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Injured workers in North Carolina often have a pending workers’ compensation claim or had one in the past. It is also common for such workers, even when fully unable work, to hesitate to file for Social Security disability benefits. This is due, at times, due to concern about an offset. However, delays in filing for SSD can cause workers to lose some or all of their Social Security benefits. An explanation of the offset related to WC and SSD may clear things up.

The 80 percent rule will apply to a worker who receives both WC payments and SSD payments related to the same month of disability. This means that the combined amount in any given month may not exceed 80 percent of the worker’s average monthly earnings.

The Social Security Administration will determine the average monthly earnings figure. The formula uses certain years of indexed income prior to the worker becoming disabled. Typically, the SSA will deduct the amount exceeding 80 percent from the claimant’s subsequent Social Security lump sum back benefits payment. Future offsets are also possible.

The offset rule is generally not a wise reason to refrain from filing for SSD for a multitude of reasons. However, becoming eligible for Medicare is among the most important reasons to file for SSD. Medicare eligibility for those under age 65 stems from an SSD award, not a WC settlement. After collecting 24 months of SSD payments, a disabled individual is generally eligible for Medicare. He or she also has an initial but brief option to choose to buy a supplement plan without underwriting. This is a valuable right for a disabled person whose preexisting medical conditions could otherwise bar any reasonably priced health insurance plan.

When injured on the job, properly filing a WC claim and being aware of misconceptions regarding WC remains a priority. However, if one is unable to work full time in any job for reasons of Medicare, among others, it is generally never a good idea to forgo SSD or to delay applying when it would otherwise be a valid claim.