Frank J. Kelley, Attorney General
Opinion No. 6111; December 13,1982;
MTLA File No. 3085
STATUTORY INDEXING:
Standards for Deductibility of State and Federal Governmental Benefits [§3109(1)]
Social Security Disability Benefits [§3109(1)]
TOPICAL INDEXING:
Social Security Disability and Death Benefits
CASE SUMMARY:
In addressing a question which has not been specifically addressed by any appellate court, Attorney General Frank J. Kelley ruled that a no-fault insurer is not authorized to require, as a condition precedent to the continued payment of work loss benefits under the No-Fault Act, that an injured person apply for Social Security disability benefits. The no-fault insurer is authorized to deduct Social Security disability benefits from no-fault work loss benefits payable to an injured person only if the Social Security disability benefits are actually received. In so ruling, Kelley stated:
“The decision by insurance companies to refuse or reduce work loss payments unless the accident victim applies for and pursues Social Security disability benefits denies the victim assured, adequate and prompt reparation for his or her economic losses. Work loss benefits should begin immediately upon the determination of the amount to which the victim is entitled. An insurance company does not have the unilateral right to offset what it contemplates to be the amount the victim may be entitled to receive from some other governmental sources. The criteria administered by the Secretary of Health and Human Services are different from all those for entitlement to work loss benefits. An insurer may grant the immediate work loss benefits conditioned upon an assignment from the beneficiary of the Social Security disability payments actually received. However, the insurer could not unilaterally deduct from the work loss benefits those amounts which it alleges are required to be provided under federal law."
