Social Security Reverse Offset Worksheet {WKC-6119}

WKC-6119-E - SOCIAL SECURITY REVERSE OFFSET WORKSHEET. This form is completed from the Social Security Administration Office information. It shows how Worker's Compensation arrived with the Social Security Offset. The form is used by the Wisconsin Department of Workforce Development’s Worker’s Compensation Division to calculate how Social Security disability benefits affect an injured worker’s weekly worker’s compensation payments. This form is completed by the insurance company or self-insured employer using information obtained from the Social Security Information Request form. It helps determine whether an offset should be applied by comparing the worker’s compensation benefit amount with Social Security disability payments to avoid duplicate or excessive benefits. The worksheet includes calculations such as the 80% Average Current Earnings (ACE), the redetermined ACE, weekly worker’s compensation due, and the weekly balance owed to the employee after any applicable offset. www.FormsWorkflow.com