Welcome to our Orthopedics Practice Workers’ Compensation Guide! This resource is designed to offer a concise overview of workers’ compensation concerning orthopedic injuries. While we aim to provide valuable insights, it is crucial to understand that this guide is not a substitute for professional advice.
For more specific and detailed information tailored to your situation, we recommend visiting the official workers’ compensation portal. This portal is a reliable source for the latest regulations, forms, and additional resources, ensuring you have access to the most current and accurate information.
Your well-being is our priority, and we hope this guide serves as a helpful starting point for your understanding of workers’ compensation in the context of orthopedic care.
Total Disability and second injury fund
Establishment and Purpose of Second Injury Fund: First introduced in the 1920s, the Second Injury Fund aims to encourage the employment of disabled individuals and mitigate potential Workers’ Compensation (WC) costs for employers in cases involving pre-existing conditions. The Fund steps in to cover permanent disability benefits after an initial period during which the employer or their insurance carrier handles these payments.
Eligibility Criteria for Fund Benefits: To qualify for benefits from the Fund, an individual must experience total and permanent disability directly resulting from a work-related injury combined with a pre-existing permanent partial disability. The pre-existing disability need not be work-related.
Comparison of Fund Benefits with Employer Payments: Fund benefits match the amount received from the employer or the employer’s insurance carrier and commence when the employer’s obligation to make benefit payments concludes.
Duration and Termination of Fund Benefits: Fund benefits are potentially paid throughout the lifetime of the injured worker, contingent upon their continued total and permanent disability and unemployment. Benefits cease upon the worker’s death, with no provision for death, funeral, or dependents’ benefits from the Fund.
Limited Circumstances for Earning Wages and Benefit Reduction: In specific situations, individuals may earn wages while receiving Second Injury Fund benefits, but any such wages will lead to a reduction in benefit amount. This reduction is proportionate to the current earnings compared to those at the time of being declared permanently and totally disabled. Notably, benefits beyond the initial 450 weeks are only payable if the individual has undergone prescribed physical and/or educational rehabilitation by the Division of Vocational Rehabilitation Services and can demonstrate an inability to earn wages equal to those pre-disability.
Reporting Earnings and Potential Consequences: It is crucial to promptly inform the Office of Special Compensation Funds when commencing employment to avoid reductions or removal of benefits, potentially necessitating the recovery of benefits paid during employment.
Impact of Employment on Permanent and Total Disability Status: Engaging in employment that raises doubts about the ongoing permanent and total disability may trigger a reassessment of the individual’s medical condition, leading to possible benefit removal. Vigilance is essential to navigate potential consequences.
Introduction to Supplemental Benefits: Supplemental benefits refer to additional amounts paid beyond the standard weekly Workers’ Compensation benefit rate, intended to account for changes in the cost of living. These benefits, recalculated annually, hinge on the current maximum weekly Workers’ Compensation rate relative to the percentage of the recipient’s basic benefit rate to the maximum rate applicable at the time of their injury. Factors such as receipt of Social Security, Black Lung, employer disability pension benefits, and employment in cases of total and permanent disability can impact the amount of supplemental benefits.
Eligibility Criteria for Supplemental Benefits: According to the statute, only individuals classified as totally and permanently disabled workers and dependents of deceased workers with a date of injury or death before January 1, 1980, qualify for supplemental benefits. In specific situations, dependents of deceased workers may also be eligible if the worker’s death, occurring after 1979, can be directly attributed to the injury resulting in total and permanent disability before 1980.
Expansion of Supplemental Benefits for COVID-19 Related Cases: Recent legislative changes extend supplemental benefits eligibility to dependents of public safety workers and essential workers whose death is directly linked to COVID-19. This expansion broadens the scope of individuals entitled to receive supplemental benefits.
