How Are Average Current Earnings Calculated?
The higher of three methods may be used to determine average current earnings. One method is to look at the average monthly wage that SSA uses for its benefits calculation. There is also the “high five” method which is the average of the five highest earning months or the “high one” method which looks at the average for the claimant’s highest earning year.
To illustrate, if a claimant’s average current earnings is $5,000 a month. Eighty percent of $5,000 is $4,000. In this example, say the worker gets $2,500 in SSDI benefits. The injured worker could not receive more than $1,500 a month in workers’ compensation ($2,500 SSDI + $1,500 workers’ comp = $4,000 total benefits).
Will Medicare offset workers’ compensation medical benefits?
The Medicare Secondary Payment Act (MSP) provides that Medicare is the second payer on any medical expenses where an insured has other coverage liable for the expenses. If the medical expense is directly caused by the work injury, it’s the employer’s workers’ comp insurer that is responsible to pay the expense.
Things might get a little more complex if medical benefits are included in a workers’ compensation settlement, which may end the worker’s rights to future workers’ comp benefits. Medicare may request these funds designed for medical expenses be set aside so the worker can use them instead of relying on Medicare to pay medical expenses.
The American Bar Association (ABA) has advocated for Congress to pass legislation that addresses the uncertainty that can accompany these cases “to return an appropriate level of certainty, predictability, and efficiency to the Medicare set aside process.”
Injured workers can learn more about how the intersection of workers’ compensation, Social Security disability, and Medicare rules and regulations affects their case by talking with an attorney. Markhoff & Mittman can navigate you through difficult areas of workers’ compensation as well as Social Security disability.