MARIO RIVERA v. Commissioner of Social Security

102 F. Supp. 2d 545, 2000 U.S. Dist. LEXIS 9287, 2000 WL 854412
CourtDistrict Court, D. New Jersey
DecidedJune 26, 2000
DocketCIV.A.98-1073
StatusPublished

This text of 102 F. Supp. 2d 545 (MARIO RIVERA v. Commissioner of Social Security) is published on Counsel Stack Legal Research, covering District Court, D. New Jersey primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
MARIO RIVERA v. Commissioner of Social Security, 102 F. Supp. 2d 545, 2000 U.S. Dist. LEXIS 9287, 2000 WL 854412 (D.N.J. 2000).

Opinion

OPINION

WOLIN, District Judge.

This matter is opened before the Court, pursuant to 42 U.S.C. §§ 405(g) and 1631(c)(3), upon the request of plaintiff Luis Mario Rivera for review of the final determination of the Commissioner of Social Security (“Commissioner”) that plaintiffs Social Security Disability Insurance (“SSDI”) benefit should be offset by his workers’ compensation award. The complaint has been decided upon the written submissions of the parties pursuant to Federal Rule of Civil Procedure 78. For the reasons set forth below, the Commissioner’s decision will be affirmed.

BACKGROUND

The plaintiffs back was injured in October, 1990. On May 3, 1994, finding that the plaintiff had been disabled since De- *547 eember 10, 1990, an Administrative Law Judge (“ALJ”) awarded the plaintiff SSDI benefits effective June, 1991. On the basis of the same injury, the plaintiff also received weekly New Jersey workers’ compensation payments of $154.00 from December 7, 1990 to February 6, 1991. Those payments were stopped, pending a court decision on the plaintiffs workers’ compensation claim. On August 11, 1994, the plaintiff received a settlement of $30,000 on the workers’ compensation claim. On August 19, 1994, an insurance claims adjustor notified the Social Security Administration (“SSA”) that the settlement had been reached, of which $22,375 was paid to the plaintiff, $1,375 was used to satisfy a lien to the State of New Jersey Department of Labor, and $7,625 was used to pay attorney’s fees and medical expenses.

Pursuant to 42 U.S.C. § 424a, SSA reduced the plaintiffs SSDI benefits by the $30,000 lump-sum workers’ compensation payment. On appeal, the ALJ found that the plaintiffs SSDI benefits should be offset by his workman’s compensation benefits. The Appeals Council, on February 6, 1998, affirmed the ALJ’s finding that the lump-sum settlement required a reduction in the plaintiffs SSDI benefits, but excluded the plaintiffs expenses of $7,625 from reduction. The Appeals Council’s decision was the final decision of the Commissioner.

The plaintiff appeals the Commissioner’s decision, contending that the Commissioner used an incorrect legal standard. The plaintiff argues that he was awarded payment under N.J.S.A. 34:15-20 in lieu of

his workers’ compensation claims, and therefore the settlement was not subject to offset as workers’ compensation.

DISCUSSION I. Standard of Review

A final administrative decision to reduce the plaintiffs SSDI benefits will be upheld on review if it is based on correct application of law and is supported by “substantial evidence.” 42 U.S.C. § 405(g); see also Van Horn v. Schweiker, 717 F.2d 871, 873 (3d Cir.1983). In this case, there is no dispute as to the Commissioner’s findings of fact. At issue, rather, is the Commissioner’s interpretation and application of the law to the facts. This Court must defer to the Commissioner’s findings of law “as long as it is reasonable and not arbitrary or capricious.” Wheeler v. Heckler, 787 F.2d 101, 104 (3d Cir.1986).

ANALYSIS

The present dispute focuses on 42 U.S.C. § 424a(a), according to which a person collecting both social security benefits and state workers’ compensation benefits cannot receive from both sources greater than eighty percent of his or her pre-disability income. 1 A claimant’s benefits are reduced “so that the disabled person does not receive a windfall.” Sciarotta v. Secretary of Health & Human, 647 F.Supp. 132, 133 (D.N.J.1986), rev’d on other grounds, 837 F.2d 135 (3d Cir.1988); see also Wheeler, 787 F.2d at 104.

Furthermore, the Act provides:

*548 If any periodic benefit for a total or partial disability under ... [a workmen’s compensation law or plan of the United States or a state] is payable on other than a monthly basis (excluding a benefit payable as a lump-sum except to the extent that it is a commutation .of, or a substitute for, periodic payments), the reduction under this section shall be made at such time or times and in such amounts as the Commissioner of Social Security finds will approximate as nearly as practicable the reduction prescribed by [42 U.S.C. § 424a(a) ].

42 U.S.C. § 424a(b) (emphasis added). A lump-sum benefit, therefore, is not excluded from the offset rule if it is a substitute for periodic payments.

In New Jersey, a workers’ compensation dispute can be resolved if a judge of compensation enters

“an order approving settlement.” Such a settlement ... shall have the “force and effect” of a dismissal of the claim petition, ... and shall be a complete surrender of any right to compensation or other benefits arising out of such claim under the statute.... Any payments made under this section shall be recognized as payments of workers’ compensation benefits for insurance rating purposes only.

N.J.S.A. § 34:15-20 (emphasis added). Although this statute asserts that a settlement shall be considered a workers’ compensation benefit “for insurance rating purposes only,” the SSA has ruled that lump-sum settlements of New Jersey workers’ compensation claims should be offset by reductions in Social Security payments. See Social Security Ruling 82-5. Such settlements “are made in lieu of periodic benefits and thus are [workers’ compensation] benefits subject to the offset provisions [of 42 U.S.C.. § 424a(a) ]” Id. Significantly, the ruling explicitly states that the characterization of settlements of N.J.S.A. § 34:15-20 is not binding on the SSA, and that application of a federal statute is not dependent on state law, although state law is important for assessing the nature and purposes of the benefit payment at issue. See id.; see also Nicely v. McBrayer, 163 F.3d 376, 384 (6th Cir.1998) (noting that SSR 82-5 asserts the importance of New Jersey state law in assessing the nature and purposes of benefit payments).

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Cite This Page — Counsel Stack

Bluebook (online)
102 F. Supp. 2d 545, 2000 U.S. Dist. LEXIS 9287, 2000 WL 854412, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mario-rivera-v-commissioner-of-social-security-njd-2000.