Opinion ID: 1435949
Heading Depth: 2
Heading Rank: 3

Heading: Social Security Disability Benefits

Text: Alternatively, DRBA maintains that Kopacz's receipt of SSD benefits satisfied its maintenance obligation, at least in part. For its position, DRBA relies on our statement in Shaw that a vessel owner has no obligation to provide maintenance and cure if it is furnished by others at no expense to the seaman. 526 F.2d at 201. In Shaw, discussed earlier, we held that Blue Cross-Blue Shield benefits satisfied the shipowner's cure obligation. We reasoned that these benefits, which covered the costs of the seaman's medical care and hospitalization, were the exact[] equivalent of cure. Shaw, 526 F.2d at 201. Accordingly, we concluded that the parties intended the Blue Cross-Blue Shield payments be in lieu of, rather than in addition to, the cure owed to the injured sailor. However, we reached the opposite conclusion with respect to the Prudential disability benefits, which the record indicated were intended as a substitute for lost wagesnot as payment for food and lodgingand which were owed to the seaman, independent of his eligibility for maintenance and cure. On that basis, we held that the Prudential payments did not offset the maintenance owed to the seaman. Distinguishing the Blue Cross-Blue Shield benefits from the Prudential payments, we explained, [I]t is also true that the vessel owner has no obligation to provide maintenance and cure if it is furnished by others at no expense to the seaman.... The essential difference between the Blue Cross-Blue Shield and the Prudential payments [which do not satisfy the maintenance obligation] is that the former provides the exact equivalent of maintenance and cure whereas the latter, at least under this collective bargaining agreement, constitutes a substitute for lost wages which are owed to a seaman even if he is ineligible for maintenance and cure. Id. at 201 (emphasis added). The dispositive issue here, therefore, is whether SSD benefits provide the exact equivalent of maintenance, or whether the two differ in their scope, purpose, and conditions of eligibility. Id. SSD benefits and maintenance are distinguishable in several important respects. First, distinct policy aims underlie maintenance and SSD payments. Whereas maintenance is intended to provide for the cost of food and lodging comparable in quality to that the seaman is entitled to at sea, Barnes, 900 F.2d at 634-35, SSD benefits aim[] to replace the income of beneficiaries when that income is reduced on account of retirement and disability. Temple Univ. v. United States, 769 F.2d 126, 130 (3d Cir.1985); see Barnes, 900 F.2d at 634 (noting that maintenance does not entitle a seaman to a pension or a lump-sum payment to compensate for disability or lost earning capacity). Hence, SSD benefits are more closely analogous to LTD payments, which aim to replace lost wages, than to maintenance. Second, the conditions of eligibility for maintenance and SSD payments differ substantially. Maintenance is available solely when a seaman: (1) is injured during the course of his employment or at a place where he is subject to the call of duty, Barnes, 900 F.2d at 633 (citing Aguilar v. Standard Oil Co., 318 U.S. 724, 732, 63 S.Ct. 930, 87 L.Ed. 1107 (1943)); (2) is incapable of performing seaman's work, Vaughan, 369 U.S. at 531, 82 S.Ct. 997; and (3) has actually incurred food and lodging expenses during his recovery. Barnes, 900 F.2d at 642; see Vaughan, 369 U.S. at 531, 82 S.Ct. 997 (noting that maintenance is limited to food and lodging expenses incurred); Gypsum Carrier, Inc. v. Handelsman, 307 F.2d 525, 535 (9th Cir. 1962) (Maintenance and cure is based upon need, and the seaman is under a duty to minimize expenditures). Maintenance, moreover, is available immediately upon the seaman's incapacitation, but ceases once the seaman attains maximum cure, defined as the point at which he is either cured or his condition is diagnosed as permanent and incurable. Barnes, 900 F.2d at 633-34; see Vella v. Ford Motor Co., 421 U.S. 1, 5, 95 S.Ct. 1381, 43 L.Ed.2d 682 (1975); Crooks, 459 F.2d at 635 (Payments must be promptly made, at a time contemporaneous to the illness or injury.) (internal citation omitted). The conditions of eligibility for SSD benefits, by contrast, are both moreand lessstringent than those required to obtain maintenance. On the one hand, the SSD requirements are more onerous: a claimant must demonstrate that he has suffered a disability for a minimum period of five months, Gaines v. Amalgamated Ins. Fund, 753 F.2d 288, 290 (3d Cir.1985); that his disability is permanent, having lasted, or been expected to last, for a continuous period of 12 months, id. ; 20 C.F.R. § 416.909; and that his impairment precludes performance not only of his former job but also of any work existing in significant numbers in the national economy, including basic work activities. McCrea v. Comm'r of Social Sec., 370 F.3d 357, 360 (3d Cir.2004); see 42 U.S.C. § 423(d)(2)(A); 20 C.F.R. §§ 404.1520, 416.920. On the other hand, the conditions of eligibility for SSD benefits are, in certain other respects, less burdensome than those required to receive maintenance. Claimants with nonoccupational injuries may recover SSD benefits, 42 U.S.C. § 423(d)(1)(A), [9] and proof of actual expenditure of funds on food, lodging, or other expenses is not necessary to obtain benefits. Further, SSD payments need not be expended on food and lodging, and financial need is not a prerequisite to obtain assistance. Mazza v. Sec. of Health and Human Servs., 903 F.2d 953, 956 (3d Cir. 1990). Further, a Social Security claimant is entitled to benefits, even if his condition is diagnosed as permanent or incurable. 42 U.S.C. § 423(a)(1). These important differences support classification of maintenance and SSD payments as different, rather than exact[ly] equivalent, benefits. Shaw, 526 F.2d at 201; see Handelsman, 307 F.2d at 537 (holding that payments received by sailor under state disability program do not offset amount owed under maintenance duty); see also Barnes, 900 F.2d at 637 (upholding seaman's right to maintenance, despite possibility of double recovery from his receipt of disability pensions, overtime and premium pay, and vacation allowances). Nonetheless, DRBA attempts to analogize SSD payments to Medicare benefits, which at least one court of appeals has concluded may satisfy a shipowner's cure obligation. Moran Towing & Transportation Co. v. Lombas, 58 F.3d 24, 26-27 (2d Cir.1995). In Moran, the Second Circuit Court of Appeals held that a seaman's receipt of Medicare-funded treatment relieved the shipowner of its duty to provide cure. The court relied on our pronouncement in Shaw that a vessel owner has no obligation to provide maintenance and cure if it is furnished by others at no expense to the seaman. Id. at 27 (quoting Shaw, 526 F.2d at 201). Significantly, Moran did not analyze a consideration that we identified as critical in determining whether offset was appropriate in Shaw whether the payments received are the exact equivalent of cure. Shaw, 526 F.2d at 201. Because Moran omitted an aspect of the offset analysis that we deemed essential in Shaw, its holding lacks persuasive force. Even if Moran were binding on this Court, Moran 's core holdingthat Medicare benefits may satisfy a shipowner's cure obligationcomports with the reasoning in Shaw. There, as discussed, we held that Blue Cross-Blue Shield benefits, which covered all of the seaman's medical expenses during his recovery, provided the exact equivalent of cure. Likewise, the Medicare benefits in Moran, which covered the seaman's hospital bills during his convalescence, provided the equivalent of cure. SSD benefits, by contrast, differ in scope and purpose from maintenance. Hence, Moran 's conclusions with respect to Medicare benefits do not govern our analysis of SSD payments made to Kopacz. Hence, we conclude that Kopacz's receipt of SSD benefits did not relieve DRBA of its maintenance obligation.