Disability Services & Legal Center

Basic Orientation for Benefits Counseling

Disability Programs

SECTION 2

Disability Programs: 5 types

Workers Compensation (WC)

Workers Compensation (WC)

WC is a moving picture – it is is constantly being modified. Some changes apply to all claims while other changes only apply to

new claims with older claims being grandfathered.

3 Groups - Typically there are three groupings. 1st group – Returning to the same job (broken leg, pregnancy). 2nd group – Not returning to the same job and will need a

rehabilitation program to retrain for another job. 3rd group – Never returning to work and will receive a settlement.

WC payments - Clients can be offered monthly maintenance payments, medical insurance coverage payments, and/or lump sum settlements.

Worker Compensation

WARNING:Workers Comp

AFFECTS SDI, SSDI & SSI!

WARNING: Workers Comp AFFECTS SDI, SSDI & SSI!

NO Double Dipping - Any WC monthly payments or lump sums that cover the the same disability time period will affect a person’s SDI, SSDI, or SSI.

♦ Example: Lazarus gets $300.00/month from WC. His SSDI amount is reduced by $300.00 each month.

WC = NO Change! Some WC settlements do not affect SDI, SSDI, or SSI!

♦ Example: medical insurance coverage does not affect SDI. It does affect SSDI or SSI in that the WC medical coverage is primary and Medicare or Medi-Cal is secondary.

Workers Compensation (WC)

3 Groups - Typically there are three groupings to WC. 1st group – Returning to the same job, e.g. a broken leg. 2nd group – Not returning to the same job and will need a

rehabilitation program to retrain for another job. 3rd group – Not returning to work and will receive a settlement.

Consumer wants to change groups – WC clients come to DSLC when they have been placed in one group and they want to move to a different group. A client in the 3rd group does not want a settlement. The client wants

a rehab plan. This client will need to change how WC categorizes them in order to change groups.

Explain WC groupings AND refer client to additional rehab options, such as Department of Rehabilitation (DR or DOR).

Workers Compensation

WARNING: The client may be represented by a Workers

Comp attorney – they have signed a contract.

DSLC can ONLY offer the client information.

The client will need to work with their attorney to resolve their WC issues.

BREAKTIME

SSA, SDI, SSDI & SSIAcronyms & Definitions

• Check out this site at Duke University Law. It lists Social Security acronyms and their definitions.

• http://law.duke.edu/aidsproject/400_01/SSA_Acronyms.pdf

SDI, SSDI & SSIThey all sound alike

• There are 3 disability programs with similar sounding acronyms.

• Workers in agencies and clients often confuse these 3 disability programs.

• Let’s cover them one at a time. Please find the handout on SSDI, SSI, & SDI.

State of California State Disability Insurance (SDI)

• State Disability Insurance (SDI) is a temporary disability insurance program administered by the State of California through the Employment Development Department (EDD).

• Insurance premiums are paid by withholding from the workers' wages. If your paycheck stubs show a withholding for SDI, you have paid into this insurance program.

• If you become temporarily or permanently disabled you may receive up to one year of disability payments.

• SDI payments are roughly ½ of your average monthly working wage.

State of California State Disability Insurance (SDI)

• SDI payments are roughly ½ of your average monthly working wage.– If you’re a full time worker you are going to get a

larger SDI check than a part time worker or a person who earns less per hour than you do.

– If you’re a part time minimum wage worker you will not get as large an SDI check as a full time high wage earner.

SDI – How Long?

WARNING:SDI is a TEMPORARY disability program – only 1 year or less.

SDI - Eligibility Requirements

To be covered under this program you must meet two requirements:

• You must have paid into the SDI system within the last 18 months (check paycheck stubs to see if SDI was withheld from check).

• A doctor must verify that you are disabled, unable to work, and specify how long you cannot work.

SDI & What Else?

Check it out - A person can be on SDI and eligible for or might be receiving benefits from UI, WC or private disability programs.

Important to explain UI, WC, and private disability programs & check to see if they might be eligible for or already receiving benefits from these programs.

SDI & What Else?

Check it out - A person can be on SDI and eligible for or might be receiving benefits from UI, WC or private disability programs.

If they might be eligible for or receiving benefits from any of these programs, you will need to spend time explaining how these program are similar and how they differ.

SDI & UI (Unemployment Insurance) is a NO NO

A person cannot collect both SDI & UI.

• To be on UI a person must be ready, willing, and able to work, but unable to find a job.

• To be on SDI a person must have a disabling condition that prevents them from working and have paid into the SDI system.

SDI – Doctors Verify

The doctor will verify disability and work status in weekly increments.

For example, the doctor might verify that a disability will prevent someone from working for 12 weeks. SDI will pay the benefits for 12 weeks. At the end of the 12 week period, the SDI payments stop.

SDI – Doctors Re-Verify

If the person is still disabled, the doctor may verify the disability and work status again. Doctor decides how many additional weeks of disability are needed before the patient returns to work.

After receiving the doctor’s verification of continued disability, SDI will grant an extension and continue the disability payments.

REMEMBER

Doctors are the keys to the SDI

kingdom.

SDI – up to 1 year of coverage

If a person is fully paid into the SDI system at the time of disability and a doctor verifies the length of disability, the person is eligible for up to one year of disability payments.

SDI – Why Less Than 1 year?

If a person is only partially paid into the SDI system at the time of disability, they will be eligible for less than one year of coverage.

SDI – First Scenario Returning to my same ‘ol job.

• Most people use SDI as a temporary disability program. They have a broken leg, are on total bed rest last two months of their pregnancy, or have quadruple bypass heart surgery.

• These folks use a portion of the SDI that is available to them. They recover and return to their job.

• When a person has returns to work their SDI claim ends.

SDI – Second ScenarioMy disability ran out.

• The person is still disabled. Their doctor has verified disability and specified the maximum length of disability.

• SDI claim ends - There is less than 1 year of coverage available (not fully paid into system) OR is fully paid into system & used entire claim period of 1 year.

• SDI ends even though the person is still disabled. The SDI program is temporary. It only covers up to one year.

SDI – second scenario continuedMy disability has ended. What now?

• The person is still disabled and their SDI claim has ended. This person will need to apply for a permanent disability program.

• Many folks with permanent disabilities do not understand that SDI is a temporary disability program.

• Whenever you encounter a consumer on SDI, explain SDI is temporary and encourage them to apply for permanent disability.

SDI – second scenario & planning aheadNo one ever told me.

• Planning ahead is an essential part of acquiring a severe and permanent disability.

• Many consumers with severe and permanent disabilities will state they plan on going back to work before their SDI claim ends.

• Plan ahead for three different outcomes.– Get better and return to work.– Stay the same and unable to return to work.– Disability worsens and cannot return to work

Severe & permanent disability – Plan three different outcomes

Three different outcomes the reality for individual with a disability (IWD).

– Get better and return to work.– Stay the same and unable to return to work.– Disability worsens and cannot return to

work.

Severe & permanent disability – Three different outcomes

& DSLC support

DSLC staff use ILS and Peer Support services to help the IWD understand changed reality in their lives.

– Apply for SSA permanent disability to plan for the possibility of staying the same or getting worse.

– If you get better, call SSA and cancel your disability application.

SDI – medical coverage

• There is no medical coverage under SDI.

• If a person has been covered under a medical insurance plan through their employer, they may be eligible to continue this coverage. This is called COBRA (Consolidated Budget Reconciliation Act of 1985, and specifically to Title X of the Act).

SDI & COBRA

Consolidated Budget Reconciliation Act of 1985, and specifically to Title X of the Act

• For many consumers, COBRA is difficult to keep. They must pay their employee share PLUS the employers share of the insurance.

• Many consumers drop COBRA because they cannot afford the monthly payments.

• More information can be obtained from the employer.

SDI – the end

REMEMBER:SDI program is administered

through the

State of California