Workers' Comp Interaction With Other Public Benefits Programs: Medicare, Medicaid, SSDI, State Programs; Client Impact

Many claimants who receive workers' compensation payments do so while receiving other public benefits like SSDI, Medicare, Medicaid, or payments through state disability programs. Counsel should understand how workers' comp interacts with other public benefits programs and the impact it may have on workers' comp benefits and settlement agreements to help manage claimants' expectations and guide them through any additional administrative obligations.

For example, parties on Medicare who are resolving workers' comp claims must adhere to the Medicare Secondary Payer Act (MSPA) and its various reporting and reimbursement obligations to ensure Medicare cannot seek potential reimbursement of paid medical expenses or impose penalties for noncompliance.

Where a claimant is unable to return to work and must apply for SSDI benefits, the amount to which they are entitled may be affected. The general rule followed by SSDI is that if a worker receives workers' comp and SSDI benefits, the total combined amount cannot exceed 80 percent of the worker's average current earnings before they become disabled.

Additionally, where a claimant is entitled to Medicaid, a needs-based program, workers' comp payments may affect a claimant's eligibility for continued Medicaid benefits.

Listen as our expert panel provides a comprehensive examination of how workers' compensation interacts with other public benefits programs and offers best practices for assisting claimants through this administrative maze.