WCMU – WC/PDB Offset Program

DI 52165.010C.1,
MSOM ICFT2 031.002

WCPA- Options

DI 52165.010C.2,
MSOM ICFT2 031.003

WCGI – General Information

DI 52165.010C.3,
MSOM ICFT2 031.006

WCSP – Spouse Data

DI 52165.010C.4,

MSOM ICFT2 031.009

WCCH - Child Data

DI 52165.010C.5,

MSOM ICFT2 031.010

WCCL – Claims

DI 52165.010C.6,
MSOM ICFT2 031.011

WCCD - Claim Data

DI 52165.010C.7,
MSOM ICFT2 031.012

WCEE - Periodic Payment Excludable Expenses

DI 52165.010C.8,
MSOM ICFT2 031.013

WCPP - Periodic Payments

DI 52165.010C.9,
MSOM ICFT2 031.014

WCLS – Lump Sum Data

DI 52165.010C.10,
MSOM ICFT2 031.015

WCDE - Computational Earnings

DI 52165.010C.11,
MSOM ICFT2 031.017

WCAC - ACE Data

DI 52165.010C.12,
MSOM ICFT2 032.003

WCWE – Lump Sum Proration Expenses Involved

DI 52165.010C.13,
MSOM ICFT2 036.004

WCGO - General Offset Data

DI 52165.010C.14,
MSOM ICFT2 032.006

WCAO - Account Data

DI 52165.010C.15,
MSOM ICFT2 032.007

WCPO - PIC Offset Data

DI 52165.010C.16,
MSOM ICFT2 032.008

WCNM - Notice Menu

DI 52165.010C.17,
MSOM ICFT2 033.002

WCEP - Enclosure Notice Block

DI 52165.010C.18,
MSOM ICFT2 033.003

WCDA - Adjudicate WC/PDB Claim

DI 52165.010C.20,
MSOM ICFT2 034.004

Enter the DIB Entitlement Start Date (MMYY)

Enter DIB DOE for the period that is being processed.

Start date for current action (MMYY)

If WC data is on the MBR and does not show the legend converted.

• If WC/PDB began prior to DIB DOE, then input a date equal to the DIB DOE (Disability Date of Entitlement)

• If payments began after DIB DOE, then input the date of change caused by the new information.

If WC/PDB data is not on the MBR or shows the legend converted.

• Input the first date in which WC/PDB payments are being considered.

Is this computation for an A101/Manual award (Y/N)

Code this field with a “Y” if you will be completing an A101 or EF101. If not, leave it blank or answer “N”.

NOTE: If processing an A101, you must complete the ICF input prior to completion of the A101.

(A101 and WC/PDB DI 52155.025)

(EF101 and WC/PDB DI 52155.030)

This field will not be displayed if you are using ICF function #31.

Select (X) WC/PDB Records available for propagation.

The system will allow you to input an “X” next to any option that is available. If you can not place an “X” next to a record then the record does not exist for propagation. A Pre-adjudicate or Adjudicate record indicates the date they were created or “NIF”, if the record does not exist.

Your options include:

• Pre-adjudicate record – a record that has been saved for future adjudication.

• Adjudicate record – created by a prior claim or PE input.

• T2 shared data.

• No propagation.

NOTE: When you use propagated data, ICF will not consider any MBR changes or earnings changes that occurred after the prior datasheet was created.

Display Datasheet Query Menu for Print/View Options (Y/N)

This field is not required.

Enter a “Y”, if it is necessary to view prior datasheets before processing an action. A “Y” response bypasses the current screen and allows you to view or print prior records. Once the datasheet has been viewed, the WCPA screen is brought back into the path.

Recomps after DIB Entitlement Start Date? (Y/N)

If “N”, a response is not required.

Indicate “Y”, if a recomputation is present on the MBR or to add a Recomp PIA. To determine if a Recomp has occurred, review the MBR for an increase in the PIA, effective with January of any year. For exceptions to a January effective date, see RS 00605.401B.1.

NOTE: A PIA decrease requires an OREO action.

Is Spouse Entitled? (Y/N)

Are Children Entitled? (Y/N)

Answer, “N” if a spouse or child(ren) are not involved

Answer, “Y” if a spouse or child (ren) have been entitled on the record, even if they are no longer entitled. The system will allow you to indicate the date of termination.

ACE Comp Needed? (Y/N)

The system needs an ACE to compute the offset. This information may have propagated. You have two options.

Answer “Y”. Let the system compute the ACE. You will need to enter the Divisor months. You must answer “Y” whenever there is a recomputation of the PIA.

Answer “N”. Enter the ACE and the Method.

NOTE: Unless you are certain the ACE you computed is correct, enter the divisor months and let the system compute the ACE.

Enter Original ACE 100%: 80%: Method

The calculated Ace and method used is located on the ACE line of the MBR or in MCS/EC. If you computed the ACE, you must also indicate the method used in the field below.

Enter dollar and cents amount in the 100% or 80% field, and

Indicate the Method used for the ACE computation.

High 1 (H1), High 5 (H5), AMW (AM)

This field is not completed if you choose to have ICF to compute the ACE.

NOTE: Useful Help screens available.

Divisor Months

This entry is mandatory if you answer “Y” to Ace Comp Needed. If you do not know the number of Divisor Months (DM) you can calculate them yourself or use the system to compute them.

NOTE: Divisor Months are used in the AMW ACE calculation so it is important that this number is correct.

• System calculation

  1. If MCS/EC performed a computation then the Divisor Months will be shown on the PIA Calculation screen (DPIA) in the EC screen path.

  2. ICERS #23 from the Master File Query Menu (MFQM) can compute Divisor Months.

     1. Choose #4, Certified Earnings Record on the ICMN screen and press enter.

     2. Type the Date of Onset and Date of Filing on the ICIC screen and press enter.

     3. Choose “Y” to print a full record from the ICRS screen.

     4. The Divisor Months can be found in the Comp Data section at the end of your printout indicated by “DM: XXX”. Use the DM figure that was used for the PIA calculation in the OED.

  3. ICF function #24 may be the preferable method for cases involving multiple periods of disability. See MSOM ICFT2.024

• Manual calculation - Use the divisor month help screen for an explanation of the manual calculation.

Delayed? (Y/N)

Delayed claimants are not common. They are included when dividing up the total base benefit payable to auxiliaries, but are not included in the Total Family Benefit until they are paid. If a Delayed Claimant exists, the HISTORY field for that claimant will show a Reason for Suspension or Termination (RFST) of DELYD.

Number of Credit Months

Credit Months can only apply if the spouse benefit is reduced for age. Credit Months are awarded for months, or partial months of non-payment. To determine if Credit Months apply, review the History segment of the MBR.

If all months are payable, then there are no Credit Months.

If there are months of non-payment see the link below to determine if Credit Months will apply.

See Requirements to earn Credit Months, RS 00615.482B.2.

Delayed? (Y/N)

Delayed claimants are not common. They are included when dividing up the total base benefit payable to auxiliaries, but are not included in the Total Family Benefit until they are paid. If a Delayed Claimant exists the HISTORY field for that claimant shows a Reason for Suspension or Termination (RFST) of DELYD.

Inj/Ill Date (MMDDYY)

The Injury/Illness is the injury date shown in the Workers’ Compensation/Public Disability claim. This is NOT necessarily the same as the DIB Date of Onset.

Type

Indicate the type of WC/PDB benefit received.

1. (WC) Workers’ Compensation payments

   1. State WC

      WP = State WC payments

   2. Federal WC

      BL = Black Lung Benefits, Part C

      FC = Federal Employees Compensation Act

      HW = Longshore and Harbor Workers’ Compensation

2. (PDB) Public Disability Benefits

   1. SG= State PDB only

   2. ML = Local PDB only

   3. FM = Federal PDB only

NOTE: Useful Help screens available.

Inj/Ill State

Input the two letter abbreviation for the state or political subdivision responsible for the WC payments. The field will be left blank for types BL, FC, FM, and HW.

NOTE: Useful Help screens available.

• When the field is empty and “F1” is selected a list of valid state codes is provided.

• When the field is completed with a valid state code and “F1” is selected, State specific instructions are provided.

Offset First Considered (MMYY)

This date is equal to the date that the NH was simultaneously entitled to both WC and DIB payments, with three exceptions.

1. A break in offset exists due to a break in DIB entitlement or WC entitlement. (If a break in offset exists, use the first month that offset applies after the break.)

2. There is more than one WC claim involving different injury dates.

3. The input is for a complex case, such as a structured settlement.

NOTE: You cannot enter an OED prior to the injury date for the current claim.

NOTE: The “Start Date for Current Action” from the WCPA screen is often coded incorrectly as the “Offset First Considered” date on this screen. These dates may or may not be the same. For instructions on Start Date for Current Action, see DI 52165.010C.2. in this section.

Periodic Payments Involved?

Enter “Y” to bring the input screen into your path.

Lump Sum Payments Involved?

Enter “Y” to bring the input screen into your path.

WC/PDB Claim Pending? (Y/N)

“Y” indicates the Number Holder has filed for WC/PDB benefits and is waiting for a decision on the claim.

WC/PDB Appeal Pending? (Y/N)

“Y” indicates the Number Holder has already been awarded benefits, but has filed an appeal regarding the award.

Reverse Jurisdiction Involved? (Y/N)

If a Reverse Jurisdiction (RJ) or Reverse Offset agreement exists, the offset is performed by the State agency rather than SSA. This means that we pay the NH his or her full DIB and the State determines if any benefit adjustments are needed to the WC/PDB benefit.

ICF requires you to answer this question, if the State of injury has a Reverse Offset plan.

If you do not know whether Reverse Jurisdiction applies follow these steps:

1. Consult the list of RJ States in DI 52105.001 or, leave the question blank and attempt to enter past the screen.

   • If you move to the next screen, Reverse Offset does not apply.

   • If you receive this message, “REVERSE JURISDICTION MAY APPLY, INDICATE IF RJ INVOLVED”, Proceed to step 2.

2. You are working with a RJ State and need to determine if RJ applies for your input and how to code the input.

   • Refer to the procedures for your State, as they vary from state-to-state. For State specific POMS procedures, see DI 52120.001 and for PDB State specific procedures, see DI 52135.000.

   • Complete the start and/or stop date fields, using the State specific procedures and the instructions below.

   • If all WC ends and will be offset prior to the RJ Start date (periodic payments or a prorated lump sum), complete the field with an “N”. Answering “Y” may cause incorrect results.

If Yes,

Start (MM/YY)

The start date is the month that SSA will no longer reduce the NH’s benefit. SSA will pay the NH his or her full DIB.

NOTE: Review your payment output screens: The NH’s payment should not be reduced effective with the RJ start date month.

Stop (MM/YY)

The stop date is the month before the month that SSA begins to offset the NH’s benefit, after a period of Reverse Offset. You are not required to answer this question unless the State procedures require SSA to re-impose offset.

EXAMPLE: For Florida, RJ starts with the month of adjudication and ends with the month the NH attains age 62. If the NH attains age 62 in 03/2008, then we must input a stop date = 02/2008. Based on this, ICF will apply offset to the NH’s benefits effective with 03/2008 (the month of age 62 attainment).

Are Gross Amount Excludable Expenses from Periodic Payments Involved? (Y/N)

This field is not required. An answer of “Y” will cause the WCEE screen to come into the path. Excludable expenses for periodic payments can be coded on the WCEE or the WCPP screen.

• If expenses are paid periodically corresponding to the periodic payments, answer “N” to this field or leave it blank. Enter the expenses on the WCPP screen.

• It may be desirable to code the expenses on the WCPP screen, rather than the WCEE screen, due to the limitations of the WCEE screen.

• However, if expenses are attributable to the first month of offset or a specific month of offset, it may be desirable to answer “Y” and code the expenses on the WCEE screen.

Lump Sum Start

• Determining the correct start date can be complicated. Review the help screens to determine the correct start date. For more detailed information regarding the lump sum start date, see DI 52150.060D.2.

• Useful Help screens available

Gross

Enter the total amount of the lump sum prior to any deduction for expenses.

Proof? (Y/N)

• If “Y” is not coded, the lump sum information is ignored by the system and is not included in the offset computation.

• Useful Help screens available.

Rate

Frequency

We consider offset for a Lump Sum, as if it will be distributed in periodic payments over an extended period of time. Use Rate and Frequency to specify the amount of money that will be offset each month.

• Rate is the dollar value of the payment we count.

• Frequency represents how often (monthly, weekly, etc) that the “Rate” is paid.

• Useful Help screens available.

• (Lump sum proration rate, see DI 52150.060E.3.

Excludable Expenses

Proof? (Y/N)

Input any expenses that can be excluded from the NH’s WC/PDB payment.

• The system will calculate all three proration methods and display them for you later in the screen path.

• “Y” must be coded in the proof column for the expenses to be included in the offset computation. The system ignores the expenses if proof is not received.

• Useful Help screens available.

• For excludable expenses, see DI 52150.050.

Amounts to be Deducted from Gross

This field is only for amounts intended to be deducted from the gross lump sum amount before the LS is prorated. This is not an excludable expense. Special deductions from a LS should be rare, and either specifically authorized in POMS or approved by a policy expert.

Remarks

Remarks displayed in this screen are informational only. Based on the remarks, you should decide what actions are necessary. For example, prepare a diary if the remark states that offset should be removed when the NH attains 62.

Adjudicate WC/PDB Claim? (Y/N)

“Y”

• Post Entitlement input will transmit and attempt to effectuate the changes on the MBR.

• A101 or EF101 input will save the WC/PDB data to be used by the PC when processing the award.

• The datasheet will be locked and you will not be able to update it for two workdays.

“N”

Typing “N” will cancel the adjudicate action. Type “Y” in the following field to save as a pre-adjudicate record for future propagation. If you choose not to adjudicate the claim and fail to save the record as a pre-adjudicate record, all of the information will be discarded.

Special Instructions

Use this field to give additional information regarding your input. Examples include,

• Input additional claim numbers for States that have both carrier and State claim numbers

• Inform others where the documentation supporting your action has been stored.

• If specifically required by POMS, such as when you used the LS Method A/B/C override or when you need to identify the system exception or limitation that required you to use OREO.