Episode 46 Federal Workers Compensation Coffee Break Podcast- SSDI, OWCP-TTD & FERS Concurrent Benefits

Federal Workers Compensation Coffee Break Podcast is an educational and informative training on how to navigate the DOL -OWCP claims filing process for all types of injured US government and federal workers. The podcast is free and is educational. If you need help with anything related to a federal workers compensation claim...help is just a cup of coffee away.

Section 1:15 of the Federal Employees' Compensation Act (FECA) Practice Manual states that Social Security Disability Retirement (SSDR) benefits are payable concurrently with FECA compensation. However, this does not mean that an injured federal worker claimant can receive both Social Security Disability benefits and temporary disability benefits under FECA without any reduction.

When an injured federal worker is eligible for both SOCIAL SECURITY DISABILITY RETIREMENT and temporary disability benefits under FECA, the SOCIAL SECURITY DISABILITY RETIREMENT benefits are typically subject to an offset or reduction. The purpose of this reduction is to prevent the claimant from receiving a double benefit for the same period of disability, as both SOCIAL SECURITY DISABILITY RETIREMENT and FECA temporary disability benefits are meant to provide financial assistance during periods of disability.

 Generally, the reduction is designed to ensure that the total amount of benefits the claimant receives (when combining SOCIAL SECURITY DISABILITY RETIREMENT and FECA) does not exceed a certain percentage of their average pre-disability earnings.

For the scenario of a federal employee who is eligible for temporary disability benefits under FECA and also qualifies for permanent Social Security Disability benefits due to a disability that makes them permanently unable to return to a government position of employment. Listen to the podcast and download the attached show transcript for  an explanation of the relevant federal laws and provisions for eligibility of receiving SSDI & OWCP temporary disability or FERS disability benefits concurrently.

Dr. Taylor’s contact information is: https://fedcompconsultants@protonmail.com If you need a provider or assistance with a DOL claim in Tampa, Pensacola or Jacksonville Florida  or Oklahoma City you can make an appointment to see him and the other providers at the clinic at  M & R Medical & Therapy Center or FWC Medical Centers. To make a consult with Dr. Taylor  to discuss your case or if you know someone if Florida who is recently injured you can call the clinic at 813-877-6900 or go  to our website at https://mrtherapycenter.com/
Fed Comp Coffee Break Podcast on Youtube  Be sure and subscribe, like, and/or share a comment or review if you find this podcast information to be beneficial. 

Transcript

Section 1:15 of the Federal Employees' Compensation Act (FECA) Practice Manual states that Social Security Disability Retirement (SSDR) benefits are payable concurrently with FECA compensation. However, this does not mean that an injured federal worker claimant can receive both Social Security Disability benefits and temporary disability benefits under FECA without any reduction.

When an injured federal worker is eligible for both SOCIAL SECURITY DISABILITY RETIREMENT and temporary disability benefits under FECA, the SOCIAL SECURITY DISABILITY RETIREMENT benefits are typically subject to an offset or reduction. The purpose of this reduction is to prevent the claimant from receiving a double benefit for the same period of disability, as both SOCIAL SECURITY DISABILITY RETIREMENT and FECA temporary disability benefits are meant to provide financial assistance during periods of disability.

The specific rules regarding the reduction or offset of SOCIAL SECURITY DISABILITY RETIREMENT benefits can be complex and may vary depending on individual circumstances and applicable regulations. Generally, the reduction is designed to ensure that the total amount of benefits the claimant receives (when combining SOCIAL SECURITY DISABILITY RETIREMENT and FECA) does not exceed a certain percentage of their average pre-disability earnings.

For the scenario of a federal employee who is eligible for temporary disability benefits under the Federal Employees' Compensation Act (FECA) and also qualifies for permanent Social Security Disability benefits due to a disability that makes them permanently unable to return to a government position of employment. Here's an explanation of the relevant federal laws and provisions:

1. Federal Employees' Compensation Act (FECA):
    
   • FECA is the primary federal law that provides workers' compensation benefits to federal employees who suffer work-related injuries or illnesses.
2.  
   • FECA provides temporary disability benefits to eligible federal employees who are temporarily unable to work due to a work-related injury or illness. These benefits are intended to provide wage replacement during the period of temporary disability.
3.  
4. Social Security Disability Insurance (SOCIAL SECURITY DISABILITY INSURANCE):
    
   • SOCIAL SECURITY DISABILITY INSURANCE is a federal program administered by the Social Security Administration (SOCIAL SECURITY ADMINISTRATION). It provides benefits to individuals who are deemed disabled under Social Security rules and who are unable to engage in substantial gainful activity due to a medical impairment that is expected to last for at least 12 months or result in death.
5.  
   • SOCIAL SECURITY DISABILITY INSURANCE benefits are considered permanent disability benefits, as they are available to individuals whose disabilities are expected to be long-lasting or result in death.
6.  

Now, here's how these two systems can interact:

• It is possible for an injured federal employee to receive temporary disability benefits under FECA while also being eligible for and receiving SOCIAL SECURITY DISABILITY INSURANCE benefits from the Social Security Administration. These benefits can run concurrently.
• However, as mentioned earlier, SOCIAL SECURITY DISABILITY INSURANCE benefits are considered permanent disability benefits, and they may continue as long as the individual's disability persists. If an individual is deemed permanently disabled under SOCIAL SECURITY DISABILITY INSURANCE rules, this generally implies that they are unable to engage in substantial gainful activity in any capacity, which includes returning to a government position of employment or any other substantial work.
• While an individual can receive both FECA temporary disability benefits and SOCIAL SECURITY DISABILITY INSURANCE benefits concurrently, the FECA benefits may eventually cease or transition to other forms of FECA benefits if the individual's condition stabilizes or if they are found to have reached maximum medical improvement but are still unable to return to their federal job.

It's important to note that the specific rules and interactions between FECA and SOCIAL SECURITY DISABILITY INSURANCE can be complex, and they may vary based on individual circumstances and legal interpretations. I recommend that you consult with a legal professional or benefits specialist who can provide guidance tailored to the specific case and the most up-to-date information on relevant regulations. There are several good ones I can recommend to you if you email me. 

Okay, Here is the scenario that I get the most questions about over the years… It is when an approved OWCP provider or an OWCP requested second opinion doctor deems that an injured worker is no longer eligible for total temporary disability benefits under the Federal Employees' Compensation Act (FECA) due to their qualification for a different employment position through vocational rehabilitation, the effects on FECA temporary total disability benefits and SOCIAL SECURITY DISABILITY INSURANCE benefits can vary based on the specific circumstances and the individual's ability to return to work.

1. FECA Temporary Total Disability Benefits:
    
   • If a vocational rehabilitation program determines that the injured worker is qualified for a different employment position and is capable of returning to work in that capacity, FECA temporary total disability benefits may be terminated or reduced.
2.  
   • FECA aims to provide benefits to individuals who are unable to perform their regular federal job due to a work-related injury or illness. If the worker can perform a different job as a result of vocational rehabilitation, they may no longer meet the criteria for temporary total disability benefits.
3.  
   • Depending on the circumstances, the FECA benefits may transition to other forms of FECA benefits, such as partial disability benefits or wage-loss compensation, which take into account the individual's new earning capacity.
4.  
5. SOCIAL SECURITY DISABILITY INSURANCE Benefits:
    
   • SOCIAL SECURITY DISABILITY INSURANCE benefits may continue as long as the individual's medical impairment meets the SOCIAL SECURITY ADMINISTRATION's definition of disability. The fact that the individual is deemed qualified for a different job through vocational rehabilitation does not automatically disqualify them from SOCIAL SECURITY DISABILITY INSURANCE benefits, as long as their medical condition still meets the criteria for disability under SOCIAL SECURITY DISABILITY INSURANCE rules.
6.  
   • However, it's important to note that SOCIAL SECURITY DISABILITY INSURANCE benefits can be affected by factors such as work activity and earnings. If the individual returns to work, including a different job, and earns above the substantial gainful activity (SGA) threshold set by SOCIAL SECURITY ADMINISTRATION, their SOCIAL SECURITY DISABILITY INSURANCE benefits may be subject to reduction or termination due to substantial work activity.
7.  

Situational Examples for FECA Benefits Transition or Termination:

1. Stabilization of Medical Condition: If the injured worker's medical condition stabilizes to the point where further medical improvement is not expected, but they are still unable to return to their federal job, FECA temporary total disability benefits may transition to other forms of FECA benefits, such as partial disability benefits.
2. Maximum Medical Improvement (MMI) but Unable to Return to Federal Job: If the individual reaches MMI but is still unable to return to their federal job due to the work-related injury, FECA benefits may continue as long as they meet the criteria for partial disability or wage-loss compensation.
3. Return to Work at a Different Job: If vocational rehabilitation helps the injured worker qualify for and secure a different job, FECA temporary total disability benefits may be terminated or reduced, and the individual's FECA benefits may be adjusted accordingly.
4. Earnings Above SGA: If the individual returns to work, including a different job, and their earnings exceed the substantial gainful activity (SGA) threshold set by SOCIAL SECURITY ADMINISTRATION, their SOCIAL SECURITY DISABILITY INSURANCE benefits may be affected or terminated.

Injuries resulting in a permanent disability that makes it impossible to rejoin the workforce may qualify for lifelong benefits. Workers who are partially disabled may receive reduced benefits for the rest of their lives.

Apart from these situations, benefits cease when the worker fully recovers. Because of this, the OWCP will continue requesting second opinions, proof of examinations, and treatment protocols to verify whether the injury still exists. Failure to submit documentation on time could result in having workers’ compensation benefits withdrawn. Non-compliance with vocational rehabilitation orders is another reason OWCP could withdraw benefits.

Loss of Social Security Disability Benefits

There are several things that can cause you to lose your Social Security Disability benefits. They include:

An improvement in your medical condition

Returning to work

Becoming incarcerated

Getting an increase in income

Reaching retirement age

Here are the official places that all of this OWCP/FECA ACT information can be found:

FECA BULLETIN NO. 23-01

Issue Date: October 25, 2022

Subject: Obtaining Information from the Social Security Administration Regarding Dual Benefits and Determining Federal Employees’ Retirement System Offsets

Background: Section 8116(d)(2) of the Federal Employees’ Compensation Act (FECA) requires that a claimant’s compensation be reduced if they receive Social Security Administration (SOCIAL SECURITY ADMINISTRATION) retirement benefits based on Federal service or if a beneficiary receives SOCIAL SECURITY ADMINISTRATION survivor benefits that are attributable to the decedent’s federal service. If a claimant was enrolled in the Federal Employees’ Retirement System (FERS) or another federal retirement program that contributes to Social Security, their entitlement to compensation must be reviewed for possible dual benefits when they reach retirement age

Previously, OWCP - FECA program employees were responsible for responding to annual requests to SOCIAL SECURITY ADMINISTRATION on an individual basis based on review of the yearly returned CA-1032 forms as part of a Periodic Entitlement Review (PER) since there was no other way to determine if the claimant was receiving SOCIAL SECURITY ADMINISTRATION benefits. This is to see if you are receiving any other unreported income or benefits!

However, the U.S. Department of Treasury’s, Bureau of the Fiscal Service, Do Not Pay Business Center (DO NOT PAY) is now providing the FECA program with a matching report, using the social security number (SSN), of claimants in receipt of compensation from the SOCIAL SECURITY ADMINISTRATION and temporary total disability payments under the FECA. Even though the report confirms that SOCIAL SECURITY ADMINISTRATION benefits are being paid, it does not detail whether the payments made are for SOCIAL SECURITY ADMINISTRATION disability or SOCIAL SECURITY ADMINISTRATION retirement benefits.  That is worth remembering!

Purpose: To provide guidance regarding information provided by the SOCIAL SECURITY ADMINISTRATION pertaining to whether a claimant requires a FERS Offset.

Action:

1. The Fiscal Branch should cross-reference the DO NOT PAY matching report with a report of cases (age 62 to 75) on the periodic roll on a monthly basis to determine which cases already have offsets in place and which cases need to be sent to SOCIAL SECURITY ADMINISTRATION for benefit confirmation and calculation.

 SOCIAL SECURITY ADMINISTRATION should continue to upload their Do not pay response via the Employees’ Compensation and Management Portal (ECOMP). The response will be added to the case file.  The Claims Examiner (CE) should review the response. If an offset is needed, the CE may send a notification letter to the you regarding the offset and refer the case to the assigned Debt Claims Examiner to process any overpayment in accordance with existing procedures. If an offset is not needed no further action is required.

In summary, Ok gang we covered a lot of OWCP rules on this topic but in review we now know the following…concurrent receipt of FECA temporary total disability and SOCIAL SECURITY DISABILITY INSURANCE benefits is generally allowed, but it's essential to understand the nature of the Social Security benefits being received and ensure compliance with benefit coordination rules to avoid potential overpayments or issues with benefits. 

Ok, Lastly let’s cover Office of personnel & management or OPM and FERS retirement program. The Federal Employees Retirement System has 3 components: the FERS basic benefit, Social Security benefit, and the Thrift Savings Plan benefit. Because Social Security is one component, often it can be confusing how each one affects the other and how they are related to one another. This becomes especially true if you become disabled and need disability benefits. The following will help you understand how these 2 programs relate to one another.

Requirements

Federal Disability Retirement:

• You need to 18 months of creditable federal civilian service to qualify for federal disability retirement, and you must have become disabled in a position while in federal service
• The disability must last at least one year
• Your agency must certify that it is unable to accommodate your medical condition in your current position and it has considered you for any vacant position in the same agency at the same grade and pay level, within the same commuting area, for you which you are qualified for reassignment
• You, or your legal guardian, must apply before your separation of service, or with one year
• You must apply for Social Security benefits

Social Security Disability:

• You must suffer from a long-term (1 year or more) or permanent disability that completely prevents you from performing any type of work. It’s a total and permanent disability benefit awarded when you can’t complete gainful employment.

No let’s talk about the confusing formulas for figuring out your amounts that you will receive when you receive one or more of these disability or retirement annuity allotments at the same time. 

Federal Disability Retirement:

• You receive 60% of your High-3 average salary the first year on federal disability retirement and then 40% of your High-3 every year after that, until age 62. The high-three average salary is defined as a retiring employee’s highest basic pay averaged over any three consecutive years in federal service.
• Please listen up to the next part ...it is very important to know! Because this type of disability retirement is considered “occupational” and not total or permanent, you can work in the private sector and earn up to 80% of your current salary in any position within your doctors’ restrictions. So you can earn an income in the private sector if you receive only FERS disability retirement benefits and that is a much better financial option that receiving social security disability benefits at the same time as FERS disability. 

Social Security Benefit:

• The dollar amount you receive is based on taxes you’ve paid throughout your working life.

**You may have the situation where you receive approval for both benefits. In this case, they offset. Social Security becomes the primary benefit and you receive those payments in full, but your federal disability retirement payments will be reduced by a percentage of Social Security.

OK let’s try some Examples:

• 1st year=FDR-100%SOCIAL SECURITY DISABILITY
• 2nd year=FDR-60%SOCIAL SECURITY DISABILITY

Having both these benefits usually results in a higher annuity disbursement, but it severely restricts your earnings potential because it completely cuts out the option of being able to earn up to 80% of your salary in the private sector.

How to calculate Federal Disability Retirement & Social Security Disability Offsets

If you are eligible and qualified for both Social Security Disability and OPM/FERS Disability ….

Here is the basic formula = SOCIAL SECURITY DISABILITY plus (OPM/FERS disability  minus the allowable offset) So let’s discuss the offsets. 

So, SOCIAL SECURITY DISABILITY is considered the Primary of the two-----First year when you are qualified for both goes like this…your  OPM/FERS Disability money minus 100% of SOCIAL SECURITY DISABILITY allotment.

For the 2nd year and all additional ongoing years= SOCIAL SECURITY DISABILITY is Primary-----Second year on OPM Disability = OPM $ minus 60% of SSD

Second year on OPM/FERS Disability formula works like this…

The following numbers are based on a simple example:

The average OF SOCIAL SECURITY DISABILITY = APPROXIMATELY $1,500/mo 

First year on OPM/FERS IF YOU ARE MAKING FOR EXAMPLE 50K A YEAR = $30,000(60%) WHICH EQUALS =$2,500/mo  

Second year on OPM/FERS = $20,000(40%) OF THE 50K  OVER 12 MONTHS = 1667.00/MONTH

                                         SSD =1500/MONTH REDUCED TO 60% =900

Second Year THE GOVERNMENT WILL TAKE THE FORMULA AND APPLY IT SO THAT YOU TAKE ($1,667-$900=$767)OPM = $2,267/mo Total

Well that does it for this episode of Federal Workers Comp Coffeebreak  Podcast. 

I want to thank you for listening and want to remind you to share this podcast with other federal workers you think would benefit from this information. Also if you need an approved  medical provider for your DOL -OWCP Or Longshore case in Florida you can find me in Tampa and  Pensacola in Florida and coming soon to Oklahoma City in a new office. The new Clinic will be named FWC Medical Centers. If you live in Alabama, Georgia and North Florida you now have access to me. So, I know a lot of Oklahoma people have been asking me about where I am going to be located and I can announce it will be in Oklahoma City. If you live in those areas send me an email and I will give you updates on these locations. I plan on being open in February of 2024. To make a consult with me to discuss your case or if you know someone if Florida who is recently injured you can call the clinic at 813-877-6900 or go  to our website at https://mrtherapycenter.com/  Also if you are in another state and you want me to assist you with claim questions or assistance for your doctor you can email me at fedcompconsultants@protonmail.com  LASTLY I want to ask all you listeners to help me for a change! I now have a youtube channel named after the podcast (Federal Workers Compensation Coffee Break Podcast). I would appreciate if you would subscribe, like and share and leave reviews of these episodes in both the podcasts and the youtube channel. My grand kids tell me that is how you get people to find your internet content. I get 100s of emails but no one comments, reviews or shares the podcast and I have been told that I need to start asking for that. So this time You can be Here to Help…ME! And thanks in advance for all of the people who take the time to do that to help get the podcast and youtube channel seen by more injured government workers. 

I need to warm up this coffee and get going. As usual I want to thank all of you who put on that uniform, that badge, deliver that mail, take care of our veterans and make this government run… a big thank you. I do this for free just for you…We could not do this without all of the work all of you out there do…so a big thank you. And remember if you have an injured federal claim and you need assistance….

I am  here to help!.

See you next time.

Off to get my coffee!