DI 52135: State Specific Public Disability Benefit (PDB) Procedures
This section provides information on various PDB plans paid in Puerto Rico.
A. Seguro Incapacidad No Ocupacional (SINOT)
Puerto Rico law provides for up to 26 weeks of disability benefits for non-work related disabilities. The worker’s salary determines the weekly rate. The minimum weekly rate is $12.00 and the maximum rate is $113.00. If the disability is later determined to be work related, the worker will receive worker's compensation benefits from the State Insurance Fund known as Dietas, Temporary Partial (TP), or Temporary Total (TT) payments.
In most instances, SINOT benefits will not cause offset of Social Security disability insurance benefits (DIB). This is because SINOT benefits are generally not payable for any period in which the worker is entitled to DIB.
SINOT benefits are payable during DIB entitlement if the SINOT benefit is due to a different disability than that of the DIB and the DIB onset began prior to the SINOT onset. In this situation, the SINOT benefits will cause offset of DIB and reverse offset is not applicable.
In the absence of evidence to the contrary, assume that both benefits are based on the same disability and that the SINOT onset was before or simultaneous with the DIB onset. (i.e. reverse offset is applicable).
B. Automobile Accident Social Protection Act (AASPA)
The Commonwealth of Puerto Rico Automobile Accident Compensation Administration (ACAA, Spanish acronym) administers AASPA. The basis for eligibility is the payment of a fee when registering a car and not based on performed services. Payments may be made on a weekly basis up to two years, and/or a lump sum (LS) payment when dismemberment occurs. The amount of income lost determines the weekly rate paid in each case. The rate is limited to $100.00 during the first 52 weeks and to $50.00 from the 53rd through the 104 week. The amount of the LS varies with each case. Payments are at a $50.00 weekly flat rate. Payment of the LS and periodic payments are concurrent in the cases where the worker has the right to both benefits.
1. Applicability of offset in AASPA/ACAA cases
Disability benefits paid pursuant to the AASPA will cause offset. There is no potential exclusion from offset because the worker was engaged in covered employment.
2. Imposing offset in AASPA/ACAA cases
Impose offset. Code the case “SG”, State PDB only.
Chapter 45 of Title 29 of the laws of Puerto Rico provide for two types of benefits based on disability under this plan. Verify the section of the statute involved.
1. Section 683 payments
Such payments, known in Puerto Rico as “Negociado de Seguro Social para Choferes y Otros Empleados,” (commonly known as Seguro Choferil), are sickness pensions payable on a weekly basis for a maximum of 30 weeks to workers unable to work driving a motor vehicle. Payments made under Section 683 are offsettable.
NOTE: Section 684 determines eligibility only.
2. Section 686 payments
Section 686 provides a pension for total permanent disability before age 65. The basis of the pension is the age of the worker and the period over which the worker pays into the pension fund. The benefit is a single lump sum payment and is not a substitute for periodic payments. Section 686 benefits are not offsettable.
3. Section 683 payments converted to Section 686 payments
After receiving 30 weeks of sickness pension payments under Sections 683, these payments may convert to total permanent disability pension payments under Section 686, as follows:
After the Section 683 payments expire, the worker is given an additional 30 weeks timeframe (but no further payments) to prove he/she is totally and permanently disabled based on the same injury/illness.
If the worker is determined to be totally and permanently disabled within this timeframe, the previously paid Section 683 benefits are then considered an “advance” of Section 686 payments.
The Section 686 single lump sum payment is reduced by the amount of the Section 683 payment previously made. Any Section 683 payment deducted from the Section 686 payment is deemed to be converted to payment under Section 686 and, therefore, does not cause offset.
D. Other public employees
Certain disability payments are specifically excluded by law as PDBs that cause offset of DIB per DI 52125.001B. One of these excluded categories are State or local disability benefits based on State or local employment under Section 218 all or “substantially all” of which was covered for Social Security purposes. See DI 52125.001B.2 for a definition of “substantially all”. See DI 52125.010 for determining when to apply PDB offset.
The State/Commonwealth in its 218 Agreement with SSA determines coverage for state/local employees. SL 20001.201 provides an understandable history of 218 Agreements. Because of permitted modifications to State Agreements, it is extremely difficult to maintain a current listing of public employees covered under Section 218. The following are the most common examples of non-covered public employees:
Teachers working for the Puerto Rico Department of Education
Use caution not to confuse the following workers of similar job class covered under the 218 Agreement with the non-covered public employees.
Teachers employed by private schools
Teachers employed by the University of Puerto Rico
Employees of the Electric Power Authority (Autoridad Energia Electrica)
1. Processing guidelines
a. Initial development
Develop each case individually since work histories and dates of covered service will differ.
Determine if an individual public employee is a Section 218 covered employee following instructions in DI 52125.005.
Secure a SSA-1709 Request for Workers' Compensation/Public Disability Benefit Information in every case.
b. Reviewing development response
After all developmental issues are resolved:
The PDB is excluded by law as a PDB that causes offset if the claimant meets all the criteria for State or local employment under Section 218 all or “substantially all” of which was covered for Social Security purposes as noted in DI 52125.001B.2. The PDB is not offsettable.
The PDB is not excluded by law as a PDB that causes offset if the claimant does not meet all the criteria for State or local employment under Section 218 all or “substantially all” of which was covered for Social Security purposes as noted in DI 52125.001B.2. The PDB is offsettable.
c. Imposing offset
If the PDB is offsettable, code the case “SG”, State PDB only. See DI 52125.010 for additional information on when PDB is offsettable.
DI 52120.215 - Explanation of Puerto Rico WC terms.
SL 20001.201 -Program Overview.
English translation of Puerto Rico Law http://www.michie.com/puertorico/lpext.dll?f=templates&fn=main-h.htm&cp=prcode