Benefits Application

Offset Calculator

This calculator is meant to provide calculation assistance to determine the offset amount that can be taken against benefits due to the receipt of social security or employer sponsored retirement. These offsets may only be taken against temporary total disability (TTD), temporary partial disability (TPD), or permanent total disability (PTD). See § 8-42-103 for any additional restrictions.

* Required fields are indicated with an asterisk

Name:

*Date of Entitlement:

The day the injured worker or dependents began receiving this entitlement.

*Initial Entitlement:

Amount of entitlement prior to any cost of living inflation.

Choose Offset Type:

PERA / Pension

Amount of entitlement prior to any cost of living inflation.

SSDI

Employer Paid %

Percentage of PERA / Pension paid by the employer, such as 6.5%.

Dependents Amount of Entitlement

Spouse:

Child 1:

Child 2:

Child 3:

Child 4:

Amount of entitlement prior to any cost of living inflation.

Total Dependents Amount

Weekly SS Benefit

Weekly Offset