97-23506. Reduction of Disability BenefitsWorkers' Compensation and Public Disability Benefits and Payments  

  • [Federal Register Volume 62, Number 171 (Thursday, September 4, 1997)]
    [Proposed Rules]
    [Pages 46682-46686]
    From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
    [FR Doc No: 97-23506]
    
    
    ========================================================================
    Proposed Rules
                                                    Federal Register
    ________________________________________________________________________
    
    This section of the FEDERAL REGISTER contains notices to the public of 
    the proposed issuance of rules and regulations. The purpose of these 
    notices is to give interested persons an opportunity to participate in 
    the rule making prior to the adoption of the final rules.
    
    ========================================================================
    
    
    Federal Register / Vol. 62, No. 171 / Thursday, September 4, 1997 / 
    Proposed Rules
    
    [[Page 46682]]
    
    
    =======================================================================
    -----------------------------------------------------------------------
    
    SOCIAL SECURITY ADMINISTRATION
    
    20 CFR Part 404
    
    [Regulations No. 4]
    RIN 0960-AE35
    
    
    Reduction of Disability Benefits--Workers' Compensation and 
    Public Disability Benefits and Payments
    
    AGENCY: Social Security Administration (SSA).
    
    ACTION: Proposed rule.
    
    -----------------------------------------------------------------------
    
    SUMMARY: We propose to revise our rules on reduction of Social Security 
    benefits based on disability on account of receipt of workers' 
    compensation and/or public disability benefits and payments provided 
    under Federal (other than Social Security), State, or local laws or 
    plans to clarify our existing policies. We also propose to adopt a 
    uniform method for proration of workers' compensation and public 
    disability benefit/payment settlements. In addition, we propose to 
    incorporate into our rules certain policy interpretations established 
    previously in relevant Social Security Rulings (SSRs). Finally, we 
    propose to update provisions that have not been changed since 1984.
    
    DATES: To be sure that your comments are considered, we must receive 
    them no later than November 3, 1997.
    
    ADDRESSES: Comments should be submitted in writing to the Commissioner 
    of Social Security, P.O. Box 1585, Baltimore, MD 21235, sent by telefax 
    to (410) 966-2830, sent by E-mail to regulations@ssa.gov'', or 
    delivered to the Division of Regulations and Rulings, Social Security 
    Administration, 3-B-1 Operations Building, 6401 Security Boulevard, 
    Baltimore, MD 21235-0001, between 8:00 a.m. and 4:30 p.m. on regular 
    business days. Comments may be inspected during these same hours by 
    making arrangements with the contact person shown below.
    
    FOR FURTHER INFORMATION CONTACT: Daniel T. Bridgewater, Legal 
    Assistant, Division of Regulations and Rulings, Social Security 
    Administration, 6401 Security Boulevard, Baltimore, MD 21235, (410) 
    965-3298 for information about these rules.
    
    SUPPLEMENTARY INFORMATION:
    
    Background
    
        Certain disabled workers may be eligible for cash benefits under 
    both workers' compensation and/or other public disability benefit 
    programs and the Social Security disability insurance (SSDI) program. 
    Section 224 of the Social Security Act (the Act) provides for a 
    reduction in SSDI benefits so that total benefits under both workers' 
    compensation and/or other public disability benefit programs and SSDI 
    do not exceed the higher of 80 percent of a worker's predisability 
    earnings (``average current earnings'') or the total family benefit 
    (i.e., the sum of the individual's Social Security disability benefits 
    and the Social Security benefits payable to others based upon his work 
    record) under Social Security before reduction.
    
    Present Policy
    
        The policy interpreted in SSRs over the years has focused mainly on 
    certain aspects of the law. First, some State workers' compensation 
    laws prescribe specific benefit amounts for certain permanent 
    impairments (e.g., loss of a bodily member) without regard to actual 
    loss of wages. Some beneficiaries questioned whether Congress intended 
    to exclude such benefits based on permanent impairments from the SSDI 
    benefit reduction. This issue was resolved in the courts, and SSA 
    developed two SSRs to reflect its policy that permanent impairment 
    benefits, compensable under State workers' compensation laws, are 
    subject to offset against SSDI benefits. (SSR 74-21c, based on Grant v. 
    Weinberger, 482 F.2d 1290 (6th Cir. 1973), and SSR 92-6c, based on 
    Davidson v. Sullivan, 942 F.2d 90 (1st Cir. 1991)). More recent cases, 
    Krysztoforski v. Chater, 55 F.3d 857 (3rd Cir. 1995) and Hodge v. 
    Shalala, 27 F.3d 430 (9th Cir. 1994), also uphold SSA's policy in this 
    regard. We now propose to amend our regulatory language to reflect this 
    policy interpretation.
        Second, some have questioned our policy that non-covered earnings 
    (i.e., those earnings from employment not covered under the Act) cannot 
    be used in determining the ``average current earnings'' for an 
    individual. This policy, which is described in SSR 92-2a, is based on 
    section 224(a) of the Act, which provides that ``average current 
    earnings'' are to be computed by reference to the average monthly wage 
    under section 215(b) of the Act and to wage and self-employment income 
    totals under sections 209(a)(1) and 211(b)(1) of the Act. These 
    statutory sections are concerned strictly with wages and self-
    employment income covered under the Act, and, thus, we cannot count 
    non-covered earnings.
        Judicial precedent strongly supports the Social Security 
    Administration's (SSA) position: Prather v. Shalala, 844 F. Supp. 239 
    (D. Md. 1993), aff'd w/o opinion, 14 F.3d 595 (4th Cir. 1994); Smith v. 
    Sullivan, 982 F.2d 308 (8th Cir. 1992); Sousa v. Shalala, No. C-92-2796 
    MHP (N.D. Cal. Jan. 19, 1995); Everette v. Chater, No. 92-C-714 (E.D. 
    Wis. Aug. 8, 1995). Accordingly, we propose to clarify the regulatory 
    language to express this policy in a more direct manner.
    
    Proposed Policy--Proration of Lump-Sum Awards
    
        In many cases, an individual may receive some or all of his or her 
    workers' compensation in a lump-sum. Because a lump-sum award is a 
    substitute for periodic payments, the Act requires that we look to 
    State law to see what rate would have been paid had the workers' 
    compensation payment been made on a periodic basis, and that we prorate 
    and offset at the rate that most closely approximates State law.
        State workers' compensation laws clearly define how to compute the 
    periodic rate. States base the weekly rate on a specified percentage of 
    the worker's average weekly wage subject to a maximum amount set by 
    law. Forty-two States use sixty-six and two-thirds percent.
        SSA has been using three methods to establish the rate of offset. 
    In order of priority, they are as follows:
        1. The rate specified in the award. (If the award specifies a rate 
    based on life expectancy, we use that rate and list the case for future 
    reference.)
        2. The periodic rate paid prior to the lump-sum award (if no rate 
    was specified in the award).
        3. The State's workers' compensation maximum weekly rate in effect 
    at the time of the injury (if no rate was
    
    [[Page 46683]]
    
    specified in the award and if no periodic payments were made).
        For years, lump-sum awards were rare, and they were prorated using 
    method 1 or 2. Method 3 was added later.
        Our experience in determining rates has been that, in almost every 
    case, because of the worker's actual earnings, the specified percentage 
    of the average weekly wage would have exceeded the State's maximum 
    rate. Thus, the worker would have received the State's maximum periodic 
    rate. Likewise, the prior periodic rate would have been paid at the 
    maximum rate.
        Although we believed that this policy would closely approximate the 
    monthly rate that would have been paid in the absence of a lump-sum 
    settlement, we have witnessed an ever-increasing number of cases 
    nationwide where attorneys are requesting insurers to specify an 
    artificially low rate in the lump-sum award. For example, some awards 
    purport to set a proration rate based on the worker's life expectancy. 
    This rate, often lower than the State's minimum rate, results in little 
    or no offset under our present method of proration.
        We do not believe that the use of a life expectancy rate in the 
    lump sum award is a bona fide representation of the periodic rate that 
    would have otherwise been paid. We do not believe that disabled workers 
    would, in fact, accept such low rates if the lump-sum award were paid 
    periodically. Also, we do not believe that these low rates are 
    specified when SSA disability benefits and offset are not an issue.
        Life expectancy can be based on subjective factors, such as health, 
    life style, age, job, etc. Given the fact that these workers are 
    disabled, it does not appear to be reasonable to utilize life 
    expectancies to age 75 or older as these awards specify.
        We conducted a survey in States where this practice started. One of 
    the questions we asked of the States was whether a low rate based on 
    life expectancy was a bona fide representation of the lump-sum award 
    and in accordance with State law. Six of the eight States said, ``No.'' 
    (One State said the question did not apply and one did not return the 
    survey.)
        It is clear that while State law may not provide life expectancy as 
    the basis for a lump-sum award or as the basis for periodic benefits 
    that the lump-sum represents, the actual awards do contain such 
    language. Once a lump-sum award has been agreed upon, it is of no 
    consequence to the insurer how the award is portrayed (i.e., whether 
    the proration rate of the lump-sum award is based on the worker's life 
    expectancy or the State's maximum weekly rate).
        When our order of priority for setting the rate of offset was 
    established, lump-sum awards were quite straightforward, even rare. 
    Currently, lump-sum awards are being structured individually in order 
    to best circumvent the offset required by section 224 of the Act. 
    Attorneys have even called SSA personnel to seek guidance in 
    structuring lump-sums to avoid offset.
        In short, our policy on the proration of lump-sum awards has become 
    a tool by which people avoid the offsets intended by Congress, rather 
    than a means of approximating, as nearly as practicable, the offset 
    that would have occurred had benefits been paid periodically. It thus 
    can be viewed as no longer satisfying the requirements of section 
    224(b) of the Act.
        In order to prorate and offset a lump-sum award using a rate that 
    is more representative of the periodic rate that would have otherwise 
    been paid under State law and in order to ensure a more uniform policy 
    for all lump-sum cases nationwide, we propose a change in the order of 
    priority for determining the weekly rate used. Specifically, we propose 
    that lump-sum awards be prorated based on:
        1. The rate specified in the award; but only if that rate is based 
    on the percentage of the worker's average weekly wage required by State 
    law;
        2. The periodic rate paid prior to the lump-sum award (if method 1 
    does not apply); or
        3. The State's maximum weekly rate in effect at the time of the 
    injury (if methods 1 and 2 do not apply).
        We believe this proposed change is needed to better implement 
    section 224 of the Act more effectively.
    
    Proposed Policy--Exclusion of Legal and Medical Expenses
    
        Our present policy is that when workers incur legal, medical, and 
    related expenses in connection with the claim for workers' compensation 
    payments or related injury, those expenses are excluded from the lump-
    sum award for purposes of the offset computation to the extent 
    consonant with applicable law. Any deductions from the workers' 
    compensation payment such as tax withholdings, life insurance, medical 
    premiums, etc., are included in the amount used in the offset 
    computations, as are amounts garnished or attached to satisfy legal 
    obligations.
        There are three methods which we use in prorating a lump-sum award 
    with excludable expenses:
        Method A--Delays imposition of offset because it allows SSA to take 
    the excludable expenses from the beginning of the proration. This is 
    advantageous to the worker who is approaching age 62 or 65 years of age 
    or when a closed period of disability is involved.
        Method B--Divides the lump-sum award, minus the expenses by the 
    total lump-sum award. This percentage is then multiplied by the weekly 
    rate, resulting in a reduced weekly rate. This method reduces the 
    weekly workers' compensation rate so the offset amount is lowered 
    during the entire proration period.
        Method C--Reduces the lump-sum award by the amount of the 
    excludable expenses prior to the proration. This method removes offset 
    at the earliest possible time and could even end the proration prior to 
    the first possible month of offset.
        Until 1971, only Method C was used. Since then, we have used the 
    method most advantageous to the claimant, unless the lump-sum award 
    specifies the manner in which expenses are to be deducted.
        We propose to return to our pre-1971 policy for prorating a lump-
    sum award with excludable expenses. Using only Method C would provide 
    uniformity and consistency for all claimants. Since the Act and the 
    regulations do not require a specific method of proration, we believe 
    Methods A and B can be discontinued.
        Lastly, the meaning of the term ``related'' expenses has caused 
    unnecessary confusion. We have received several questions as to whether 
    items such as new homes, patios, ramps, costs of vans and vacations, 
    moving expenses to a milder climate, etc., may be ``related'' expenses. 
    Because we are aware of no expenses, other than medical or legal 
    expenses, that should be excluded from offset, we propose to remove the 
    category of ``related'' expenses and offset only medical and legal 
    expenses.
    
    Miscellaneous Proposed Changes
    
        We propose to change the language in section 404.408(a)(1) 
    regarding the application of the offset to certain individuals who 
    first became entitled to SSDI after 1965 but before September 1981 
    based on a period of disability that began after June 1, 1965, and 
    before March 1981. We wish to delete the word, ``first,'' as it is not 
    required by the law. Also, we wish to delete the dates ``September 
    1981'' and ``March 1981'' to remove an anomaly that affects claims with 
    a month of entitlement of September 1981 or later with disability 
    onsets prior to March 1981.
    
    
    [[Page 46684]]
    
    
        Example: A claim is filed September 1982 establishing a 
    disability onset date of January 10, 1980. The month of entitlement 
    is determined to be September 1981. This example would not be 
    covered by the current regulatory language.
    
        We also propose to change the language in section 404.408(a)(1)(i) 
    and elsewhere to refer to ``benefits or payments'' under a workers' 
    compensation law or plan, rather than simply ``benefits,'' as many 
    attorneys have claimed that certain workers' compensation is not a 
    ``benefit'' but is in fact a ``payment.''
        We propose to change the language in section 404.408(a)(2)(i) 
    regarding individuals entitled to SSDI who also are concurrently 
    entitled to certain other payments based on disability. We believe 
    ``concurrently'' is redundant.
        In addition, we propose to make revisions throughout Sec. 404.408 
    to add the language ``workers' compensation,'' where appropriate, to 
    current references to ``public disability benefits'' because ``workers' 
    compensation'' is the designation given for the majority of public 
    disability benefits other than SSDI or Supplemental Security Income 
    benefits. Using this language makes explicit that section 404.408 
    applies to ``workers' compensation'' laws.
        Finally, in Sec. 404.408 (h), (i), (j), (k), and (l), we propose to 
    remove outdated, unnecessary computation examples, leaving one basic 
    example in paragraph (h) of this section. We believe that the removal 
    of outdated, unnecessary examples will clarify this rule.
    
    Electronic Version
    
        The electronic file of this document is available on the Federal 
    Bulletin Board (FBB) at 9:00 a.m. on the date of publication in the 
    Federal Register. To download the file, modem dial (202) 512-1387. The 
    FBB instructions will explain how to download the file and the fee. 
    This file is in WordPerfect and will remain on the FBB during the 
    comment period.
    
    Regulatory Procedures
    
    Executive Order 12866
    
        We have consulted with the Office of Management and Budget (OMB) 
    and determined that these proposed rules do not meet the criteria for a 
    significant regulatory action under Executive Order 12866. Thus, they 
    are not subject to OMB review.
    
    Regulatory Flexibility Act
    
        We certify that these proposed rules will not have a significant 
    economic impact on a substantial number of small entities since these 
    rules affect only individuals. Therefore, a regulatory flexibility 
    analysis as provided in Public Law 96-354, the Regulatory Flexibility 
    Act, is not required.
    
    Paperwork Reduction Act
    
        These proposed rules impose no additional reporting or 
    recordkeeping requirements necessitating clearance by OMB.
    
    
    (Catalog of Federal Domestic Assistance Program No. 96.001 Social 
    Security--Disability Insurance)
    
    List of Subjects in 20 CFR Part 404
    
        Administrative practice and procedure, Blind, Disability benefits, 
    Old-Age, Survivors, and Disability Insurance, Reporting and 
    recordkeeping requirements, Social Security.
    
        Dated: August 26, 1997.
    John J. Callahan,
    Acting Commissioner of Social Security.
    
    PART 404--FEDERAL OLD-AGE, SURVIVORS AND DISABILITY INSURANCE 
    (1950-    )
    
        For the reasons set out in the preamble, subpart E of part 404 of 
    chapter III of title 20 of the Code of Federal Regulations is amended 
    as follows:
        1. The authority citation for subpart E of part 404 continues to 
    read as follows:
    
    
        Authority: Secs. 202, 203, 204 (a) and (e), 205 (a) and (c), 
    222(b), 223(e), 224, 225, and 702(a)(5) of the Social Security Act 
    (42 U.S.C. 402, 403, 404 (a) and (e), 405 (a) and (c), 422(b), 
    423(e), 424a, 425, and 902(a)(5)).
    
        2. Section 404.408 is amended by removing Example 2 from paragraph 
    (h)(2) and by removing the examples from paragraphs (i), (j), (k), and 
    (l)(3) and by revising the section heading and the headings and texts 
    of the following paragraphs: (a)(1) introductory text, (a)(1)(i), 
    (a)(1)(ii), (a)(2)(i), (b)(1), (b)(2)(ii), (c)(1) introductory text, 
    (c)(1)(i), (c)(3), (c)(5), (d)--introductory text, (d)(1), (d)(2), (e), 
    (f), (g), (h)(2)--Example 1, (j), (k), (l)(1), and (l)(2)(i). They read 
    as follows:
    
    
    Sec. 404.408  Reduction of benefits based on disability on account of 
    receipt of certain other disability benefits or payments provided under 
    Federal, State, or local laws or plans.
    
        (a) * * *
        (1) The individual became entitled to disability insurance benefits 
    after 1965 based on a period of disability that began after June 1, 
    1965 (but see paragraph (a)(2) of this section), and
        (i) The individual entitled to the disability insurance benefit is 
    also entitled to periodic benefits or payments under a workers' 
    compensation law or plan of the United States or a State for that month 
    for an injury or illness, and
        (ii) The Commissioner has, in a month before that month, received a 
    notice of the entitlement, and
    * * * * *
        (2) * * *
        (i) The individual entitled to the disability insurance benefit is 
    also, for that month, entitled to a periodic benefit (including 
    workers' compensation or any other payments) on account of a total or 
    partial disability (whether or not permanent) under a law or plan of 
    the United States, a State, a political subdivision, or an 
    instrumentality of two or more of these entities, and
    * * * * *
        (b) When reduction not made. (1) The reduction of a benefit 
    otherwise required by paragraph (a)(1) of this section is not made if 
    the workers' compensation law or plan under which the periodic benefit 
    or payment is payable provides for the reduction of such periodic 
    benefit or payment when anyone is entitled to a benefit under title II 
    of the Act on the basis of the earnings record of an individual 
    entitled to a disability insurance benefit under section 223 of the 
    Act.
        (2) * * *
        (ii) The benefit or payment is a Veterans' Administration benefit, 
    a public disability benefit (except workers' compensation) payable to 
    an employee based on employment covered under Social Security, a 
    benefit based on need, or a wholly private pension or private insurance 
    benefit.
        (c) Amount of reduction--(1) General. The total of benefits for a 
    month under sections 223 and 202 of the Act to which paragraph (a) of 
    this section applies is reduced monthly (but not below zero) by the 
    amount by which the sum of the monthly disability insurance benefits 
    payable on the disabled individual's earnings record and benefits or 
    payments under a workers' compensation law or plan payable for that 
    month exceeds the higher of:
        (i) Eighty percent of the individual's average current earnings, as 
    defined in paragraph (c)(3) of this section; or
    * * * * *
        (3) Average current earnings defined.
        (i) Beginning January 1, 1979, for purposes of this section, an 
    individual's average current earnings is the largest amount computed 
    under either paragraph (c)(3)(i)(A), (B), or (C) of this section (after 
    reducing the amount to the next lower multiple of $1 when the amount is 
    not a multiple of $1):
        (A) The average monthly wage (determined under section 215(b) of 
    the Act as in effect prior to January 1979) used for purposes of 
    computing the individual's disability insurance benefit under section 
    223 of the Act;
    
    [[Page 46685]]
    
        (B) One-sixtieth of the total of the individual's wages and 
    earnings from self-employment covered under the Act, without the 
    limitations under sections 209(a) and 211(b)(1) of the Act (see 
    paragraph (c)(3)(ii) of this section), for the 5 consecutive calendar 
    years after 1950 for which the wages and earnings from self-employment 
    covered under the Act (see subpart K of this part) were highest; or
        (C) One-twelfth of the total of the individual's wages and earnings 
    from self-employment covered under the Act, without the limitations 
    under sections 209(a) and 211(b)(1) of the Act (see paragraph 
    (c)(3)(ii) of this section), for the calendar year in which the 
    individual had the highest wages and earnings from self-employment 
    during the period consisting of the calendar year in which the 
    individual became disabled and the 5 years immediately preceding that 
    year.
        (ii) Method of determining calendar year earnings in excess of the 
    limitations under sections 209(a) and 211(b)(1) of the Act. For the 
    purposes of paragraph (c)(3)(i) of this section, the extent by which 
    the wages or earnings from self-employment of an individual exceed the 
    maximum amount of earnings creditable under sections 209(a) and 
    211(b)(1) of the Act in any calendar year after 1950 and before 1978 
    will ordinarily be estimated on the basis of the earnings information 
    available in the records of the Social Security Administration. (See 
    subpart I of this part.) If an individual provides satisfactory 
    evidence of the actual earnings in any year, the extent, if any, by 
    which the earnings exceed the limitations under sections 209(a) and 
    211(b)(1) of the Act shall be determined by the use of such evidence 
    instead of by the use of estimates.
    * * * * *
        (5) Computing disability insurance benefits. When reduction is 
    required, the total monthly Social Security disability insurance 
    benefits payable after reduction can be more easily computed by 
    subtracting the monthly amount of the other workers' compensation/
    public disability benefits or payments from the higher of paragraph 
    (c)(1)(i) or (ii) of this section. This is the method employed in the 
    example used in this section.
        (d) Items not counted for reduction. Amounts paid or incurred and/
    or a reasonable estimate of amounts to be incurred, by the individual 
    for medical and/or legal expenses in connection with the claim for 
    workers' compensation/public disability benefits or payments (see 
    Sec. 404.408 (a) and (b)) or the injury or occupational disease on 
    which the workers' compensation/public disability award or settlement 
    agreement is based, are excluded in computing the reduction under 
    paragraph (a) of this section to the extent they are consonant with the 
    applicable Federal, State, or local law or plan. The reduction must 
    reflect either the actual amount of expenses already paid or incurred 
    and/or a reasonable estimate of amounts to be incurred, given the 
    circumstances in the individual's case, of future medical and/or legal 
    expenses. The total of such expenses will be subtracted from the total 
    of a settlement agreement prior to the proration of the reduction. Any 
    expenses not established by evidence required by the Commissioner or 
    not reflecting a reasonable estimate of the individual's actual future 
    expenses will not be excluded. These medical and/or legal expenses may 
    be evidenced by the workers' compensation/public disability award, 
    compromise agreement, a court order, or by other evidence as the 
    Commissioner may require. This other evidence may consist of:
        (1) A detailed statement by the individual's physician or the 
    employer's insurance carrier; or
        (2) Bills, receipts, or canceled checks; or
    * * * * *
        (e) Certification by individual concerning eligibility for workers' 
    compensation/public disability benefits or payments. Where it appears 
    that an individual may be eligible for a workers' compensation/public 
    disability benefit or payment which would give rise to a reduction 
    under paragraph (a) of this section, the individual may be required, as 
    a condition of certification for payment of any benefit under section 
    223 of the Act to any individual for any month, and of any benefit 
    under section 202 of the Act for any month based on such individual's 
    earnings record, to furnish evidence as requested by the Commissioner 
    and to certify as to:
        (1) Whether he or she has filed or intends to file any claim for a 
    workers' compensation/public disability benefit or payment; and
        (2) If he or she has so filed, whether there has been a decision on 
    the claim. The Commissioner may rely, in the absence of evidence to the 
    contrary, upon a certification that he or she has not filed and does 
    not intend to file such a claim, or that he or she has filed and no 
    decision has been made, in certifying any benefit for payment pursuant 
    to section 205(i) of the Act.
        (f) Verification of eligibility or entitlement to a workers' 
    compensation/public disability benefit or payment under paragraph (a). 
    Section 224 of the Act requires the head of any Federal agency to 
    furnish the Commissioner information from the Federal agency's records 
    that is needed to determine the reduction amount, if any, or verify 
    other information to carry out the provisions of this section. The 
    Commissioner is authorized to enter into agreements with States, 
    political subdivisions, and other organizations that administer a law 
    or plan of workers' compensation/public disability benefits in order to 
    obtain information that may be required to carry out the provisions of 
    this section.
        (g) Workers' compensation/public disability benefit or payment 
    payable on other than a monthly basis. (1) Where workers' compensation/
    public disability benefits or payments are paid periodically but not 
    monthly, or are paid in a lump-sum as a commutation of or a substitute 
    for periodic benefits or payments, the reduction under this section is 
    made at the time or times and in the amounts that the Commissioner 
    determines will approximate, as nearly as practicable the reduction 
    required under paragraph (a) of this section.
        (2) The rate at which to prorate the benefits or payments is the 
    rate in the award if that rate is based on the percentage of the 
    worker's average weekly wage required by Federal or State law. 
    Otherwise, the rate to be used is the prior periodic rate or the 
    State's maximum weekly rate in effect at the time of the injury.
        (3) All lump-sum awards, whether for total or partial disability, 
    for temporary or permanent disability, or for scheduled or unscheduled 
    disabilities, including loss of body function, will be offset against 
    Social Security disability insurance benefits as provided in paragraph 
    (a) of this section.
        (h) * * *
        (2) * * *
    
        Example: Effective September 1995, Harold is entitled to a 
    monthly disability primary insurance amount of $507.90 and a monthly 
    public disability benefit of $410.00 from the State. Eighty percent 
    of Harold's average current earnings is $800.00. Because this amount 
    ($800.00) is higher than Harold's disability insurance benefit 
    ($507.90), we subtract Harold's monthly public disability benefit 
    ($410.00) from eighty percent of his average current earnings 
    ($800.00). This leaves Harold a reduced monthly disability benefit 
    of $390.00.
    
        (j) Effect of social security disability insurance benefit or 
    payment increases. Any increase in benefits due to a recomputation or a 
    statutory increase in benefit rates is not subject to the reduction for 
    workers' compensation/public disability benefits or payments
    
    [[Page 46686]]
    
    under paragraph (a) of this section and does not change the amount to 
    be deducted from the family benefit or payment. The increase is simply 
    added to what amount, if any, is payable. If a new beneficiary becomes 
    entitled to monthly benefits on the same earnings record after the 
    increase, the amount of the reduction is redistributed among the new 
    beneficiaries entitled under section 202 of the Act and deducted from 
    their current benefit rate.
        (k) Effect of changes in the amount of the workers' compensation/
    public disability benefit or payment. Any change in the amount of the 
    workers' compensation/public disability benefit or payment received 
    will result in a recalculation of the reduction under paragraph (a) of 
    this section and, potentially, an adjustment in the amount of such 
    reduction. For those individuals described in paragraph (a)(1) of this 
    section who do not meet the conditions specified in paragraph (a)(2) of 
    this section, any increased reduction will be imposed effective with 
    the month after the month the Commissioner received notice of the 
    increase in the workers' compensation benefit or payment (it should be 
    noted that only workers' compensation can cause this reduction). 
    Adjustments due to a decrease in the amount of the workers' 
    compensation/public disability benefit or payment will be effective 
    with the actual date the decreased amount was effective. For 
    individuals described in paragraph (a)(2) of this section, any increase 
    or decrease in the reduction will be imposed effective with the actual 
    date of entitlement to the new amount of the workers' compensation/
    public disability benefit or payment.
        (l) Redetermination of benefits--(1) General. In the second 
    calendar year after the year in which reduction under this section in 
    the total of an individual's benefits under section 223 of the Act and 
    any benefits under section 202 of the Act based on his or her wages and 
    self-employment income was first required (in a continuous period of 
    months), and in each third year thereafter, the amount of those 
    benefits which are still subject to reduction under this section are 
    redetermined. The redetermination will be made unless it results in any 
    decrease in the total amount of benefits payable under title II of the 
    Act on the basis of the workers' wages and self-employment income. The 
    redetermined benefit is effective with the January following the year 
    in which the redetermination is made.
        (2) * * *
        (i) The ratio of the average of the total wages (as defined in 
    Sec. 404.1048(c)) of all persons for whom wages were reported to the 
    Secretary of the Treasury or his delegate for the calendar year before 
    the year in which the redetermination is made, to the average of the 
    total wages of all persons reported to the Secretary of the Treasury or 
    his delegate for calendar year 1977 or, if later, the calendar year 
    before the year in which the reduction was first computed (but not 
    counting any reduction made in benefits for a previous period of 
    disability); and
    * * * * *
    [FR Doc. 97-23506 Filed 9-3-97; 8:45 am]
    BILLING CODE 4190-29-P
    
    
    

Document Information

Published:
09/04/1997
Department:
Social Security Administration
Entry Type:
Proposed Rule
Action:
Proposed rule.
Document Number:
97-23506
Dates:
To be sure that your comments are considered, we must receive them no later than November 3, 1997.
Pages:
46682-46686 (5 pages)
Docket Numbers:
Regulations No. 4
RINs:
0960-AE35: Reduction of Disability Benefits--Workers' Compensation/Public Disability Benefits (567F)
RIN Links:
https://www.federalregister.gov/regulations/0960-AE35/reduction-of-disability-benefits-workers-compensation-public-disability-benefits-567f-
PDF File:
97-23506.pdf
CFR: (2)
20 CFR 404.1048(c))
20 CFR 404.408