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Second Injury Fund: Employee Benefits

Second Injury Fund: Employee Benefits

Missouri’s Second Injury Fund can help an injured worker, or the survivors of an employee killed at work, when a current work-related injury combines with a prior disability to create an increased combined disability. The basic concept is that the whole is greater than the sum of the parts. For example, if an injured employee has a 15 percent disability from the prior injury, and the combined disability is 40 percent, the Second Injury Fund pays for the increased disability. The formula for calculating the Second Injury Fund benefits depends on each case. The Fund provides five different kinds of benefits; one or more may be available to you.

  1. Disability Benefits.

    Disability benefits may be available from the Fund for injured employees who already were partially disabled at the time of the work-related injury. When an employee sustains a compensable work injury and the work-related injury combines with the prior disability(ies) to result in permanent total disability, or increased permanent partial disability, the employer (at the time of the last injury) is liable only for compensation due from the last injury. If more disability benefits are owed to the employee, they may be paid from the Second Injury Fund.

    In order to claim these benefits, you must file a Claim for Compensation against the Fund.

    1. Permanent Partial Disability (PPD) Benefits. An employee must have a permanent, pre-existing disability combining with the work-related injury to create greater disability to qualify for Permanent Partial Disability (PPD) benefits from the Fund. In order for an employee to recover from the Fund, minimum threshold limits regarding both the pre-existing disability and work-related disability must be met. The employee must have disability of at least 12.5 percent of the body as a whole, or at least 15 percent of a major extremity (foot, ankle, knee, hip, hand, wrist, elbow, shoulder). When these thresholds are met for both the work-related disability and the pre-existing disability, the Fund may pay a modest lump-sum amount, based on a formula. Usually, this is paid pursuant to a settlement agreement between the injured employee and the Fund, but some cases do require an evidentiary hearing (trial) before an administrative law judge.
    2. Permanent Total Disability (PTD) Benefits. If the last work-related injury, considered alone, makes the injured worker permanently and totally disabled, the Second Injury Fund has no liability for PTD benefits. However, the Second Injury Fund is liable for PTD benefits when the work-related injury and the prior disability(ies) combine to make the employee permanently and totally disabled (that is, the employee is no longer able to work at any job). In this situation, the employer is liable only for the compensation for the most recent injury and the Second Injury Fund pays the remaining lifetime benefits. For an employee to receive lifetime PTD benefits from the Fund, an evidentiary hearing (trial) before an administrative law judge is required; in other words, the Fund cannot simply agree to make those lifetime benefit payments without an award (order) from a judge. In some cases, the Fund may agree to a modest lump-sum settlement with an employee to settle the employee’s claim for lifetime benefit payments.
  2. Death Benefits.

    When an employee dies due to a work injury and was employed at the time of the injury by an uninsured employer (employer without workers’ compensation coverage), the Fund may be liable for payment of death benefits, including burial expenses and weekly death benefit payments to the surviving spouse and/or other dependents. For the dependents to receive weekly death benefit payments from the Fund, an evidentiary hearing (trial) before an administrative law judge is usually required. In other words, the Fund generally cannot agree to make those weekly benefit payments without an award (order) from a judge. In some cases, the Fund may agree to a modest lump-sum settlement with the dependents to settle the dependents’ claim for weekly benefit payments.

    For more information on death benefits, who is a dependent, how the death benefits are calculated and how long death benefits last, read Survivors’ Benefits

  3. Rehabilitation Benefits.

    These benefits are available to restore a seriously injured employee to a condition of self-support and self-maintenance through rehabilitation. Serious injuries that may qualify for rehabilitation include: quadriplegia, paraplegia, amputation of the hand, arm, foot or leg, atrophy due to nerve injury or non-use, and back injuries not amenable alone to recognized medical and surgical procedures.

    Upon order of the Director of the Division of Workers' Compensation, the employee will receive $40 per week for up to 20 weeks only for the period the employee actually attends physical rehabilitation. Although unusual, the weekly payment may be extended by special order of the Division of Workers' Compensation for up to 20 additional weeks for a maximum of 40 weeks. The injured worker only receives the benefit from the Second Injury Fund if he/she attends therapy as ordered by the physician at a facility that is certified by the Division. This does not mean that the employee cannot be rehabilitated in other facilities. However, the employee is not eligible to receive this benefit if the employee uses a facility not certified by the Division.

    The Division generally starts physical rehabilitation benefits after a review of the injury and medical reports. The Division receives many referrals for rehabilitation benefits from case managers, lawyers, and physical therapists.

    For more information on the Rehabilitation benefits, please contact 573-526-3876.

  4. Second Job Wage Loss Benefits.

    This benefit may be available to an employee who works at two or more jobs. When an employee is injured on the job with one employer and is physically unable to work at his other job(s) due to that injury, the employee may claim additional benefits from the Fund for the loss of wages from the second job. The qualifications for these additional benefits are technical, and not everyone in this situation may qualify. If you want to claim second job wage loss benefits from the Second Injury Fund, you must file a Claim for Compensation against the Fund.

  5. Medical Expenses for Injured Employees of Uninsured Employers.

    The Second Injury Fund also may be responsible for payment of medical bills of injured employees when the employer fails to insure its workers’ compensation liability as required by law. Generally, both the uninsured employer and the Second Injury Fund are liable for the medical care and expenses. (The Second Injury Fund is entitled to seek reimbursement against the employer as allowed by law.) The Second Injury Fund is only responsible for payment of medical bills in this situation, and has no responsibility for payment of temporary or permanent disability benefits. In order to claim these benefits, you must file a Claim for Compensation against the Second Injury Fund.