DI 52120: State Specific Workers' Compensation (WC) Procedures
BASIC (09-08)
A. Types of WC Payments
Temporary Total (TT) – reverse offset applies (see DI 52120.145B below)
Permanent Total (PT) – reverse offset applies (see DI 52120.145B below)
Temporary Partial (TP) - limited to a total of 26 weeks, but the period can be extended by the insurer
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Permanent Partial (PP)
Impairment Awards (IA) – (code as PP)
Wage Supplement (WS) – (code as PP); paid for dates of injury from 07/01/1987 through 06/30/1991. Maximum period was 500 weeks
Total Rehabilitation (TR) – (type of VR); maximum period is 104 weeks. A written, signed rehabilitation plan must be in place before these benefits can be paid.
B. Reverse offset for TT and PT awards
Since July 1971 Montana WC law has provided for a reduction of TT and PT WC payments due to the receipt of Social Security disability insurance benefits (DIB) based on the same injury occurring after 7/01/1971. This is a reverse offset plan. For more information, see DI 52105.001 - Reverse Offset Plans.
C. Cost-of-living adjustments (COLAs)
Annual cost of living adjustments given for Permanent Total (PT), which are under reverse offset, after 104 weeks of benefits have been paid and are computed each July 1. Increases for the dates of injury prior to 03/26/2003 limited to 3 percent.
D. Other types of WC and settlements
The following types of WC payments are offsettable under the DIB provisions:
TP, PP, IA, TR, WS
Other types of settlements and ratings that do not specify the type of payment involved
Awards that state there is no acceptance of liability by the insurer
WC benefit categories created after the 1981 Amendments. For more information, see DI 52105.001A - Recognized Reverse Offset Plans.
E. Reverse offset factored into WC settlement award
TT and PT settlement awards are processed through the State WC office for approval and therefore always reflect consideration of the State reverse offset provisions and DIB entitlement by SSA.
If the type of payment is TT or PT, then reverse offset provisions apply whether or not reverse offset is mentioned in the award.
If the award specifies a type of payment other than TT or PT, then reverse offset provisions do not apply, even if that award also mentions reverse offset.
If the award does not specify the type of payment, further development is needed.
F. Attorney fees
For cases settled without an order of the workers’ compensation judge or the Supreme Court, the attorney can charge up to 20 percent of the amount of additional compensation pay the worker receives.
For cases that go to a hearing before the workers’ compensation judge or the Supreme Court, the attorney can charge up to 25 percent of the amount of additional compensation pay awarded.
The WC judge can determine a reasonable attorney fee and access costs.
G. Retirement insurance benefit (RIB) considerations
Payment of permanent partial (PP) other than impairment award, permanent total (PT) and rehabilitation ends when a worker receives SSA RIB or is eligible to receive SSA RIB or retirement benefits from a system that is an alternative to SSA RIB. The insurer remains liable for temporary total (TT), impairment award (IA), and medical benefits.
H. Verifying WC
Follow the verification procedures in DI 52105.001E – Verifying Reverse Offset Plans.
If offset does not apply due to reverse offset, code the case “RJ”.
If the lump-sum award represents settlement of either a TT or PT award, no further verification is needed.
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If the WC award does not specify the type of benefit involved, verify the type of award. This may require contacting the Montana Department of Labor and Industry.
From 1987, Montana law provided compensation must run consecutively and not concurrently, and payment may not be made for two classes of disability over the same period, except for impairment awards (IA).
Example:
The claimant sustained a work related injury to his lower back and right arm. He became eligible for TT benefits since his back injury prevented him from returning to his previous employment or performing other employment with similar requirements.
Subsequently, the claimant also received an IA benefit for his right arm injury based on the loss of bodily function. The IA benefit may be paid biweekly or in a lump-sum.
In determining the DIB payment amount, the TT benefit falls within the scope of the State reverse offset provisions. Therefore, DIB offset does not apply to the TT benefit.
However, the IA benefit does not fall within the scope of the State reverse offset provisions and, therefore, DIB offset may apply to the IA benefit. If the IA is paid as a lump-sum, development is necessary to determine the rate, start date, and duration of payments had the IA been paid biweekly. Offset is imposed using the biweekly payment information provided.