Second Injury Fund Reimbursement States

The following are the major second injury fund reimbursement states that are open to claims with new dates of injury.

The following are the major second injury fund reimbursement states that are not open to claims with new dates of injury, but where a focused review of claims can still result in additional recovery:

States Open to Second Injury Claims / Dates of New Injury

The following are the major second injury fund reimbursement states that are open to claims with new dates of injury.

  • Alaska – The Alaska Workers’ Compensation Second Injury Fund (AWCSIF) reimburses medical and indemnity payments on a claim after the first 104 weeks of disability if employee had a prior statutorily listed permanent physical impairment and combined disability is substantially greater, and employer had knowledge of the prior impairment.  AWCSIF requires notice within 100 weeks from the date the employer or insurer knew about the injury.

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  • Arizona – Two types of claims: Sub B Claims:  Prior work-related scheduled injury and second work-related scheduled injury combine to make an unscheduled injury and loss of earning capacity.  Fund and insurer apportion the remaining loss of earning capacity benefit.

 

Sub C Claims:  Prior known physical impairment is not work-related and was at least a 10% permanent impairment in accordance with the AMA Guides to the Evaluation of Permanent Impairment and is listed in the statute ― combines with a non-scheduled second injury, which eventually results in a loss of earning capacity benefit.  Insurer and Fund apportion the loss of earning capacity benefit.  Notice to the Fund needs to be filed at the same time the insurer notifies the Commission that the employee has reached a maximum medical improvement.

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  • Louisiana – The Louisiana Second Injury Board will reimburse medical and indemnity payments where the employer knew of the pre-existing permanent impairment, and the prior and the second created a substantially greater disability.  Fund needs notice within 52 weeks of first payment of medical or indemnity. The reimbursement schedule is as follows:

Before July 1, 2004 and on/after July 1, 2009, but before July 1, 2010, 100% of indemnity after the 104th week and 50% of all reasonable and necessary medical expenses actually paid which exceed $5,000, but no less than $10,000, 100% of all reasonable and necessary medical expenses actually paid which exceed $10,000.

On or after July 1, 2004, and before July 1, 2009, 100% of indemnity after the first 130 weeks of payment of benefits and 100% of all reasonable and necessary medical expenses actually paid which exceed $25,000.

On or after July 1, 2010, and before July 1, 2015, 100% of indemnity benefits after the first 104 weeks of indemnity, and 100% of all reasonable and necessary medical expenses actually paid which exceed $25,000, including reasonable and necessary. This can include vocational rehabilitation expenses, if such expenses are directly related to services provided in the actual retention or reemployment of employee.

The Louisiana Second Injury fund will be closed to dates of injury after 12/31/14.

 

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  • Massachusetts – The Fund need name will reimburse for injuries between 12/10/85 and 12/23/91, with reimbursement of 75% of medical and indemnity paid after 104 weeks if prior physical impairment combines with second injury to create a substantially greater disability.  The Fund will reimburse for dates of injury after 12/23/91, up to 75% reimbursement for permanent total claims where employer knew about the prior physical impairment within 30 days of hire or retention and the prior and second injury created a substantially greater disability.  Insurer can only seek two years of retroactive reimbursement from the date the claim is filed on claims with post 12/23/91 injury dates.

If employee is a veteran and aggravates a disability that was a result of a wartime injury, reimbursement is 50% from date of first payment and 100% after 104 weeks.

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  • New Hampshire – The Fund will reimburse 50% of all medical and indemnity paid over $10,000 within the first 104 weeks and 100% reimbursement thereafter on claims where the employer-known (in writing) pre-injury permanent impairment combines with the second injury to create a greater disability.  Notice must be filed within 100 weeks of the date of injury or death.

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  • Nevada – The Fund will reimburse 100% on claims where the employer-known pre-injury permanent impairment (which rates to at least a 6% whole person per AMA Guides) combines with the second injury to create a substantially greater disability.

 

States Closed to New Claims but with Recovery Potential on Past Claims

The following are the major second injury fund reimbursement states that are not open to claims with new dates of injury but where a focused review of claims can still result in additional recovery:

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  • District of Columbia – If injury occurred before 4/16/99 but after 3/16/91 and employer knew about pre-existing impairment and claim results in permanent disability and combination of prior and second injury created a substantially greater disability, then insurer is entitled to 100% reimbursement of compensation after the 104th week of permanent benefits.  Prior to 3/16/91, the insurer was entitled to recover all medicals after the first $1,000.00 and all indemnity after the first 104 weeks.

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  • Florida – The Florida Special Disability Trust Fund (SBTF) is closed to injuries after 1/1/98.  Claims can still be submitted to the Fund. The statute of limitations provides that claims are timely if they are submitted within two years of the first payment of permanent benefits or when the employee reaches maximum medical improvement, whichever occurs last.  The statute requires:  (1) a pre-existing physical impairment, (2) a subsequent permanent impairment from injury or occupational disease arising out of, and in the course of, her or his employment, (3) merger with the pre-existing physical impairment, and (4) to cause a permanent impairment. Further, reimbursement is allowed only if the pre-existing physical impairment is known by the employer prior to the second injury AND is one of the enumerated impairments listed in the statute.

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  • Georgia – The Georgia Subsequent Injury Trust Fund (SITF) is closed to injuries before 7/1/06.  SITF will reimburse 50% of medical payments made on a claim after the first $5,000 and 100% after the first $10,000.  Reimbursement at 100% of indemnity payments is made after the 104th week for claims where the employer knew of the pre-existing permanent impairment and the prior injury created a substantially greater disability.  Fund requires notice within 78 weeks of the loss of income benefits.  Once notice is filed, there is a deadline of three years or 6/30/09, whichever occurs later, to obtain an acceptance agreement.

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  • New York – The New York Special Fund (NYSF) is closed to dates of injury after 6/30/07.  100% reimbursement of medical and indemnity on claims where prior permanent impairment and subsequent injury created a materially and substantially greater permanent disability.  NYSF reimburses 100% of medical and indemnity on death claims where death would not have occurred except for a pre-existing permanent impairment.  NYSF reimburses 100% of medical and indemnity on claims where death or disability is due to silicosis or other dust disease (no prior impairment required).  For injuries prior to 8/1/94, indemnity is reimbursed after 104 weeks of indemnity payments and medical is reimbursed after 104 weeks after the first date of medical treatment.  For injuries after 8/1/94, indemnity and medical are reimbursed after 260 weeks. A notice generally required to be filed with the NYSF within 104 weeks from date of injury.  There is a one-year look-back period to request reimbursement for payments made.

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  • South Carolina – The South Carolina Second Injury Fund (SCSIF) is closed to dates of injury on or after 7/1/08 and all evidence had to be submitted to the Fund by 6/30/11 for it to make a determination by 12/31/11.  SCSIF reimburses 50% of medical payments made on a claim after the first $3,000 and within the first 78 weeks of payments and 100% reimbursement thereafter.  Reimbursement at 100% of indemnity payments made after the 78th week for claims where the employer knew of the pre-existing permanent impairment and the prior injury created a substantially greater disability.  SCSIF requires notice within 78 weeks of compensation to the employee.

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