SSDI (Social Security Disability Insurance) Inquiry

Posted by Carol Brown

Question:
I represent a gentleman who was rear ended by a truck. As a result of the accident, he is receiving social security disability benefits. Is social security entitled to subrogation regarding benefits paid?

Answer:
Social Security Disability Insurance (SSDI) is an entitlement program based on a person’s prior work history and disability qualifiers. Social Security does not have a statutory right of reimbursement for disability benefits paid in liability situations. However, generally SSDI beneficiaries under age 65 are eligible for Medicare coverage in the month after they have received 24 months of SSDI benefits. There is a five-month waiting period from onset of the disabling condition for disabled individuals to be qualified to receive SSDI benefits. As a result of this waiting period, there is a total of 29 months after the onset of the disability before an individual is eligible for Medicare benefits.

Having said that, if your client becomes eligible for Medicare prior to settlement and/or is still treating for accident related care it is important to note that CMS has a direct right of action to recover its payments from any entity, including a beneficiary, provider, supplier, physician, attorney, state agency, or a private insurer that has received a third party payment, 42 CFR 411.24. MSP laws are applicable to situations where a beneficiary may file a claim and/or a civil action against a third party seeking damages for injuries received and medical expenses incurred as a result of that illness/injury. Per 42 U.S.C. 1395y(b) (2) and 1862 (b) (2)(A)(ii) of the Act, Medicare is precluded from paying for a beneficiary's medical expenses when payment "has been made or can reasonably be expected to be made under a workers' compensation (WC) plan, an automobile or liability insurance policy or plan (including a self-insured plan), or under no-fault insurance.

Hope you find this helpful. If we can assist you in the future, please do not hesitate to contact me.

Carol Brown