Google Translate

Second Injury Fund: Employers Roles and Responsibilities

Second Injury Fund: Employers Roles and Responsibilities

The Second Injury Fund compensates injured employees when a current work-related injury combines with a prior disability to create an increased combined disability. The Fund is funded by a surcharge paid by employers. The Missouri State Treasurer is the custodian of the Second Injury Fund. The Missouri Attorney General’s Office defends the claims made against the Fund and obtains the Treasurer’s authority to settle cases for the Fund. The Second Injury Fund Unit is responsible for the billing and collection of the Second Injury Fund Surcharge from commercial insurance companies writing workers’ compensation premiums in Missouri and from self-insurers or group trusts authorized to self-insure in Missouri.

Overview

An injured employee must have a permanent, pre-existing disability to trigger liability of the Second Injury Fund. The prior disability must be "of such seriousness as to constitute a hindrance or obstacle to employment." In order for an employee to recover from the Second Injury Fund, certain minimum limits must be met.

The Second Injury Fund also is responsible for paying medical bills of injured employees when the employer fails to insure its workers' compensation liability. In addition, if the employee is killed, burial expenses and death benefits in the form of weekly payments to the surviving spouse or dependents of the employee are paid from the Second Injury Fund if the employer is uninsured.

The Fund also provides benefits to injured employees who are undergoing physical rehabilitation. To qualify for these benefits, the employee must be seriously injured and be receiving therapy at a facility certified by the Division. If the injured worker qualifies, he/she will receive $40 per week for up to 20 weeks for rehabilitation.

The last benefit from the Second Injury Fund is second job wage loss benefits. The benefit applies to injuries that occurred after August 28, 1998. The employee must be injured on the job with the first employer. If the employee is unable to work at a second job as a result of the injury, these benefits may be claimed from the Second Injury Fund.

Only the employee, the employee's lawyer or the employee's dependent(s) can make a claim against the Second Injury Fund. Claims for permanent total and permanent partial disability benefits, uninsured employer medical cost, or death benefits are made by filing a Form 21, Claim for Compensation form, with the Division.

Workers’ Compensation Insurance Companies & Self-Insured Employers: Responsible for Paying SIF Surcharge

The Second Injury Fund Surcharge is funded through a surcharge on employers’ workers’ compensation net deposits, net premiums or net assessments and net premium equivalent for individual self-insured employers. Each year by October 31 the Director of the Division of Workers’ Compensation estimates the benefits payable from the Second Injury Fund during the following calendar year in order to set the surcharge rate. The rate is based on a statutory formula to generate 110% of the moneys to be paid from the Second Injury Fund in the following calendar year less any moneys contained in the fund at the end of the previous calendar year. Due to SBs 1 and 130, the rate has been capped at three percent.

The surcharge is collected quarterly from insurance companies and self insurers. In order to satisfy your obligation under RSMo 287.715, insurance carriers writing worker’s compensation premiums or having the authority to write workers’ compensation premiums in Missouri and employers/group trusts that have been authorized to self-insurer in Missouri need to register with the Second Injury Fund Surcharge Unit by sending us an email at SIFsurcharge@labor.mo.gov or call us at 573-526-5756.

Upon contacting us, we will get your company set up to file all quarterly reports online. Our online filing system is a Web-based system. Most correspondence from the Division is now electronic; therefore, each company representative responsible for Second Injury Fund Surcharge Quarterly reporting will need to complete and fax an Electronic Partnering Confidentiality Agreement to the Division at the fax number on the agreement. The information on this agreement will be entered into our system and a printout will be faxed to the representative (company contact) with the information necessary to login to our online reporting system. The link to the log in is: https://apps..labor.mo.gov/dwc/surcharge/login.asp. At this link, you will find the Electronic Partnering Confidentiality Agreement, Affidavit of Zero Reporting (commercial insurance companies only), other information regarding our system and the actual login.

Each quarter, approximately 15 days prior to the quarter end, an e-mail with the login link will be sent from SIFsurcharge@labor.mo.gov to the company contact stating that the quarterly report is available for completion. The contact will need to click on the link and log in the site with the e-mail address, Access Code and ID Number (faxed printout). After accessing the quarterly report, there are instructions for completing the report. Be sure to submit the form prior to printing the form so that you have a confirmation number reflecting that the form was properly filed and a copy to send with the payment. If you have any problems with the quarterly filing or cannot find the items needed to access the log in, please contact us at SIFsurcharge@labor.mo.gov or call us at 573-526-5756.

The Division will send an e-mail approximately 10 days prior to the due date as a reminder. If your payment and printed report have a postmark date after the 30th (due date), you will receive an e-mail stating that you are delinquent or have underpaid and now are subject to a late fee (.5% of unpaid balances) and interest (1.5% per month or fraction thereof delinquent). Each month that your payment is delinquent or underpaid, the interest will increase. After 90 days of non-compliance, the Division will refer the delinquent or underpaid amount to the Attorney General’s Office.

Commercial insurance companies who are not writing but have the authority to write in Missouri can file an Affidavit of Zero Reporting each year. You still will receive the e-mails approximately 15 days prior to the end of the quarter stating that the quarterly reports are available for completion; however, if you are not writing and you have filed the affidavit with the Division, you do not need to complete the quarterly reports. You may find the affidavit on our Web site at the link to the log in https://apps.labor.mo.gov/dwc/surcharge/login.asp.

If you have any questions regarding this information and your responsibility to be in compliance with RSMo 287.715, please e-mail us at SIFsurcharge@labor.mo.gov or call us at 573-526-5756.

If you have any questions regarding the Missouri Workers’ Compensation Administrative Tax or Administrative Surcharge, please contact the Missouri Department of Insurance, Financial Institutions and Professional Registration at Premium.tax@insurance.mo.gov or by phone at 573-526-1589.

Payment Processing to Injured Party

The Division of Workers' Compensation is responsible for processing Second Injury Fund benefits. When an employee is eligible for benefits and a compromise settlement has been approved or an award has been issued, the Division processes payments to the injured worker.

Claims for death, permanent total, permanent partial, uninsured employer – medical, and second job wage loss benefits are made by filing a WC-21, Claim for Compensation form, indicating Second Injury Fund benefits are being sought by the injured worker. Answers to claims are filed by the Office of the Attorney General that represents the Treasurer of the State of Missouri, as custodian of the Second Injury Fund.

In pre-hearing conferences, mediations or hearings before the Division’s administrative law judges, eligibility for Second Injury Fund benefits is determined based upon medical evidence submitted by the employee and the Attorney General's Office. Payments are made consistent with the award issued by an administrative law judge or stipulation agreements, properly executed by all parties, and approved by an administrative law judge.

Checks are prepared at the Office of Administration, Division of Accounting, and distributed by direct deposit or mail. Direct deposit into bank accounts is only available to claimants receiving lifetime payments.

Outstanding child support liens are deducted from payments. Medicaid liens from the Department of Social Services, Division of Medical Services, also must be honored before payments are ordered to the injured worker.

Claims for physical rehabilitation benefits are generally initiated by the Division from a review of injury and medical reports, or referrals from lawyers, rehabilitation nurses, case managers or claims adjusters.

For more information about Second Injury Fund benefits, call 800-775-2667.