DI 52150: Factors in Computing Workers' Compensation/Public Disability Benefit (WC/PDB) Offset
The TFB is the total of all disability insurance benefits (DIB) monthly amounts for the number holder (NH) and any auxiliaries entitled on the NH’s SSN in the first-considered date of offset. For the definition of first-considered date of offset, see DI 52150.020.
A. Computing the TFB
Compute the TFB using benefit amounts in the first-considered date of offset.
1. Compute the TFB after reduction events
Compute the TFB using benefit amounts after the following reduction events:
Dual entitlement - use only the excess benefit amount (LEMBA). For an explanation of dual entitlement, see RS 00615.020.
2. Compute the TFB before deduction events
Compute the TFB using benefit amounts before the following deduction events:
Annual Earnings test - for instructions, see DI 52150.075 – Work Deductions and Offset of Auxiliary Benefits.
Government Pension Offset - see GN 02608.100 – Government Pension Offset (GPO) Provision.
GN 02603.055 - Deductions When Workers' Compensation/Public Disability Benefit (WC/PDB) Offset Applies
3. Compute the TFB before suspension events
Compute the TFB using benefit amounts before the following suspension events:
Substantial Gainful Activity (SGA) during the Extended Period of Eligibility (EPE) - for information regarding suspension of disability benefits, see DI 10105.095.
No child in care - as defined in RS 01310.001.
B. Benefit amounts excluded from the TFB
The following entitlements are not included in the TFB:
Divorced spouse (B6) benefits effective 01/01/91 and later in these situations:
the couple has been divorced for at least two continuous years.
EXAMPLE: The NH and spouse were divorced in October 2003. The NH becomes entitled to DIB in April 2008. Because the couple has been divorced for at least two continuous years, the divorced spouse is not included in the TFB.
The NH was entitled to the current DIB in the month prior to the month of divorce.
EXAMPLE: The NH was entitled to the current DIB in the month prior to the month of divorce. The NH was entitled to DIB effective April 2008. The couple divorces in July 2008. The divorced spouse is not included in the TFB beginning July 2008.
For rules regarding divorced spouse entitlement prior to 01/01/91, see RS 00202.035C.2.
A divorced spouse originally entitled as an independently entitled divorced spouse
Delayed claimants. If a delayed claimant is subsequently entitled, the TFB and possibly the amounts payable after offset must be adjusted. For information regarding delayed claimants, see GN 01010.140.
Technical entitlement only benefits (the beneficiary is entitled to higher benefits on another record). For simultaneous entitlement of a spouse, see RS 00202.025; for widow’s benefits, see RS 00207.002; and for child benefits, see RS 00615.770.
C. Events that do not change the TFB
The following events are protected increases and do not change the TFB:
Cost-of-living adjustment (COLA) increase.
Primary insurance amount (PIA) increase due to a recomputation effective after the first-considered date of offset.
Combined family maximum that is first used in a month after the first-considered date of offset.
Resumption of WC/PDB payments based on the same injury after a break in payment.
For information regarding protected increases and breaks in WC/PDB payment, see DI 52150.055.
D. Changing the TFB in the first-considered date of offset
The TFB may change if any of the following occur and are retroactively effective with, or prior to, the first-considered date of offset:
A PIA increase is effective;
A change in family composition is processed; or
A combined family maximum (CFM) applies.
E. New TFB based on a new first-considered date of offset
Determine a new TFB when the following events establish a new first-considered date of offset:
A new period of DIB is established; or
A new WC/PDB claim is awarded based on a new injury or illness.
EXAMPLE: WC entitlement from one injury ends and the NH sustains a new injury. The new WC claim causes a new first-considered date of offset and a new TFB is established that month. For information regarding a break in WC/PDB entitlement but no break in DIB entitlement, see DI 52150.055C.1.
F. Changes after the first-considered date of offset that affect the TFB
If family composition changes after the first-considered date of offset, determine a new TFB to calculate the benefit amounts after offset.
For information regarding changes in family composition, see DI 52150.070.
If a windfall elimination provision (WEP) PIA becomes effective after the first-considered date of offset, a new TFB is effective with that change.
G. How to determine the TFB when a combined family maximum (CFM) is involved
Determining the TFB when CFM is involved depends on when the CFM is effective.
If the CFM is effective in the first month offset is considered or earlier, use the benefit amounts determined using the CFM in the TFB.
NOTE: A simultaneously entitled child cannot request payment on the other record in order to avoid offset. For information regarding simultaneous entitlement and CFM, see RS 00615.776.
If the CFM is effective after the first month offset is considered, the resulting increase in benefits is protected and the TFB is not recomputed.