EFFECTIVE/PUBLICATION DATE: 01/28/94
PURPOSE: To clarify that, under the supplemental security income (SSI) program, any portion of a WC payment designated for medical expenses, or for legal or other expenses attributable to obtaining the WC award is not income.
CITATIONS (AUTHORITY): Section 1612(a)(2)(B) of the Social Security Act (SSACT), as amended; Regulations No. 16, sections 416.1103(a), 416.1121(a), and 416.1123(b)(3)
PERTINENT HISTORY: WC is awarded to an injured employee or to the survivor(s) of an employee under Federal and State WC programs and the Longshoremen and Harbor Workers' Act. It may be paid by a Federal or State agency, an insurance company, or an employer. Payments may include amounts for medical expenses, or for legal or other expenses attributable to obtaining the WC award. These expenses may be past, current, or future and may be lump-sum or periodic in nature.
The SSACT at section 1612(a)(2)(B), and regulations at 20 CFR 416.1121(a) provide that WC is unearned income for SSI purposes. Regulations at 20 CFR 416.1123(b)(3) provide for counting less than the amount actually received when part of the amount received is for an expense of obtaining the income.
Regulations at 20 CFR 416.1103(a) provide that reimbursement for certain medical expenses is not income.
POLICY INTERPRETATION: If the Federal or State agency, insurance company, or employer that authorizes or makes a WC payment designates any portion of it for medical expenses, or for legal or other expenses attributable to obtaining the WC award, such portion is not income for SSI purposes. The expenses may be past, current, or future. Any portion of a WC award or payment not designated for such expenses is unearned income.
EFFECTIVE DATE: This Ruling merely clarifies longstanding SSI policy on the treatment of WC payments designated for certain types of expenses. If a case comes to SSA's attention where SSA did not apply this policy, SSA will reopen and revise the earliest determination possible under the rules of administrative finality. SSA will use the 2-year reopening rule, treating the determination as an error on the face of the evidence.
CROSS-REFERENCE: Program Operations Manual System, Part 5, Chapter 008, Subchapter 30, Section SI 00830.235.
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