Subsequent Injuries Fund & Workers’ Compensation: Additional Benefits for Seriously Disabled Injured Workers with Pre-Existing Disabilities: What You Need To Know

The State of California has a Special Program for Injured Workers who have pre-existing labor disabling conditions. It is called the Subsequent Injuries Fund. It is commonly referred to by the abbreviation “SIF”. This Special Program allows for Injured Workers who are seriously disabled to obtain additional compensation beyond their ordinary workers’ compensation case.

What is the Subsequent Injuries Benefits Trust Fund?

Per the Department of Industrial Relations, “[t]he Subsequent Injuries Benefits Trust Fund (SIBTF) is a source of additional compensation to injured workers who already had a disability or impairment at the time of injury. For benefits to be paid from the SIBTF, the combined effect of the injury and the previous disability or impairment must result in a permanent disability of at least 70 percent. The fund enables employers to hire disabled workers without fear of being held liable for the effects of previous disabilities or impairments.” In sum, ratings of an Injured Worker’s overall disability, regardless of it being industrial, must be 70 percent or more to qualify.

How Does One Qualify for Subsequent Injuries Benefits? 

Per Labor Code Section 4751, “if an employee who is permanently partially disabled receives a subsequent compensable injury resulting in additional permanent partial disability so that the degree of disability caused by the combination of both disabilities is greater than that which would have resulted from the subsequent injury alone, and the combined effect of the last injury and the previous disability or impairment is a permanent disability equal to 70 percent or more of total, he shall be paid in addition to the compensation due under this code for the permanent partial disability caused by the last injury compensation for the remainder of the combined permanent disability existing after the last injury as provided in this article; provided, that either (a) the previous disability or impairment affected a hand, an arm, a foot, a leg, or an eye, and the permanent disability resulting from the subsequent injury affects the opposite and corresponding member, and such latter permanent disability, when considered alone and without regard to, or adjustment for, the occupation or age of the employee, is equal to 5 percent or more of total, or (b) the permanent disability resulting from the subsequent injury, when considered alone and without regard to or adjustment for the occupation or the age of the employee, is equal to 35 percent or more of total.”[emphasis added]

What are the Elements to Proving Up a Subsequent Injuries Fund Case?

In order to prevail with a Subsequent Injuries Fund case, an Injured Worker should be able to provide the following elements: (1) An Applicant must have a preexisting permanent partial labor disabling disability; (2) The Applicant must sustain a compensable subsequent industrial injury (3) The Applicant’s combined disability from preexisting permanent partial labor disabling disability & subsequent industrial injury must exceed disability from subsequent industrial injury alone; (4) The Applicant’s combined disability from preexisting permanent partial labor disabling disability & subsequent industrial injury must equal 70 % or more of total disability; and (5) The Applicant’s disability from the subsequent industrial injury is equal to 35 % or more without adjustment for age or occupation (5 % for an opposite & corresponding member case.)

How Does One Get Benefits from the Subsequent injuries Trust Fund? 

Subsequent Injuries Fund cases are litigated at the Workers’ Compensation Appeals Board.   Subsequent Injuries Fund cases can be settled or tired.   They can settle via Stipulated Award which means that benefits are paid out over time or they can settle via a Compromise and Release which provides for a lump sum payout.   If the case cannot be settled, the Subsequent Injuries Fund case can be tried before a Workers’ Compensation Judge. If an Award is made, benefits will be paid in accordance with the award. Decisions from the Worker’s Compensation Judge are subject to appeal from the Subsequent Injuries Fund.

Are there Any Deductions or Credits that are Taken from a Subsequent Injuries Fund Case? 

Yes. There are deductions and credits that are taken away during the calculation of the payment of benefits.  Such deductions can from Social Security Disability Benefits, prior Workers’ Compensation Awards, and Personal Injury Claims.  These deductions are mandatory.

Per Labor Code Section 4753, “[s]uch additional compensation is not in addition to but shall be reduced to the extent of any monetary payments received by the employee, from any source whatsoever, for or on account of such preexisting disability or impairment, except as to payments being made to the employee or to which he is entitled as a pension or other compensation for disability incurred in service in the armed forces of the United States, and except as to payments being made to him or to which he is entitled as assistance under the provisions of Chapter 2 (commencing with Section 11200), Chapter 3 (commencing with Section 12000), Chapter 4 (commencing with Section 12500), Chapter 5 (commencing with Section 13000), or Chapter 6 (commencing with Section 13500) of Part 3, or Part 5 (commencing with Section 17000), of Division 9 of the Welfare and Institutions Code, and excluding from such monetary payments received by the employee for or on account of such preexisting disability or impairment a sum equal to all sums reasonably and necessarily expended by the employee for or on account of attorney’s fees, costs and expenses incidental to the recovery of such monetary payments.

All cases under this section and under Section 4751 shall be governed by the terms of this section and Section 4751 as in effect on the date of the particular subsequent injury.”

Who Pays out the Award? 

The funds for the Subsequent injuries Trust Fund are deposited with the Treasurer of the State of California. Therefore, the checks from SIF Awards are issued from the State of California.   Further, benefits are paid out when there are funds available.

Where Does the Money Come From to Pay Out Subsequent Injuries Fund Claims? 

Within the Workers’ Compensation System, there are surcharges that Insurance Companies collect from Employers when they pay for their workers’ compensation insurance.   One of the surcharges is used to fund the Subsequent Injuries Benefits Trust Fund.

What Gets Paid Out of the Fund?

Unlike regular workers’ compensation benefits, the Subsequent Injuries Fund Benefits are limited to indemnity payments. There is no entitlement to medical treatment arises from an Application for Subsequent Injuries Fund benefits.

Are there any current problems with the Subsequent Injuries Fund? 

Yes. There are some current problems with the Subsequent Injuries Fund.   The Fund has a limited number of adjusters. Currently, according to an Office of the Director Legal Attorney, there are currently only 9 adjusters for the entire State of California.

How Do I Pursue a Subsequent Injuries Fund Claim? 

First, you are required to file an Application for the Fund and serve it upon the Workers’ Compensation Appeal Board and the Subsequent Injuries Fund.  Prior to doing so, it is important that you have your case evaluated to see if you can reach the threshold.   Also, there may be some need to analyze credits and whether they will severely impact any recovery. For example, there may have been a multi-million recovery that occurred as a result of a Personal Injury claim that was the basis of the pre-existing disability. The credits arising out of that PI recovery can severely limit any SIF recovery. After you have filed your Application, the Subsequent Injuries Fund will contact you and request for you to sign releases for credit information and provide documents to support your claim.  Please note that there are time limits to filing a claim. Please note that it is incumbent upon the Injured Worker to prove up their claim.

Where can I get advice?

If you would like a free consultation regarding your workers’ compensation claim, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 26 years. Contact us today for more information.