice 2 (B): Cost of living adjustment
- Choice 3 (C): Credit for additional earnings
- Choice 4 (D): Your own benefit increased
- Choice 5 (E): His own benefit increased
- Choice 6 (F): Her own benefit increased
- Choice 7 (G): Because we stopped paying another person on this record
- Choice 8 (H): Because we started paying another person on this record
- Choice 9 (I): Because of the receipt of worker's compensation payments
- Choice 10 (J): Because of the receipt of public disability payments
- Choice 11 (K): Because of the receipt of worker's compensation and public disability payments
- WCP050 SUBSEQUENT ADJUSTMENT TO PRORATION PERIOD BASED ON NEW EVIDENCE (J75)
- (Requested)
- Caption: Your Benefits
- We told (1) earlier that we would pay (2) full Social Security benefits beginning (3) . Because of new facts we have received, we will now pay (4) full benefits beginning (5) .
- Fill-in values:
- Fill-in (1) Systems Generated
- Choice 1: you
- Choice 2: Beneficiary's name
- Fill-in (2) Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (3) - Requested As A Date In Format Shown Below
- MM/CCYY when Numberholder was informed full Disability Insurance Benefit was payable
- Fill-in (4) - Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- Fill-in (5) - Requested As A Date In Format Shown Below
- MM/CCYY when full Disability Insurance Benefit actually payable
- WCP051 CHANGE IN AMOUNT OF THE AVERAGE CURRENT EARNINGS (ACE) (J76)
- (Requested)
- Caption: Your Benefits
- We told (1) earlier that we might change the amount of (2) benefits when we got more facts about the money (3) earned while (4) working. Using the new facts about (5) earnings, we found that 80 percent of (6) average current earnings was (7) . For this reason, we are increasing (8) Social Security benefits beginning (9) .
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: you
- Choice 2: Beneficiary's name
- Fill-in (2) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (3) - Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- Fill-in (4) - Systems Generated
- Choice 1: you were
- Choice 2: he was
- Choice 3: she was
- Fill-in (5) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (6) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (7) - Requested As A Money Amount In Format $$$$$.¢¢
- Amount of the Average Current Earnings
- Fill-in (8) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (9) - Requested As A Date In Format Shown Below
- MM/CCYY
- WCP052 RESUMPTION OF OFFSET - NUMBERHOLDER ONLY (J77
- (Requested)
- Caption: Your Benefits
- Beginning (1) , we paid (2) full Social Security checks because (3) (4) payments stopped. Now that (5) these payments of (6) each week, we reduced (7) Social Security benefits beginning (8) . (9) new benefit is shown above.
- Fill-in values:
- Fill-in (1) - Requested As A Date In Format Shown Below
- MM/CCYY
- Fill-in (2) - Systems Generated
- Choice 1: you
- Choice 2: beneficiary's name
- Fill-in (3) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (4) - Systems Generated
- Choice 1: Worker's compensation
- Choice 2: Public disability
- Choice 3: Worker's compensation and Public disability
- Fill-in (5) - Systems Generated
- Choice 1: you again receive
- Choice 2: he again receives
- Choice 3: she again receives
- Fill-in (6) - Requested As A Money Amount In Format $$$$$.¢¢
- Amount of weekly Workers' Compensation
- Fill-in (7) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (8) - Requested As A Date In Format Shown Below
- MM/CCYY
- Fill-in (9) - Systems Generated
- Choice 1: Your
- Choice 2: His
- Choice 3: Her
- WCP053 RESUMPTION OF OFFSET - AUXILIARIES ONLY (J78)
- (Requested)
- Caption: Your Benefits
- Beginning (1) , we paid (2) full Social Security checks because (3) (4) payments stopped. Now that these payments have started again, we reduced (5) Social Security benefits beginning (6) . (7) new benefit rate is shown above.
- Fill-in values:
- Fill-in (1) - Requested As A Date In Format Shown Below
- MM/CCYY
- Fill-in (2) Systems Generated
- Choice 1: you
- Choice 2: Beneficiary's name
- Fill-in (3) Systems Generated
- Choice 1: Numberholder's full name (possessive)
- Fill-in (4) Systems Generated
- Choice 1: workers' compensation
- Choice 2: public disability
- Choice 3: workers' compensation and public disability
- Fill-in (5) Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (6) Requested As A Date In Format Shown Below
- MM/CCYY offset resumed
- Fill-in (7) - Systems Generated
- Choice 1: Your
- Choice 2: His
- Choice 3: Her
- WCP054 VERIFIED RATE OF WORKERS' COMPENSATION, OTHER DISABILITY PAYMENT OR BOTH (J83)
- (Requested)
- Caption: Your Benefits
- We have learned that (1) weekly (2) payment is (3) rather than (4) , as we had previously been told. Therefore, we have changed (5) Social Security benefits beginning (6) g .
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: your
- Choice 2: Beneficiary's name possessive
- Fill-in (2) - Systems Generated
- Choice 1: workers' compensation
- Choice 2: public disability
- Choice 3: workers' compensation and public disability
- Fill-in (3) - Requested As A Money Amount In Format $$$$$.¢¢
- Amount of Workers' Compensation received
- Fill-in (4) - Requested As A Money Amount In Format $$$$$.¢¢
- Amount of Workers' Compensation reported
- Fill-in (5) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (6) - Requested As A Date In Format Shown Below
- MM/CCYY (date of adjustment)
- WCP055 THIRD PARTY INVOLVEMENT (J84)
- (Requested)
- Caption: Your Benefits
- We learned that (1) received a third-party settlement. Since this was not a workers' compensation payment, we will not have to reduce (2) benefit. We also learned that the workers' compensation (3) had already received was to be repaid because of the settlement. Since we do not have to reduce (4) benefits because of the workers' compensation, we will pay (5) the money we have withheld.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: you
- Choice 2: Beneficiary's name
- Fill-in (2) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (3) - Systems Generated
- Choice 1: you
- Choice 2: he
- Choice 3: she
- Fill-in (4) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (5) - Systems Generated
- Choice 1: you
- Choice 2: him
- Choice 3: her
- WCP057 REMOVAL OF OFFSET - LUMP-SUM PRORATION ENDED (J91)
- (Requested)
- Caption: Your Benefits
- Beginning (1) , we can pay (2) benefits at the full rate. This is because we are no longer considering the (3) lump-sum award when we figure the benefit amount.
- Please let us know right away if (4) workers' compensation and/or other public disability payments.
- Fill-in values:
- Fill-in (1) - Requested As A Date In Format Shown Below
- Date offset no longer applies
- Fill-in (2) - Systems Generated
- Choice 1: you
- Choice 2: Beneficiary Name
- Fill-in (3) - Requested As A One Position Alpha Character
- Choice 1:A workers' compensation
- Choice 2:B public disability
- Choice 3:C workers' compensation and public disability
- Fill-in (4) - Systems Generated
- Choice 1: you again receive
- Choice 2: he again receives
- Choice 3: she again receives
- WCP058 CHANGE IN WORKERS' COMPENSATION RATE, OTHER DISABILITY PAYMENT OR BOTH AND OFFSET ADJUSTED NUMBERHOLDER ONLY (J81)
- (Requested)
- Caption: Your Benefits
- We have learned that (1) weekly (2) payment was changed to (3) . For this reason, we have changed (4) Social Security benefits beginning (5) .
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: your
- Choice 2: Beneficiary's name possessive
- Fill-in (2) - Requested As A One Position Alpha Character
- Choice 1: (A) workers' compensation
- Choice 2: (B) public disability
- Choice 3: (C) workers' compensation and public disability
- Fill-in (3) - Requested As A Money Amount In Format $$$$$.¢¢
- Amount
- Fill-in (4) - Systems Generated
- Choice 1: your
- Choice 2: her
- Choice 3: his
- Fill-in (5) - Requested As A Date In Format Shown Below
- MM/CCYY
- WCP059 AMOUNT OF BENEFIT RECEIVED AFTER OFFSET (J23 DETAIL LINE)
- (Systems generated)
- Caption: Your Benefits
(1) (2) (3) g- (1) (2) (3) g
- NOTE : This Universal Text Identifier is automatically generated whenever WCP049 is requested and there is more than one row of data to display under the headers in the chart.
- Fill-in values:
- Fill-in (1) - Systems Generated As A Money Amount In Format $$$$$.¢¢
- Benefit Amount
- Fill-in (2) - Systems Generated As A Date In Format Shown Below
- MM/CCYY
- Fill-in (3) - Systems Generated As An One Position Alpha Character
- Choice 1 (A): Entitlement began
- Choice 2 (B): Cost of living adjustment
- Choice 3 (C): Credit for additional earnings
- Choice 4 (D): Your own benefit increased
- Choice 5 (E): His own benefit increased
- Choice 6 (F): Her own benefit increased
- Choice 7 (G): Because we stopped paying another person on this record
- Choice 8 (H): Because we started paying another person on this record
- Choice 9 (I): Because of the receipt of worker's compensation payments
- Choice 10 (J): Because of the receipt of public disability payments
- Choice 11 (K): Because of the receipt of worker's compensation and public disability payments
- WCP060 WORKERS' COMPENSATION/PUBLIC DISABILITY BENEFIT - REMOVAL OF OFFSET – NUMBERHOLDER ATTAINS FULL RETIREMENT AGE (FRA) (BORN 12/20/1950 OR LATER)
- (Requested)
- Caption: Your Benefits
- Starting (1) , we will stop reducing (2) Social Security disability benefits because of (3) (4) payments. We stop reducing disability benefits when (5) full retirement age.
- Fill-in values:
- Fill-in (1) - Systems Generated As A Date In Format Shown Below
- Choice 1: Show date of Full Retirement Age attainment in the format Month CCYY
- Fill-in (2) - Systems Generated
- Choice 1: your
- Choice 2: Beneficiary's name (possessive)
- Fill-in (3) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (4) - Requested As An One Position Alpha Character
- Choice 1: (A) workers' compensation
- Choice 2: (B) public disability benefit
- Choice 3: (C) workers' compensation and public disability benefit
- Fill-in (5) - Systems Generated
- Choice 1: you reach
- Choice 2: he reaches
- Choice 3: she reaches
- WCP061 WORKERS' COMPENSATION/PUBLIC DISABILITY BENEFIT - OFFSET TO FRA - NUMBERHOLDER MAY FILE FOR REDUCED RETIREMENT INSURANCE BENEFIT (BORN 12/20/1950 OR LATER)
- (Requested)
- Caption: Things To Remember
- We will continue to reduce or withhold (1) disability benefits until (2) full retirement age in (3) . We must take this action because of (4) (5) payments.
(6) (7) payments do not affect retirement benefits. (8) may be eligible for reduced retirement benefits at age 62. If (9) to apply for retirement benefits, please contact us three months before (10) age 62.- (6) (7) payments do not affect retirement benefits. (8) may be eligible for reduced retirement benefits at age 62. If (9) to apply for retirement benefits, please contact us three months before (10) age 62.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: your
- Choice 2: Number holder's name possessive
- Choice 3: your and your family's
- Choice 4: your family's
- Choice 5: Number holder's name possessive and his family's
- Choice 6: Number holder's name possessive and her family's
- Choice 7: Beneficiary full name possessive plus family's
- Fill-in (2) - Systems Generated
- Choice 1: you reach
- Choice 2: he reaches
- Choice 3: she reaches
- Fill-in (3) - Systems Generated As A Date In Format Shown Below
- Choice 1: Show date of Full Retirement Age attainment in the format Month CCYY
- Fill-in (4) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Fill-in (5) - Requested As An One Position Alpha Character
- Choice 1: (A) workers' compensation
- Choice 2: (B) public disability
- Choice 3: (C) workers' compensation and public disability
- Fill-in (6) - Systems Generated
- Choice 1: Your
- Choice 2: His
- Choice 3: Her
- Fill-in (7) - Requested As An One Position Alpha Character
- Choice 1: (A) workers' compensation
- Choice 2: (B) public disability
- Choice 3: (C) workers' compensation and public disability
- Fill-in (8) - Systems Generated
- Choice 1: You
- Choice 2: He
- Choice 3: She
- Fill-in (9) - Systems Generated
- Choice 1: you decide
- Choice 2: he decides
- Choice 3: she decides
- Fill-in (10) - Systems Generated
- Choice 1: you reach
- Choice 2: he reaches
- Choice 3: she reaches
- WCPR02 NUMBERHOLDER APPEALING WORKERS' COMPENSATION DECISION - AUXILIARY ONLY (J39)
- (Requested)
- Caption: Information About Other Disability Benefits
- We will not reduce (1) because of (2) (3) payments until a decision is made on the appeal of the claim. At that time, we may collect any money that should not have been paid.
- Fill-in values:
- Fill-in (1) Systems Generated
- Choice 1: Beneficiary's Name, possessive
- Choice 2: your
- Fill-in (2) Systems Generated
- Choice 1: number holder's name possessive
- Fill-in (3) Systems Generated
- Choice 1: workers' compensation
- Choice 2: public disability
- Choice 3: workers' compensation and public disability
- WCPR06 AMOUNT OF OFFSET BASED ON ESTIMATE FOR ONE OR MORE YEARS - HIGH 1 (J49)
- (Requested)
- Caption: Information About Other Disability Benefits
- When we figured how much to reduce (1) benefits, we used an estimate for part of (2) earnings before (3) became disabled. According to our records, the year in which (4) earned the most money between (5) and (6) was (7) . We estimated (8) earnings for that year to be (9) . If (10) (11) that this amount is wrong, please let us know. (12) will also need to give us any facts (13) to show that the amount is wrong.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: your and your family's
- Choice 2: number holder's name possessive
- Choice 3: your family's
- Choice 4: number holder's name and his family
- Choice 5: number holder's name and her family
- Choice 6: number holder's name possessive plus family's
- Fill-in (2) - Systems Generated
- Choice 1: your
- Choice 2: her
- Choice 3: his
- Fill-in (3) - Systems Generated
- Choice 1: you
- Choice 2: she
- Choice 3: he
- Fill-in (4) - Systems Generated
- Choice 1: you
- Choice 2: she
- Choice 3: he
- Fill-in (5) - Systems Generated
- Choice 1: date of onset minus 5 years
- Fill-in (6) - Systems Generated
- Choice 1: date of onset in year format
- Fill-in (7) - Requested As A Date In Format CCYY
- Choice 1: year of highest regular earnings
- Fill-in (8) - Systems Generated
- Choice 1: your
- Choice 2: her
- Choice 3: his
- Fill-in (9) - Requested As A Money Amount In Format $$$$$.¢¢
- Choice 1: highest regular earnings
- Fill-in (10) - Systems Generated
- Choice 1: you
- Choice 2: she
- Choice 3: he
- Fill-in (11) - Systems Generated
- Choice 1: think
- Choice 2: thinks
- Fill-in (12) - Systems Generated
- Choice 1: You
- Choice 2: She
- Choice 3: He
- Fill-in (13) - Systems Generated
- Choice 1: you have
- Choice 2: she has
- Choice 3: he has
- WCPR07 AMOUNT OF OFFSET BASED ON ESTIMATE FOR ONE OR MORE YEARS - HIGH 5 (J25)
- (Requested)
- Caption: Information About Other Disability Benefits
- When we figured how much to reduce (1) benefits, we used an estimate for part of (2) earnings before (3) became disabled. According to our records, the 5 years in which (4) earned the most money were (5) to (6) . We estimated that (7) earned (8) during this period. If (9) that this amount is wrong, please let us know. (10) will also need to give us any facts (11) g to show that the amount is wrong.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: your and your family's
- Choice 2: number holder's name possessive
- Choice 3: your familys
- Choice 4: your
- Choice 5: number holder's name and his family
- Choice 6: number holder's name and her family
- Choice 7: number holder's name possessive plus family's
- Fill-in (2) - Systems Generated
- Choice 1: your
- Choice 2: her
- Choice 3: his
- Fill-in (3) - Systems Generated
- Choice 1: you
- Choice 2: she
- Choice 3: he
- Fill-in (4) - Systems Generated
- Choice 1: you
- Choice 2: she
- Choice 3: he
- Fill-in (5) - Requested As A Date In Format Shown Below
- Choice 1: CCYY
- Fill-in (6) - Requested As A Date In Format Shown Below
- Choice 1: CCYY
- Fill-in (7) - Systems Generated
- Choice 1: you
- Choice 2: she
- Choice 3: he
- Fill-in (8) - Requested As A Money Amount In Format $$$$$.¢¢
- Choice 1: money amount
- Fill-in (9) - Systems Generated
- Choice 1: you think
- Choice 2: number holder's name thinks
- Fill-in (10) - Systems Generated
- Choice 1: You
- Choice 2: She
- Choice 3: He
- Fill-in (11) - Systems Generated
- Choice 1: has
- Choice 2: have
- WCPR09 INTERIM NOTICE PENDING AVERAGE CURRENT EARNINGS DETERMINATION (J57)
- (Requested)
- Caption: Information About Other Disability Benefits
- We may have to change the amount of (1) benefits when we receive proof of the amount of (2) average current earnings. We use these earnings to figure how much to deduct from (3) benefits.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: Full name possessive
- Choice 2: your
- Fill-in (2) - Systems Generated
- Choice 1: number holder's name
- Choice 2: your
- Choice 3: her
- Choice 4: his
- Fill-in (3) - Systems Generated
- Choice 1: Full name
- Choice 2: your
- Choice 3: her
- Choice 4: his
- WCPR13 OFFSET IMPOSED AFTER DATE OF NOTICE (J26)
- (Requested)
- Caption: Your Benefits
- We are reducing (1) benefits beginning (2) g because of workers' compensation payments. We must reduce benefits beginning with the month after the month in which we were told about these payments.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: Number holder's name possessive
- Choice 2: Number holder's first name possessive
- Choice 3: beneficiary given and last name possessive
- Choice 4: your
- Fill-in (2) - Systems Generated
- Choice 1: first month and year of offset
- WCPR15 CHANGE IN WORKERS' COMPENSATION RATE, OTHER DISABILITY PAYMENT OR BOTH AND OFFSET ADJUSTED - AUXILIARY ONLY (J82)
- (Requested)
- Caption: Your Benefits
- We are (1) (2) benefits beginning (3) , when (4) (5) payments changed from (6) to (7) .
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: withholding
- Choice 2: reducing
- Fill-in (2) - Systems Generated
- Choice 1: Number holder's full name possessive
- Choice 2: Number holder's first name possessive
- Choice 3: your
- Fill-in (3) - Requested As A Date In Format Shown Below
- MM/CCYY
- Fill-in (4) - Systems Generated
- Choice 1: your
- Choice 2: her
- Choice 3: his
- Fill-in (5) - Systems Generated
- Choice 1: workers' compensation
- Choice 2: public disability
- Choice 3: workers' compensation and public disability
- Fill-in (6) - Requested As A Money Amount In Format $$$$$.¢¢
- Choice 1: prior money amount
- Fill-in (7) - Requested As A Money Amount In Format $$$$$.¢¢
- Choice 1: current money amount
- WCPR20 OFFSET BASED ON LUMP SUM ENDING DATE OF PRORATION (J36)
- (Requested)
- Caption: Your Benefits
We changed (1) monthly benefit because (2) received a (3) lump-sum award. We treat a lump-sum award as if it were paid on a weekly basis. We (4) a full Social Security benefit to (5) beginning (6) .- We changed (1) monthly benefit because (2) received a (3) lump-sum award. We treat a lump-sum award as if it were paid on a weekly basis. We (4) a full Social Security benefit to (5) beginning (6) .
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: Number holder's name possessive
- Choice 2: beneficiary given name possessive
- Choice 3: beneficiary given and last name possessive
- Choice 4: your
- Fill-in (2) - Systems Generated
- Choice 1: you
- Choice 2: she
- Choice 3: he
- Fill-in (3) - Systems Generated
- Choice 1: workers' compensation
- Choice 2: public disability
- Choice 3: workers' compensation and public disability
- Fill-in (4) - Systems Generated
- Choice 1: will pay
- Choice 2: will start paying
- Fill-in (5) - Systems Generated
- Choice 1: you
- Choice 2: her
- Choice 3: him
- Fill-in (6) - Systems Generated
- Choice 1: Month and Year
- WCPR22 WORKERS' COMPENSATION EXCLUDABLE AMOUNTS DEDUCTED (J42)
- (Requested)
- Caption: Information About Other Disability Benefits
- When we figure how much to reduce (1) benefits, we do not count certain medical, legal, or other expenses which were paid out of (2) (3) payments. We excluded (4) when we figured (5) benefits.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: your and your family's
- Choice 2: number holder's name possessive
- Choice 3: your family's
- Choice 4: your
- Choice 5: number holder's name and his family
- Choice 6: number holder's name and her family
- Choice 7: number holder's name possessive plus family's
- Fill-in (2) - Systems Generated
- Choice 1: your
- Choice 2: her
- Choice 3: his
- Fill-in (3) - Systems Generated
- Choice 1: workers' compensation
- Choice 2: public disability
- Choice 3: workers' compensation and public disability
- Fill-in (4) - Requested As A Money Amount In Format $$$$$.¢¢
- Choice 1: actual amount of excludable expenses
- Fill-in (5) - Systems Generated
- Choice 1: your and your family's
- Choice 2: number holder's name possessive
- Choice 3: your family's
- Choice 4: your
- Choice 5: number holder's name and his family
- Choice 6: number holder's name and her family
- Choice 7: number holder's name possessive plus family's
- WCPR23 OFFSET BASED ON LUMP SUM PRORATION METHOD A (J45)
- (Requested)
- Caption: Your Benefits
(1) (2) received a lump-sum award of (3) to settle (4) (5) claim. A lump-sum award affects Social Security benefits in the same way that periodic payments do. We treat a lump-sum award as if it were paid on a weekly basis.- (1) (2) received a lump-sum award of (3) to settle (4) (5) claim. A lump-sum award affects Social Security benefits in the same way that periodic payments do. We treat a lump-sum award as if it were paid on a weekly basis.
- When we figured how much to reduce (6) benefits, we treated the lump sum as if (7) had been paid (8) each week. We excluded (9) for legal expenses, and (10) for medical expenses. Based on these facts, we can pay (11) full benefits for (12) through (13) . We will reduce (14) benefits beginning (15) . We will again pay full benefits beginning (16) .
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: You
- Choice 2: Number holder's full name
- Fill-in (2) - Systems Generated
- Choice 1: have
- Choice 2: has
- Fill-in (3) - Systems Generated
- Choice 1: money amount
- Fill-in (4) - Systems Generated
- Choice 1: his
- Choice 2: her
- Choice 3: your
- Fill-in (5) - Systems Generated
- Choice 1: workers' compensation
- Choice 2: public disability
- Choice 3: workers' compensation and public disability
- Fill-in (6) - Systems Generated
- Choice 1: your
- Choice 2: your and your family's
- Choice 3: your family's
- Choice 4: Number Holder's name possessive
- Choice 5: number holder's name and his family
- Choice 6: number holder's name and her family
- Choice 7: number holder's name possessive plus family's
- Fill-in (7) - Systems Generated
- Choice 1: you
- Choice 2: Number Holder's full name
- Fill-in (8) - Systems Generated
- Choice 1: money amount
- Fill-in (9) - Systems Generated
- Choice 1: attorney fee amount
- Fill-in (10) - Systems Generated
- Choice 1: amount of medical expenses
- Fill-in (11) - Systems Generated
- Choice 1: you
- Choice 2: you and your family
- Choice 3: your family
- Choice 4: him
- Choice 5: her
- Choice 6: his family
- Choice 7: her family
- Choice 8: him and his family
- Choice 9: her and her family
- Fill-in (12) - Requested As A Date In Format Shown Below
- Choice 1: MM/CCYY
- Fill-in (13) - Requested As A Date In Format Shown Below
- Choice 1: MM/CCYY
- Fill-in (14) - Systems Generated
- Choice 1: youy
- Choice 2: youy and your family
- Choice 3: your family
- Choice 4: his
- Choice 5: her
- Choice 6: his family's
- Choice 7: her family's
- Choice 8: his and his family's
- Choice 9: her and her family's
- Fill-in (15) - Requested As A Date In Format MM/CCYY
- Choice 1: Date (beginning of offset)
- Fill-in (16) - Requested As A Date In Format MM/CCYY
- Choice 1: Date (end of offset)
- WCPR24 OFFSET BASED ON LUMP SUM PRORATION METHOD B (J46)
- (Requested)
- Caption: Your Benefits
(1) (2) received a lump-sum award of (3) to settle (4) (5) claim. A lump-sum award affects Social Security benefits in the same way that periodic payments do. We treat a lump-sum award as if it were paid on a weekly basis.- (1) (2) received a lump-sum award of (3) to settle (4) (5) claim. A lump-sum award affects Social Security benefits in the same way that periodic payments do. We treat a lump-sum award as if it were paid on a weekly basis.
- When we figured how much to reduce (6) benefits, we treated the lump sum as if (7) had been paid (8) each week. We excluded (9) for legal expenses, medical and other expenses. For this reason, we lowered the weekly rate from (10) to (11) . This means that we will send (12) (13) benefits beginning (14) . (15) (16)
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: Number holder's full name
- Choice 2: You
- Fill-in (2) - Systems Generated
- Choice 1: have
- Choice 2: has
- Fill-in (3) - Systems Generated
- Choice 1: lump sum gross amount
- Fill-in (4) - Systems Generated
- Choice 1: your
- Choice 2: his
- Choice 3: her
- Choice 4: their
- Fill-in (5) - Systems Generated
- Choice 1: workers' compensation
- Choice 2: public disability
- Choice 3: workers' compensation and public disability
- Fill-in (6) - Systems Generated
- Choice 1: your
- Choice 2: your and your family's
- Choice 3: your family's
- Choice 4: number holder's name possessive
- Fill-in (7) - Systems Generated
- Choice 1: Number holder's full name
- Choice 2: you
- Fill-in (8) - Systems Generated
- Choice 1: money amount
- Fill-in (9) - Systems Generated
- Choice 1: total amount of excludable expenses
- Fill-in (10) - Systems Generated
- Choice 1: money amount
- Fill-in (11) - Systems Generated
- Choice 1: money amount
- Fill-in (12) - Systems Generated
- Choice 1: you
- Choice 2: you and your family
- Choice 3: your family
- Choice 4: him and his family
- Choice 5: her and her family
- Choice 6: her family
- Choice 7: his family
- Choice 8: him
- Choice 9: her
- Fill-in (13) - Requested As A One Position Alpha Character
- Choice 1: (A) additional
- Choice 2: (B) partial
- Choice 3: (C) full
- Fill-in (14) - Requested As A Date In Format Shown Below
- Choice 1: MM/CCYY
- Fill-in (15) - Systems Generated
- Choice 1: We will pay full benefits beginning
- Choice 2: null
- Fill-in (16) - Systems Generated
- Choice 1: ending date plus 1 month
- Choice 2: null
- WCPR25 OFFSET BASED ON LUMP SUM PRORATION METHOD C (J47)
- (Requested)
- Caption: Your Benefits
(1) (2) received a lump-sum award of (3) to settle (4) (5) claim. A lump-sum award affects Social Security benefits in the same way that periodic payments do. We treat a lump-sum award as if it were paid on a weekly basis.- (1) (2) received a lump-sum award of (3) to settle (4) (5) claim. A lump-sum award affects Social Security benefits in the same way that periodic payments do. We treat a lump-sum award as if it were paid on a weekly basis.
- When we figured how much to reduce (6) benefits, we excluded (7) for legal, medical and other expenses. We treated the rest of the lump sum, (8) , as if (9) had been paid (10) per week. We will pay full benefits beginning (11) .
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: Number holder's full name
- Choice 2: You
- Fill-in (2) - Systems Generated
- Choice 1: have
- Choice 2: has
- Fill-in (3) - Systems Generated
- Choice 1: lump sum gross amount
- Fill-in (4) - Systems Generated
- Choice 1: your
- Choice 2: her
- Choice 3: his
- Fill-in (5) - Systems Generated
- Choice 1: workers' compensation
- Choice 2: public disability
- Choice 3: workers' compensation and public disability
- Fill-in (6) - Systems Generated
- Choice 1: your
- Choice 2: your and your family
- Choice 3: your family's
- Choice 4: number holder's name possessive
- Choice 5: number holder's name plus his family's
- Choice 6: number holder's name plus her family's
- Choice 7: number holder's name possessive plus family's
- Fill-in (7) - Systems Generated
- Choice 1: sum of attorney and medical expenses
- Fill-in (8) - Systems Generated
- Choice 1: lump sum which remains
- Fill-in (9) - Systems Generated
- Choice 1: you
- Choice 2: she
- Choice 3: he
- Fill-in (10) - Systems Generated
- Choice 1: money amount
- Fill-in (11) - Systems Generated
- Choice 1: lump sum prorated ending date plus one month (month and year full benefits payable)
- WCPR27 OFFSET BASED ON UNVERIFIED ALLEGATION (J41)
- (Requested)
- Caption: Information About Other Disability Benefits
- We may have to change the amount of (1) benefits when we receive proof of the amount of (2) (3) payments.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: Full name possessive
- Choice 2: your
- Fill-in (2) - Systems Generated
- Choice 1: Name possessive
- Fill-in (3) - Systems Generated
- Choice 1: workers' compensation
- Choice 2: public disability
- Choice 3: workers' compensation and public disability
- WCPR31 NUMBERHOLDER APPEALING WORKERS' COMPENSATION DECISION - NUMBERHOLDER AND AUXILIARY (J40)
- (Requested)
- Caption: Your Responsibilities
- We will not reduce (1) benefit, or the benefits of (2) family, because of (3) payments until a decision is made on the appeal of (4) claim. Please let us know when a final decision is made. At that time, we may collect any money that should not have been paid.
- Fill-in values:
- Fill-in (1) - Systems Generated
- Choice 1: Number holder full name possessive
- Choice 2: your
- Fill-in (2) - Systems Generated
- Choice 1: your
- Choice 2: her
- Choice 3: his
- Fill-in (3) - Systems Generated
- Choice 1: workers' compensation
- Choice 2: public disability
- Choice 3: workers' compensation and public disability
- Fill-in (4) - Systems Generated
- Choice 1: your
- Choice 2: her
- Choice 3: his
x
← This means that the line
was removed and
was added – in other words, the "Effective Dates" line at the top of the document has been updated to reflect that the new version is effective as of the date the change was made.