Second Injury Fund Program
Mitigating loss through recovery
What is the second injury fund?
A second injury fund (SIF) can be an employer’s best friend. A second injury fund reimburses the insurer, or the employer if self-insured, part or all of the cost of a workers compensation claim if the employee is already partially disabled prior to the occurrence causing the work comp claim. This encourages employers to retain disabled employees or hire employees with disabilities. SIF protects the employer from the additional cost of a workers compensation claim that combines a new injury and prior disability.
Don't Overlook second injury fund
Self-insured employers often identify and process potential second-injury fund claims themselves. But even employers served by insurance carriers, who usually perform this function for policyholders, should have such funds on their radar, experts say. Under an experience-based policy, a single eligible claim missed by an employer or its insurer could result in a hefty premium increase. And while insurers say they look for such claims, their expertise and interest in doing so varies, some experts say. The average smaller employer is not getting its share of benefits from the second-injury funds.
Elements of second injury fund recovery
- The employee must have a pre-existing permanent partial disability as listed and defined by R.S.23:1378(F) that is an obstacle or hindrance in obtaining employment.
- The employer must establish that they had actual knowledge of the employee’s pre-existing permanent partial disability prior to the subsequent injury.
- The employee must sustain a subsequent (occupational) injury that results in liability for workers’ compensation.
- The subsequent injury would not have occurred but for the pre-existing permanent partial disability.
- The disability is greater than would have resulted had the pre-existing permanent disability not been present, and the employer had been required to pay compensation for the greater disability.
- The employer, or if insured, his insurer, must file a Notice of Claim (PDF) form within 52 weeks after the first payment of any benefit (indemnity or medical) by mailing, faxing or emailing the form to the Second Injury Board.
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