When you’re injured on the job in Georgia and unable to work for more than seven days, workers’ compensation pays part of your lost wages if you have a compensable workers’ compensation injury. This weekly income replacement known as temporary total disability usually equals two-thirds of your average wage, up to the state’s maximum. The workers’ comp insurance provider calculates that payment from your earnings during the thirteen weeks before the injury date, so bonuses, overtime, and shift changes can raise or lower the benefit amount.
Long-term disability insurance uses a different formula because the carrier relies on insurance policy terms that set the required waiting period, the percentage of income replaced, and the medical condition standards you must meet before payments start. You can receive both types of benefits at the same time, but long-term disability carriers usually adjust their payment once they verify a weekly wage replacement from the workers’ compensation claim. Also, some long term disability policies exclude coverage for work-related injuries.
Many of these long term disability insurance policies cut the long-term disability check by the exact amount of that weekly rate, and some require repayment when a workers’ comp settlement arrives. In the next sections, we review the common offset language that creates these reductions and point to the policy clauses you need to read before you accept or negotiate any payment.
How Do You Know What You Should Receive?
Your long-term disability insurance policy sets the rules that determine when payments start and the type of payments the carrier will issue. You should request a full copy of the policy so you can review the terms that control deadlines, documentation, and the income calculations the carrier applies. The policy language decides how the insurer evaluates your claim, so you need the exact text, not a summary sheet or brochure.
The policy should state several core requirements, including:
- The medical condition details you must show to qualify for payments
- The schedule the carrier uses for issuing checks, such as monthly or biweekly
- The events that stop payments, including a return to work, missed medical updates, or a shift in the definition of disability after the first review period
- The income sources that reduce the long-term disability amount, such as workers’ compensation benefits, Social Security Disability benefits, or state disability programs
The long-term disability insurance policy will also explain how the carrier calculates the benefit amount. Many plans pay roughly sixty percent of your prior income, but some use lower percentages or set a dollar cap that limits the total.
If your check differs from the amount you believe should be owed under the policy, you need to confirm the reason by comparing the payment to the offset section of the policy. Carriers sometimes miscalculate, but they also apply offsets when you receive income from another source listed in the policy. A clear review of the policy’s offset chart usually shows whether the reduction matches the policy terms or deviates from them.
What Are “Offsets”?
Offsets are benefit reductions the carrier applies under the terms of the long-term disability policy. Let’s assume your policy results in a monthly long term disability benefit of two thousand dollars. You’d expect that benefit amount during any month you can’t work.
Most policies include a section that describes income sources that reduce the long-term disability payment. The document may label these as “other benefits” or “deductible sources of income.” The carrier subtracts these amounts because the policy gives them credit for income you receive from listed programs. Two of the most common sources that trigger reductions are workers’ compensation and Social Security Disability Insurance.
Return to the two-thousand-dollar example. If you receive one thousand dollars a month from the job-injury claim, the policy may allow the carrier to subtract that exact amount from the long-term disability payment. In that situation, the carrier would issue one thousand dollars, and the workers’ compensation claim would provide the other one thousand dollars. The combined total stays at two thousand dollars because the offset section caps the long-term disability payment.
Is It Fair That Your Disability Benefit Gets Reduced When You Paid For This Insurance?
Many people think this reduction is unfair because they paid premiums expecting a steady long-term disability benefit. They see the carrier lower the monthly benefit amount once a workers’ comp payment begins, and the switch creates confusion about why the policy allows it. The reduction happens because most long-term disability plans classify workers’ compensation income as a deductible source, and the carrier applies that rule as soon as they confirm the amount.
Your options depend on the policy language. If the document lists workers’ compensation payments as a deductible source, the reduction usually stands unless the carrier miscalculates the numbers or applies the wrong income figure. A careful review of the offset section is one way to know whether the carrier followed the contract or went outside its terms. Consulting with a long term disability attorney can also be very helpful.
Why Should You Even Pursue Getting Long-Term Disability?
First, the long-term disability insurance company does not necessarily reduce your disability benefits. Some policies don’t list workers’ compensation benefits as a deductible source, and those plans pay the full monthly amount. You need to read the offset section of your policy to see whether the carrier can subtract workers’ compensation or any other income.
Even when the policy allows reductions, long-term disability benefits are still important. The benefit can continue long after workers’ comp payments end, and many policies run for years if your medical limits meet the definition set in the document. Also, some long term disabilty plans have higher maximum payment amounts than Georgia workers’ compensation law which allow you to receive increased benefits if you are a higher wage earner.
Minimum Disability Benefits From LTD
Sometimes, the offset for other benefits would completely wipe out your long-term disability. For example, if your policy lists a monthly disability benefit of fifteen hundred dollars and you receive two thousand dollars a month from the workers’ compensation claim, the carrier may apply a full offset that removes the long-term disability payment.
Many long term disability policies include a minimum disability benefit that keeps the payment above zero even when the offset exceeds the listed amount. This minimum is usually a small fixed figure stated in the policy, and the carrier must issue that amount each month the claim remains active. Filing the claim can still produce income you wouldn’t receive if you skipped the application, even though the main disability benefit is fully offset.
Workers’ Comp Settlements And How They Affect Long-Term Disability
A workers’ comp settlement creates another reason to file for long-term disability. The offset on your long term disability benefit can change once you close your workers’ compensation claim, and the change may increase or decrease the monthly amount the carrier owes. The result depends on the terms in your long term disability policy and the language used in the settlement documents.
Most Georgia workers’ comp settlements pay in a single lump sum. Most long-term disability policies include a section that explains how the carrier converts that lump sum settlement payment into a monthly figure for offset purposes. Some policies divide the lump sum by your prior weekly or monthly benefit rate to estimate how long the payment should last, while others apply a different formula based on the policy’s own schedule.
We’ve handled cases where the offset dropped after settlement because the policy assigned a lower monthly value to the lump-sum payment than the weekly figure used during the open claim. A lower workers’ compensation offset after settlement meant the carrier paid more in long-term disability each month after settlement. But, the opposite can occur if the policy assigns a higher monthly value to the settlement. Understanding the language of the long term disability policy and how it interacts with a workers’ compensation settlement is extremely important.
Also, the lump sum payment language in some long term disability policies refers to how the settlement classifies the payments and what they represent. In these situations, the workers’ comp settlement wording matters because the long term disability carrier relies on that document when they calculate the offset. The long-term disability policy section on lump-sum conversions matters as well, since the carrier must follow that formula when they set the new monthly amount.
Should You Avoid Filing for Long-Term Disability While Receiving Workers’ Compensation?
Many situations make it useful to file for long-term disability while you receive workers’ compensation, but some can push the outcome in the opposite direction. Some factors that affect this decision include:
- The exact offset terms and definitions in your long-term disability policy
- The timeline for settling your job injury claim and the lump-sum language you expect to use
- The date your doctor projects for a return to work
- The nature of the injury and the restrictions listed in your medical diagnosis records
These points shape the income you receive from each program, and they can move the total in opposite directions. It is important to understand that you may face deadlines for applying for long term disability benefits. This means that you may completely lose the right to receive long term disability benefits if you wait too long to apply or miss a deadline to appeal a denial. Because of the different factors that must be weighed, the best thing to do is to speak with an attorney if you are uncertain.
Can Receiving Long-Term Disability Reduce Your Workers’ Compensation Benefits?
In some situations, the workers’ compensation insurer may try to take a credit when you receive long-term disability payments. They often rely on O.C.G.A. 34-9-242, a statute that allows an employer to claim a credit for payments made under an employer-funded disability plan. The insurance company reviews the policy to see whether the employer paid any part of the premiums, because the credit applies only when the employer provided the coverage.
This creates a problem when both insurers attempt to apply reductions at the same time. Georgia’s workers’ compensation statute doesn’t explain how to resolve a conflict when two programs seek credit from the same income source. Each insurance provider may argue that the other must pay the full amount, and the dispute can stall payments if no one steps in.
At least one insurer should continue issuing checks while the dispute moves forward, and a judge can determine which carrier gets the lawful credit. The system should not allow both insurers to refuse payment, since that would eliminate the income the worker is supposed to receive under one of the programs.
Other Ways That Long-Term Disability Affects Workers’ Compensation
Many long-term disability policies require you to apply for Social Security Disability Insurance. Carriers add this requirement because they usually subtract Social Security payments from the long-term disability amount. When you receive Social Security Disability Insurance, the carrier checks the award letter and reduces the monthly long-term disability payment by the amount listed in that notice if their policy properly allows them to offset for Social Security Disability.
A Social Security application can affect your workers’ compensation claim. The workers’ compensation insurer may insist on a Medicare Set Aside because the Social Security Disabiltiy application signals that you could become a Medicare beneficiary soon. A Medicare Set Aside requires a specific dollar amount to cover future medical expenses related to the injury after your workers’ compensation case settles, and the insurer may not settle without it.
In addition to Medicare Set Asides, receiving Social Security Disability Insurance adds another layer because Social Security Disability also has an offset for Georgia workers’ compensation benefits. Social Security uses a calculation that limits the combined total of workers’ compensation and Social Security Disability Insurance, and that calculation can lower the federal Social Security payment. As was discussed above, long-term disability carriers often offset their payment as well once they verify the final Social Security number.
When all three programs apply at the same time, the payment structure can shift each time one agency updates its figures. Each program uses a different formula, and the numbers rarely match. In situations like these, you should work with an attorney who handles these programs regularly so the reductions follow the correct formulas and you don’t miss the income the rules allow you to receive.
Records to Keep When You Have Workers’ Compensation and Long-Term Disability Claims
You should keep a complete set of records because both insurers rely on written documents when they calculate payments or make decisions about your claim. Each program uses its own forms and deadlines, and missing a single document can delay payments or create a dispute about your income. Keeping everything in one place also makes it easier to verify offsets and catch mistakes.
Start with your income records. Keep pay stubs for the thirteen weeks before the job injury, copies of any wage loss benefits payments the workers’ compensation insurer issues, and every notice from the long-term disability carrier. These documents show the numbers both insurers have used, and they give you a baseline when you check the accuracy of any offset.
You should also keep all medical documentation tied to both claims. This includes office notes, work-status slips, imaging results, and any letters that describe your restrictions. The two insurers compare these records when they evaluate your ability to work, and you need to know exactly what each doctor wrote in case the descriptions differ.
Additionally, it is a good idea to keep and document that the workers’ compensation insurance company, long term disability insurance company, or Social Security Administration send you. These documents are very important to reference if there is ever a dispute regarding any of these benefits.
Do You Have Other Questions About Workers’ Compensation?
Georgia’s workers’ compensation system has strict rules about medical care, income benefits, and filing deadlines, and missing any required step can affect your claim. You also have to track approved doctors, benefit rates, and notices from the insurer, which adds pressure when you’re trying to recover. These rules make it important to get clear answers as soon as questions come up.
If you want to speak with us about your claim, set up a free consultation with a workers’ compensation attorney, call 770-214-8885 or contact us online today. If you want a little more info on how our free consultation process works, please just review the information in this short article.
