The Impact of SSI Benefits and Medicare Compliance on Workers' Comp Settlements

HR Resource
January 4, 2013 — 2,142 views  
Become a Bronze Member for monthly eNewsletter, articles, and white papers.

There are many kinds of insurance programs which are designed to help the citizens of US. Medicare is one such insurance program that guarantees health coverage to Americans who are aged 65 and above and to younger people with disabilities. SSI or Supplemental Social Income is a social security insurance program designed to help aged, disabled, and blind people with little or no income. Workers’ Compensation is another insurance program that benefits employees who are disabled or injured on the job.

The policies of these insurance programs are different and complications may arise if one is entitled to receive the benefits of more than one program. There are many laws to be followed when one is eligible to receive insurance claims from more than one source.

Secondary Payer Act

The Secondary Payer Act is a federal law which was designed to reduce the costs that are usually taken on Medicare. This act is applicable when a person is eligible to claim another type of insurance, other than Medicare. Under this act, insurance programs are categorized for primary payers and secondary payers. Here, any employer sponsored health insurance, like worker’s compensation, is considered as primary payer insurance. Accordingly, the secondary payer insurance, which is not an employer-sponsored health insurance, gives the secondary payer an option of making a payment if the primary payer delays in making the payment.

The secondary payer should be reimbursed once the primary payer has paid the claim. According to the Secondary Payer Act, the secondary payer’s claim for reimbursement will take precedence over the claim of Workers’ Compensation program. This can have negative impact on Workers’ compensation, as the benefits of the program can go unutilized.

The Set-aside Arrangement

A Worker’s Compensation-Medicare set aside arrangement can be used in order to utilize the Workers’ Compensation funds first. For this, you should first file a Workers’ compensation claim with your employee if your injury is related to your work. Inform your insurance agent that you have requested for Workers’ Compensation. Finally, request a settlement for your Workers’ Compensation claim and then create a set-aside account to cover the medical expenses in the future, with the funds that you have received in your settlement.

SSI Eligibility

When an individual is injured at work, then the Workers’ Compensation practitioner should be able to identify the possible issues in the client’s claim for a social security benefits program. If the client is still working or if he/she can return to work, despite an injury which is work-related, then the instance of filing a SSI claim can be considered as moot. This means that a person who is able to work is ineligible to apply for SSI. If a client cannot continue to work or is not able to start working after taking sick leave, then filing an SSI claim should be encouraged.

SSI and Workers’ Compensation Settlement

If a SSI recipient gets a Workers’ Compensation settlement, then the amount received as payment will decide the SSI benefits. Based on the payment received, the amount to be paid to the claimant in SSI, during the months which were covered by Workers’ Compensation, will be calculated. If an SSI claimant has more than 2000 dollars as liquid assets, then his/her SSI benefits will be compromised.

HR Resource