Who Qualifies Benefits in a California Subsequent Injury Fund Case?

Who Qualifies Benefits in a California Subsequent Injury Fund Case?
Marc S. Wiesner

What happens when you are severely injured at work but are not deemed 100% disabled from that injury alone – yet can’t find a job because of the injury and other disabilities? For injured workers with prior injuries and a qualifying Subsequent Industrial Injury (“SII”), they may be able to obtain benefits from a Subsequent Injury Benefit Trust Fund (“SIBTF” or “SIF” for short) case.

Per the Division of Industrial Relations’ website, the SIF provides, “additional compensation to injured workers who already had a disability or impairment at the time of injury.” But, who qualifies?

In general, any injured worker whose final impairment rating (the percentage number in the QME or PTP report) meets or exceeds either 35% (after taking into consideration any non-industrial causes of the impairment) in total or 5% and has a prior disability to the opposite and corresponding limb (think, prior right knee surgery and left ankle SII) may have a SIF case. While the above is the starting criteria for a case, the injuries worker needs to prove more for SIF benefits.

That is because the SIF will only pay out benefits to those qualifying injured workers who are at least 70% disabled globally. From there, the SIF becomes liable to the injured worker on a biweekly basis for the percentage of their pre-existing disability plus their SII disability, less an applicable offsets and credits. If the injured worker can prove they are 100% disabled globally, the SIF becomes liable to the injured worker for payments similar to temporary disability benefits (work comp wage loss payments) for life.

Absent a prior court finding, being able to PROVE a disability from years ago is no small task. It requires mountains of medical reports and skilled medical evaluators who know how to navigate said reports. It also takes very skilled attorneys who can identify where those records are and how to best present the information in those records to the medical evaluators. SIF attorneys are also responsible for ensuring credits are taken appropriately and forcing the SIF to court when the time is appropriate.

The attorneys at Wiesner English P.C. have tackled many SIF cases in their careers and have procured numerous 100% awards on behalf of their clients. If you have a workplace injury that may be career ending when considering your prior injuries, seek out a skilled SIF attorney TODAY!

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