La. Admin. Code tit. 40 § I-6639
Attached hereto and designated as "Attachment Number 6".
STATE OF LOUISIANA
DEPARTMENT OF LABOROFFICE 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
La. Admin. Code tit. 40, § I-6639