Does Workers Compensation Affect Medicare or Other Benefits?

Posted by Allison Sullivan on Apr 6, 2017 12:48:39 PM

Does Workers Compensation Affect MedicareWorkers Compensation can be granted for any number of workplace-related injuries or illnesses caused by the workplace environment, including slips and falls, mental injuries, and more.

Previously, we've answered Workers Compensation question like:

Many workers who receive Workers Compensation may do so while receiving other benefits like SSDI or Medicare, and this grows more common as the average age of the American employee rises. Does Workers Compensation affect Medicare or other government benefits? Let's take a look.

Social Security Disability Payments

With the exception of a few situations, Social Security Disability Insurance (or SSDI) benefits will be reduced while you receive Workers Compensation, so that the total monthly amount that a disabled worker receives is no more than 80% of the amount earned when fully employed.

This reduction is referred to as an "offset", and is subject to certain complicated calculations, as Workers Comp programs vary from state to state.

Since each state has different rules about things like the max workers comp amount that can be paid out, different categories of benefits, and methods of settling a Workers Compensation case, it's important to seek experienced legal representation if possible when trying to navigate this particular issue as South Carolina law may allow certain language to be included in an award or settlement that may reduce the amount of this offset.

Medicare Recipients and Workers Compensation

Medicare provides health insurance for many individuals in the United States. If a claimant's workers' compensation claim is denied the claimant may request that Medicare make a "conditional payment" and provide coverage for treatment related to the alleged injury.  You can learn more about this here on Medicare's website.  If the claimant does get a recovery from the workers' compensation carrier, then the claimant may be required to repay Medicare's conditional payment.

A claimant may also suffer a work injury so serious that the claimant is unable to return to work and must apply for Social Security Disability and as a result create a "reasonable expectation" of becoming entitled to Medicare.  During the course of settlement discussions, the carrier may offer to pay a sum of money to the claimant for the claimant's future medical treatment.  

This situation creates further complexities and may require the creation of a separate trust account to pay for medical treatment that may be covered by Medicare.

We'll be posting more about what it means to settle a Workers Compensation claim next week, so keep an eye out!

Does Medicaid Affect Workers Compensation?

There are a number of different ways that a claimant may be entitled to Medicaid and in most cases Medicaid eligibility is based upon financial need.  

While a claimant's entitlement to Medicaid will not affect a claimant's worker's compensation benefits the reverse is not true. Because Medicaid is a needs based program, a workers' compensation settlement may make a claimant ineligible for continued Medicaid benefits.  

There are options to preserve a claimant's Medicaid eligibility while receiving a workers' compensation award but those options depend upon a claimant's particular circumstances.  

We recommend consultation with a legal representative to further explore what those options may be.  

Concerned About How Workers Comp Affects Benefits?

BNTD Law has experience handling Workers Compensation cases in South Carolina, and our own Allison Sullivan is currently President-elect of Injured Workers Advocates and Marti Bluestein is a past President of Injured Workers Advocates.  When filing for Workers Compensation, you deserve legal representation dedicated to your individual rights. To request your FREE consultation, reach us by phone at (803) 779-7599 or contact us online at any time. We'd be happy to speak with you about your unique situation regarding your Workers Compensation claim in South Carolina, and help you to decide what next step is right for you.

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Topics: Worker's Compensation