BASIC (09-08)

Citations:

Social Security Ruling 70-57a – Disability Insurance Benefits – Receipt of Benefits under the Jones Act (Injuries to Seamen)

A. The Jones Act

The Jones Act is a federal law that protects masters and crewmembers aboard floating devices that are not permanently affixed to the ocean floor (whether these vessels are on the ocean or on inland waterways). The law allows these individuals or their survivors to sue the employer due to an on-the-job injury or death caused by negligence. The law also allows the employer to make two types of payments: – maintenance (subsistence) and cure (medical). Jones Act payments are not workers’ compensation (WC) payments. Do not offset.

B. Jones Act and WC payments

1. Jones Act payments

The number holder (NH) may receive periodic maintenance and/or cure payments. In addition, settlement of a negligence lawsuit against the employer may result in a large lump sum payment. Do not offset these payments or enter them into the Interactive Computation Facility (ICF) or Modernized Claim System (MCS), as they are not WC payments.

2. Possible WC entitlement

The NH may be entitled to receive WC under federal, state or local laws as well. This does not affect his or her rights under the Jones Act. Always verify whether periodic payments are payments under the Jones Act or WC. Offset only the WC payments.

NOTE: Jones Act payments are frequently confused with Long Shore and Harbor Workers Compensation (LSHWC) payments, which are paid to employees in related occupations and are offsettable. See DI 52115.005 for an overview of LSHWC payments.

3. Jones Act settlement - reimbursement of WC

If the settlement of the negligence suit or other Jones Act payments reimburses the WC paid, remove the offset only for that part of the WC that is actually repaid.

4. Third party settlement

Be alert to the possibility of a third party settlement. The NH may sue the manufacturer of the vessel that he or she was injured upon or some other third party. The third party settlement might repay any WC paid. See third party settlements in DI 52105.010 of this section.

C. How to process cases with Jones Act involvement

Take the following actions to process cases involving Jones Act payments:

1. Verify that the NH is receiving payments under the Jones Act. If the NH alleges a work related disability that occurred while employed as a master or crewmember and has not filed under the Jones Act, briefly explain the Act and inform the NH that generally there is a three year limit for filing Jones Act claims. Develop for receipt of WC. If WC is involved, impose offset according to established procedure.

2. If the NH has filed a Jones Act claim and alleges receiving periodic payments, verify that the payments are maintenance and/or cure payments and not WC.

3. If the NH filed a Jones Act claim and receives WC:

   • impose offset for the WC only;

   • obtain the estimated settlement date or any upcoming hearing date for the Jones Act claim;

   • Diary the case accordingly.

4. When the diary matures, verify whether the suit has been settled. If it has, obtain a copy of the settlement papers and develop for any repayment of the WC.

5. If the Jones Act lawsuit or a third party settlement was settled and WC was fully or partially repaid; or if the settlement indicates a specific period of time for which the WC is repaid, remove offset for that period.

   Remove offset using the most advantageous of the following methods:

   1. Starting with the offset effective date (OED), remove only the dollar amount that was repaid; or

   2. Reduce the weekly rate for the duration of the WC award; or

   3. Starting with the last date for which WC was paid, work backwards removing the dollar amount that was repaid.

   NOTE: When determining the most advantageous option, consider triennial redeterminations and protected increases.

6. If reimbursement of the WC is waived, do not remove offset.