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Second Injury Fund

Second Injury Fund

About the Second Injury Fund

The Second Injury Fund Unit is responsible for the billing and collection of the Second Injury Fund Surcharge from insurance carriers writing workers’ compensation premiums in Missouri and from self-insurers or group trusts authorized to self insure in Missouri. In addition to billing and collecting, upon the requisition of the Division, warrants on the state treasurer for the payment of compensation benefits from the Second Injury Fund are issued to the claimants. These payments are consistent with the awards or settlements approved by administrative law judges. The Second Injury Fund Unit is also responsible for certifying physical rehabilitation facilities that are interested in rehabilitating injured workers. A seriously injured worker may be eligible for this benefit if attending a facility that has been certified by the Division of Workers’ Compensation prior to the physical rehabilitation treatment dates

How the Second Injury Fund Can Help Me As An Employee

Missouri’s Second Injury Fund may be able to help an injured worker when a current work-related injury combines with a prior disability to create an increased combined disability—depending upon the date of his or her most recent compensable injury. SB1, effective January 01, 2014, made changes in the way benefits may be awarded from the Second Injury Fund. Those benefits now depend upon the date of the most recent compensable injury. 

If the most recent compensable injury occurred BEFORE January 01, 2014, there five (5) benefits potentially available from the Second Injury Fund:

  1. Disability Benefits.
    • Permanent Partial Disability (PPD). The Missouri Supreme Court issued a decision on November 12, 2013, that interpreted §287.220.1, RSMo. This section sets out the “thresholds” for triggering the liability of the Second Injury Fund when an employee has a pre-existing Permanent Partial Disability. The Supreme Court stated as follows (i) An employee must have a pre-existing Permanent Partial Disability of such seriousness as to constitute a hindrance or obstacle to employment. (ii) An employee must have a single pre-existing Permanent Partial Disability that meets one of the “thresholds” set in the statute to trigger Second Injury Fund liability. This means that an employee must have a single pre-existing permanent disability that equals or exceeds fifty (50) weeks of disability of the “Body as a Whole” [BAW] or fifteen percent (15%) of a major extremity. Note that Sec. 287.190.3, RSMo, sets a value of 400 “weeks” of compensation on the “BAW”; so, 50 weeks of disability to the BAW is 12.5%. (iii) There is no “threshold” requirement for the “last” work injury. (iv) The combined disability, which includes all the preexisting disabilities, should be substantially greater than the disability that would have resulted from the last injury considered alone. (v) The Second Injury Fund is liable only for the degree of the combined disability that exceeds the numerical sum of the preexisting disabilities and the disability from the last injury. For example: Losing the sight in one eye would be terrible; but losing the sight in both eyes would be far more than “two times” as disabling as losing the sight in “only” one eye.
    • Permanent Total Disability (PTD). If the last work-related injury makes the injured worker permanently and totally disabled, then the Second Injury Fund has no liability. However, the Second Injury Fund is liable for permanent total disability when the combined effect of the work injury and the prior disability render the employee unemployable in the open labor market. The employer is liable only for the compensation for the most recent injury and the Second Injury Fund pays the remaining lifetime benefits.
  2. Death Benefits.  Payments are only made for cases involving the death of an employee while working for an uninsured employer. Burial expenses and death benefits in the form of weekly payments to the surviving spouse or dependents of the deceased are paid from the Second Injury Fund. Benefits may be administered by a lump sum settlement or ongoing weekly payments to the dependents.
  3. Rehabilitation Benefits. These benefits are to restore the seriously injured 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 forty dollars ($40) per week for up to twenty (20) weeks only for the period the employee actually attends physical rehabilitation. Although unusual, this may be extended by special order of the Division of Workers Compensation for up to twenty (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 initiates physical rehabilitation benefits after a review of the injury and medical reports. The Division receives many referrals from case managers, attorneys and physical therapists.
  4. Indemnity (for lost wages from a second job). This benefit applies to injuries occurring on or after August 28, 1998 but no later than December 31, 2013. The employee must be injured on the job with his first employer. If the employee is unable to work at a second job as a result of the injury, these benefits for the loss of wages from the second job may be claimed from the Second Injury Fund. The employee should contact the Division’s Toll-Free Employee Hotline, 800-775-2667, to request claim forms. The Missouri Attorney General’s Office will review the claim to determine if benefits should be voluntarily paid. If the benefits are disputed, the employee should contact the Division’s local Workers’ Compensation adjudication office to request a docket setting.
  5. Medical expenses for injured employees of uninsured employers. The Second Injury Fund is also responsible for payment of medical bills of injured employees’ when the employer fails to insure its workers’ compensation liability as required by law. Generally, the uninsured employer and the Second Injury Fund are liable for the medical care and expenses. The Second Injury Fund is entitled to reimbursement against the employer as required by law. The Missouri Attorney General’s Office would institute the appropriate action against the employer to recover the monies paid from the Second Injury Fund as set forth in §287.220 (5) RSMo. The Division’s Fraud & Noncompliance Unit investigates allegations of an employer’s failure to insure its workers’ compensation obligations and appropriate cases are referred to the Attorney General’s office for prosecution.

For cases in which the most recent compensable work injury occurred ON OR AFTER January 01, 2014, as mandated by Senate Bill 1, there are two (2) benefit categories available from the Second Injury Fund.

  1. Rehabilitation Benefits, as discussed above, were not changed by SB1. They remain available under the same conditions.
  2. Permanent Total Disability Benefits—if the following conditions are met:
    • The employee must have a medically documented preexisting disability equaling a minimum of fifty weeks of permanent partial disability compensation which is:
      1. A direct result of active military duty in any branch of the United States armed forces; or
      2. A direct result of a compensable injury under the Missouri Workers’ Compensation Law; or
      3. If not from a compensable injury, the preexisting disability must directly and significantly aggravate or accelerate the subsequent work-related injury; or
      4. A preexisting permanent partial disability of an extremity, loss of eyesight in one eye, or loss of hearing in one ear—if the subsequent compensable work-related injury is an injury to the opposite extremity, or causes loss of eyesight in the other eye, or loss of hearing in the other  ear;
    • The employee then must sustain a subsequent compensable work-related injury that, when combined with his or her preexisting disability, as just defined, results in a permanent total disability.

Special Rule for Sheltered Workshop Employees: Permanent Total Disability Benefits from the Second Injury Fund also may be paid to an employee who is employed in a sheltered workshop, as established in Sections 205.968 to 205.972 or Sections 178.900 to 178.960 of the Revised Statutes of Missouri, and who thereafter sustains a compensable work-related injury that, when combined with his or her preexisting disability, results in permanent total disability.

No Benefits from the Second Injury Fund if: SB1, effective January 01, 2014, provides: “No compensation shall be payable from the second injury fund if the employee files a claim for compensation under the workers' compensation law of another state with jurisdiction over the employee's injury or accident or occupational disease.”

Benefits may be suspended if: SB1, effective January 01, 2014, provides that the lifetime payments to an injured employee made from the Second Injury Fund shall be suspended when the employee is able to obtain suitable gainful employment or be self-employed in view of the nature and severity of the injury.

Related: Injured Workers: How the Second Injury Fund Can Help You

Roles & Responsibilities of Employers

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 Second Injury Fund is funded by a surcharge paid by employers. The Missouri State Treasurer is the custodian of the 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 Surcharge from insurance carriers writing workers’ compensation premiums in Missouri and from individual self-insurers or group trusts authorized to self-insure in Missouri.

Related: Employers: Second Injury Fund Surcharge

Physical Rehabilitation and Facility Certification

The goal of this program is to restore the injured worker, as quickly and as nearly as possible, to a condition of self-support and maintenance equal to other able-bodied workers, through physical rehabilitation. The physical rehabilitation program staff investigates and determines the employee’s eligibility to receive benefits. The program works closely with physicians, therapists, lawyers, insurers, and case managers.

The Division's supervision of physical rehabilitation is limited to seriously injured workers receiving physical rehabilitation at certified facilities and the authorization of payment from the Second Injury Fund. Serious injuries that may qualify include, but are not limited to, quadriplegia, paraplegia, amputation of the hand, arm, foot or leg, atrophy due to nerve injury or non-use, back injuries not amenable alone to recognized medical and surgical procedures, severe crushing injuries, and severe burns.

Only those seriously injured employees receiving physical rehabilitation in facilities certified by the Division are entitled to the additional benefits. This does not mean these employees cannot be rehabilitated in other facilities. It does mean that if they are rehabilitated in other facilities, they cannot receive the Second Injury Fund benefit. To be certified, each facility must meet criteria and specifications for function, personnel, equipment, quality, and facility adequacy. The Division has recently updated the criteria for certification of compliance to current professional standards. Presently, there are approximately 480 facilities certified by the Division.

The physical rehabilitation program staff investigates and determines the employees' eligibility to receive the benefit. If the employee meets the criteria and is receiving services from a certified facility, the Director authorizes the $40 weekly payment to be paid to the employee from the Second Injury Fund for up to 20 weeks.

In unusual cases, benefits may be provided for longer than the specified 20 weeks by special order. Benefits are paid to the employee only while actually being rehabilitated. The program averages 50 active cases. Each of these cases requires some type of action on a weekly basis. The rehabilitation facility is required to submit progress reports every two weeks while the employee is receiving therapy. The unit works closely with physicians, therapists, lawyers, insurers, and case managers.

For more information about rehabilitation programs and workers' compensation, call 800-775-2667 or 573-526-3876.