Missouri’s Second Injury Fund (SIF) can help an injured worker, or the survivors of an employee who lost their life at work, in certain situations. These situations are explained below.
The SIF is funded by a surcharge paid by employers. The Missouri State Treasurer is the “custodian” of the SIF. The Missouri Attorney General’s Office defends the claims made against the SIF and has the Treasurer’s authority to settle cases for the SIF.
Types of Second Injury Fund Benefits
The SIF provides five different kinds of benefits. One or more may be available to you. They are:
- Disability Benefits
Disability benefits may be available from the SIF for injured workers who were already 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 SIF.
- 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 PPD benefits from the SIF. In order for an employee to recover from the SIF, 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% of the body as a whole, or at least 15% of a major extremity (foot, ankle, knee, hip, hand, wrist, elbow, shoulder). If these thresholds are met for both the work-related disability and the pre-existing disability, the SIF may pay a lump-sum settlement. Usually, this is paid pursuant to a settlement agreement between the injured worker and the SIF, but some cases do require an evidentiary hearing (trial) before an administrative law judge.
- Permanent Total Disability (PTD) Benefits
If the last work-related injury, considered alone, makes the injured worker permanently and totally disabled, the SIF has no liability for PTD benefits. However, the SIF 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 SIF pays the remaining lifetime benefits. For an employee to receive lifetime PTD benefits from the SIF, an evidentiary hearing (trial) before an administrative law judge is required; in other words, the SIF cannot simply agree to make those lifetime benefit payments without an award (order) from a judge. In some cases, the SIF may agree to a lump-sum settlement with an employee to settle the employee’s claim for lifetime benefit payments.
- Death Benefits
If an employee dies due to a work injury while working for an uninsured employer, the SIF 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 payment from the SIF, an evidentiary hearing (trial) before an administrative law judge is usually required; in other words, the SIF generally cannot agree to make those weekly benefit payments without an award (order) from a judge. In some cases, the SIF may agree to a 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, or how long death benefits last, read Survivors’ Benefits on this website.
- Rehabilitation Benefits
Rehabilitation benefits are available to restore a seriously injured worker 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 SIF 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 also receives many referrals for rehabilitation benefits from physical therapists, physicians, injured workers, case managers and lawyers.
- Second Job Wage Loss Benefits
This benefit may be available to an employee who works at two or more jobs. When an employee has a work-related injury from his or her “first job” and is physically unable to work at his or her other job(s) due to that injury, the employee may claim additional benefits from the SIF 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 would like to claim “second job wage loss benefits”, you must file a Claim for Compensation against the SIF.
- Medical Expenses for Injured Workers of Uninsured Employers
The Second Injury Fund may also be responsible for payment of medical bills of injured workers 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 required by law.) The SIF is only responsible for the payment of medical bills in this situation, and has no responsibility for the payment of temporary or permanent disability benefits. In order to claim these benefits, you must file a Claim for Compensation against the SIF.
How Do I Claim Benefits From the Second Injury Fund?
Except for Physical Rehabilitation Benefits, no payments can be made from the SIF unless a Claim for Compensation is filed against the SIF. Only the employee or (in a death benefits case) the employee’s dependents can file a claim against the SIF. Employees or dependents may hire their own lawyer to represent their interests when filing for benefits. (Read Obtaining a Lawyer on this website for more information.)
A claim against the SIF is made by filing an approved Claim for Compensation, indicating which SIF benefits are being sought. If a claim is filed against the SIF based upon a pre-existing disability, the employee needs to complete the date(s) of previous injury(ies) or disease(s), the part(s) of the body affected by the previous injury(ies) or disease(s), as well as state whether partial permanent or total permanent benefits are being sought.
A claim against the SIF must be filed within two years after the date of the work-related injury or within one year after a claim is filed against an employer or insurer, whichever is later. This is a somewhat technical requirement; therefore, in most cases, you will want to file a claim against the employer and the SIF before entering into a settlement with your employer. As with any legal question, you may want to consult with a lawyer before filing a claim or entering into any settlement.
What Happens After a Claim is Filed?
The Division of Workers’ Compensation will send the claim for compensation to the Attorney General’s Office for their response. (Remember that the Attorney General is responsible for defending claims against the SIF.) The Attorney General then has 30 days to file its Answer to the Claim for Compensation. You will receive a copy of the Answer. The Answer will either admit or deny the allegations or statements made in the claim. The Answer may also state that it lacks information to admit or deny the statements made in the claim and in this instance will reevaluate the case when additional information is made available.
The claim will be scheduled for a “prehearing” conference before an administrative law judge. You (or your lawyer if you have one) must appear at the prehearing to discuss your claim with the assistant attorney general and the judge. This is an informal meeting which may result in a settlement of your claim. After a prehearing, a mediation may be requested. Mediation is a confidential settlement conference before an administrative law judge.
As in other workers’ compensation cases, the SIF or the employee may request an evidentiary hearing (trial) before an administrative law judge to determine whether the employee is eligible for the benefits being sought. Evidence, including medical evidence, is required. The employee has the burden of proof on all contested issues. For more information about evidentiary hearings, awards and appeals, read What to Expect If Your Case Goes to Trial and Appealing the Judge’s Decision on this website.
How Are Payments Made?
After the claim against the SIF is resolved, either by an approved settlement, or based upon a Final Award entered by an administrative law judge, the Division will requisition the payments. Payments for medical bills may go directly to the medical providers in uninsured employer cases. All lawyer’s fees and applicable liens need to be satisfied through the benefit payments made in the case. Direct deposit is an option available to persons receiving weekly benefits.
If you have a question as to the status of your payment from the SIF, call 800-775-2667 and ask to be referred to a SIF Technician.