Making NC Workers' Comp Play Nice With Others * Coordinating with Other Public and Private Plans
N.C. Workers' Compensation and Social Security DisabilitySeriously injured workers may be eligible for Social Security Disability (SSD) benefits in addition to NC workers' comp benefits. Most people will get more money by receiving both.
The total maximum benefit (Social Security plus most other income, including workers' comp) is determined by a complex formula. In general, workers' comp will pay first, then Social Security will kick in an amount up to the maximum benefit. In other words, SSD gets an a credit for the workers' compensation payments.
Another benefit of receiving SSD is you will be eligible for Medicare.
It is important to take into account how Social Security will look at any lump-sum settlement or what we call in North Carolina a "clincher." It is often possible to use Social Security "offset language" to minimize the potential consequences on SSD payments of "clinchering" a NC Workers' Comp case.
N.C. Workers' Compensation and MedicareDisabled workers who are also on SSD or Social Security Retirement may also be eligible for Medicare benefits. Medicare will generally not pay medical expenses related to a workers' compensation injury but may pay for other medical expenses.
Medicare requires that its interests be protected in the settlement or "clincher" of a workers' compensation case. Medicare does not want an injured worker to settle their workers' compensation case and then come to Medicare to pay for medical treatment for the workers' compensation injury. In some situations it may be best to "set aside" a certain sum of money from the settlement to be spent on medical treatment for the workers' compensation injury, after which Medicare will step in and provide further benefits for the workers' comp injury.
Medicare regularly changes its guidance on set-asides and determining when and how these set-asides must be established is one of the most troubling issues facing NC workers comp lawyers today.
N.C. Workers' Compensation and Private Health PlansAn injured employee should not allow an employer to push their workers' comp injury off onto health insurance. This could adversely affect the workers' comp claim and even contribute to a complete loss of benefits. Health plans will frequently attempt to recover money they spend on medical services that are related to a workers' comp injury. Whether this is allowed depends on the language of the particular health plan or policy. Many large employers have established health plans under a provision in federal law known as ERISA. These plans add an additional level of complexity to the question of reimbursement and must be carefully considered. An injured employee should not allow their health coverage to lapse because workers' compensation will only pay for services related to the particular injury. The North Carolina State Health Plan may also seek reimbursement from NC workers' comp benefits.
N.C. Workers' Compensation and Short and Long-Term Disability PlansInjured employees frequently are forced to rely on short or long-term disability plans when a workers' comp claim is denied. These disability plans may be entitled to reimbursement. Each plan is different and the only way to tell if a plan is entitled to reimbursement is to get and read the plan carefully. Another issue can arise if the policy is entirely paid for by the employer. In that event the employer may claim a credit for disability payments made by the short term or long term disability plan against workers' compensation benefits. An employer can not claim a credit for private disability payments at the same time that the private disability insurer is claiming a right of reimbursement.
What to do?Not every injured workers' needs a workers' comp attorney. But the fact is that coordinating workers' compensation benefits with other benefits, including Medicare and Social Security, can be the most complex and critical components of your workers' comp case.
If you are considering settling you workers' comp case you should carefully consider the effect that may have on these other benefits. It may be smart to consult an experience NC workers' comp lawyer.