Form Ldol-Wc-1005b - Office Of Worker'S Compensation
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1STATE OF LOUISIANA
DEPARTMENT OF LABOR
OFFICE OF WORKERS' COMPENSATION
*
SS#:
VERSUS
*
DOCKET NO:
*
DISTRICT:
ORDER RECOGNIZING RIGHT TO SOCIAL SECURITY OFFSET
This matter is before the Workers' Compensation Judge on the motion of the employer/insurer
for recognition of its right to claim the social security reverse offset in this case. The Workers'
Compensation Judge finds that the claimant is receiving permanent total disability benefits under the
provisions of the Louisiana Workers' Compensation Act in addition to benefits under 42 U.S.C. Chapter
7, Subchapter II, entitled Federal Old Age, Survivors, and Disability Insurance Benefits. The Workers'
Compensation Judge further finds the under that provisions of L.R.S. 23:1225(A) the employer/insurer
has claimed and is entitled to a reduction in the Workers' Compensation benefits paid to claimant in
the amount of
.
IT IS THEREFORE ORDERED, ADJUDGED AND DECREED that the employer/insurer is
hereby allowed to offset the Workers' Compensation benefits paid to claimant in the amount of
,
beginning on
, 20
, the date of employer/insurer's judicial demand.
IT IS FURTHER ORDERED, ADJUDGED AND DECREED that the Social Security Administration
reverse its social security offset effective
, 20
, the date of
employer/insurer's judicial demand.
READ, RENDERED AND SIGNED this the
day of
20
at
Parish, Louisiana.
WORKERS' COMPENSATION JUDGE
LDOL-WC-1005B
Rev. 1/98
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