Why Many Social Security Disability Claimants in CA Have a Workers’ Compensation Claim They Don’t Know About 

You might think that applying for one benefit program means you can’t receive the other, but that’s a common misconception. If you have a medical condition that is preventing you from working and it is also a work-related injury you may qualify for both Social Security Disability Insurance (SSDI) and Workers’ Compensation benefits. 

This article covers receiving SSDI benefits and Workers’ Compensation in the state of California.

Understanding Eligibility for both Workers’ Compensation and SSDI 

Many Workers’ Compensation claimants either don’t know about SSDI or aren’t aware that they can receive both. You can collect benefits from both programs; however, there may be an offset. In some cases, an attorney will be able to prevent an offset by adding a Hartman formula addendum to your settlement. 

The key point to understand is that if your disability resulted from—or was worsened by—a work-related incident and you have been off or will be off work for at least 12 months, you may be eligible for both programs. However, simply being disabled doesn’t automatically qualify you for Workers’ Compensation or Social Security Disability Insurance; you must meet strict guidelines for both programs.  

Note: The 12-month rule applies to SSDI, but it is not a requirement for Workers’ Compensation. 

You can—and should—file for Workers’ Compensation as soon as you know or suspect you may have a work-related injury, due to the Statute of Limitations in California. Generally, you have one year to file a Workers’ Compensation claim. However, if your injury is considered cumulative trauma, the time limit may extend up to five years unless you had “knowledge” of the industrial cumulative trauma. In that case, the Statute of Limitations is one year from the date you became aware of the injury. 

As soon as you know your disability will prevent you from working for at least 12 months, you should apply for SSDI benefits. You do not need to wait to be off work for 12 months to apply for benefits. The application process can be lengthy and complex, and it may take many months for the Social Security Administration (SSA) to make a decision. Starting your application as early as possible gives you the best chance to avoid delays and receive benefits sooner. 

Offset 

When receiving both SSDI and other income-based benefits or actual income, an offset may apply to your SSDI benefits due to a law that limits your total benefits to 80% of your average current earnings (ACE). However, if your Workers’ Compensation benefits are less than 20% on SSDI benefits, the Hartman formula can be applied and there would be no offset. 

Your monthly SSDI benefits, including any paid to eligible family members, are combined with your Workers’ Compensation. If the total exceeds 80% of your average current earnings, Social Security will reduce your SSDI payment by the amount over that limit. 

If you are receiving Workers’ Compensation and SSDI benefits, you must notify the SSA because it can affect your monthly SSDI benefit amount. 

Overlap 

In the event that you have a work-related injury and are unable to work, you may be eligible for both SSDI and Workers’ Compensation. There are different qualifications for each program. 

SSDI 

SSDI is a government assistance program that provides financial benefits to individuals with disabilities that are unable to work for at least 12 months. 

• Must meet the Social Security Administration’s (SSA) definition of disabled. 
  • You must have a disability that is expected to last at least one year, or result in death, and prevents you from performing substantial work. If you continue to work, your condition must limit you from earning income above the Social Security Administration’s threshold for “substantial gainful activity” (SGA).  
• 2025 SGA amounts: 
  • $1,620 per month for non-blind individuals 
  • $2,700 per month for individuals who are statutorily blind
• 2026 SGA amounts: 
  • $1,690 per month for non-blind individuals 
  • $2,830 per month for individuals who are statutorily blind 
• Different evaluation rules apply for people who are self-employed. 
• You must have enough work credits to qualify for SSDI. Typically, you need 40 total credits, with 20 earned in the last 10 years before your disability. 
• You must show that your condition prevents you from working through detailed medical evidence, including records of treatments, test results, medications, and doctor visits. 

Workers’ Compensation 

Workers’ Compensation is a private insurance policy that most employers are required to carry to cover injuries or illnesses sustained on the job. 

• Your injury or illness must have been caused or worsened by a work-related incident.  
• You must show proof that your injury or illness arose out of employment or was caused by employment and that it prevents you from working. 
• Workers’ Compensation operates on a no-fault system, meaning it doesn’t matter whether the employer or employee was at fault for the injured worker to receive benefits. 

An individual’s Workers’ Compensation benefits are calculated using the Average Weekly Wage (AWW), which is determined by averaging income earned from all sources during the year immediately preceding the Date of Injury (WC DOI). In contrast, your monthly SSDI benefit amount is calculated based on several factors, including your yearly earnings throughout your working life. If you will be receiving both SSDI and Workers’ Compensation, it’s important that your Workers’ Compensation settlement includes Hartman addendum language. 

Different Scope of Coverage 

Workers’ Compensation claims differ from SSDI claims because Workers’ Compensation insurance policies are held by private carriers. SSDI benefits, on the other hand, are funded by the government through FICA taxes, a payroll tax paid by both employers and employees, and are regulated by the SSA. 

Timeframe for Claiming 

For Workers’ Compensation claims, it is highly recommended that you report your injury to your employer within 30 days of the incident. You then have up to one year to file your Workers’ Compensation claim within California according to the Statute of Limitations. 

For SSDI claims, it is highly recommended to start your application process as soon as you are aware that you will be unable to work for at least 12 consecutive months.

Fierce Advocacy 

At Nyman Turkish, we lead the field with an approval rate well above the national average. We have a dedicated California team that specializes in both SSDI and Workers’ Compensation claims. Our attorneys are experts in both areas of law and are committed to achieving the best outcomes for our clients. 

Our team is ready to speak with you about your claim and will review your case for FREE. Please call us at 877-529-4773 or visit our website today!