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Claims Department Operations

The Claims Department is responsible for the preparation of all new claims in advance of the Workers' Compensation Commission hearing.

The Claims Department files issues and requests information regarding potential third party actions and prior workers' compensation claims from the claimant's attorney. Written requests for all of the medical records which both pre and post date the accidental injury are mailed to the claimant's attorney and the employer/insurer.

A decision regarding whether or not the Subsequent Injury fund obtains an independent medical evaluation follows review of the medical records and rating evaluations supplied from the claimant and the employer. Medical examinations are not scheduled in every case, but rather are only scheduled for cases having suspected Fund liability.

A written summary of the claim history and potential Fund liability is provided to the assigned attorney from the SIF Legal Department in advance of the Workers' Compensation Commission hearing.

The Claims Department is also responsible for supervising all permanent total disability claims. All permanent total disability claimants are contacted annually and asked to provide information regarding their current medical and employment status. The Inquiry Report form is initially mailed to the attorney of record, and then directly to the claimant if no response is obtained from the attorney. The purpose of the annual inquiry is to verify that claimant is still alive, eligible, and residing at the address where the benefit checks are being mailed.

How to Make a Claim Against the Subsequent Injury Fund

Claims against the Subsequent Injury Fund are made by filing an issue with the Workers' Compensation Commission impleading the Fund. Copies of the issue and all supporting medical information should also be provided to the Subsequent Injury Fund so the claim can be opened. The actual Fund liability is determined by the Workers' Compensation Commission after a complete hearing on all relevant aspects of the claim.

Criteria Determining Eligibility

For a workers' compensation claimant to be eligible to receive compensation from the Subsequent Injury fund, he/she must meet certain criteria set by statute. All of the following listed conditions must be met in order for a successful claim to be made against the Fund:

  • The claimant must have a pre-existing impairment.
  • The pre-existing impairment must be the result of an accident, disease, or congenital condition.
  • The claimant must have an overall disability exceeding 50% of the body as a whole.
  • The pre-existing impairment and the compensable injury must each be compensable for a period of 125 weeks out of a total of 500 weeks maximum possible.
  • The pre-existing impairment must be, or be likely to be, a hindrance to the claimant's employment.
  • The overall disability of the claimant due to the pre-existing impairment and the compensable injury must be greater in combination than the disability from the compensable injury alone.