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Do I need an attorney to file an SIBTF claim?

When a worker is injured on the job in California, the employer’s insurance policy will pay that worker compensation for their injuries. If the worker is partially disabled, then the worker can get benefits for that disability.

But what happens when an already disabled worker gets injured and is now totally disabled? Does the most recent employer pay for the permanent disability for the rest of the worker’s lifetime? If so, why would an employer hire someone who has a previous disability coming into the job?

To help those who are already disabled, the state of California set up the Subsequent Injuries Benefits Trust Fund (SIBTF), also called Second Injuries Fund, to help pay for the disability payments so a new employer doesn’t have to pay for the whole disability.

Who is Eligible for the Fund?

A typical example is a worker who is partially disabled with a 25 percent permanent partial disability rating to the body because of a back injury. This employee started a job with that condition and is injured on the new job but if it hadn’t been for the previous injury, they wouldn’t be completely disabled, but now they are.

Without the fund, the new employer will have to pay full disability payments potentially for the rest of the employee’s life. With this knowledge, many employers—especially one that is a typically high-injury industry—wouldn’t employ that worker in the first place.

In this example, the fund will kick in and pay for 25 percent of the disability so that the new employer isn’t “punished” for giving the worker a job.

Requirement for the Fund

In an effort to keep the fund from being depleted, the legislature put some qualifications on what is required before the fund will pay out.

  • The injured worker must have a pre-existing permanent impairment, medical condition or disability that prevented them from accessing any form of employment.
  • The worker must have an injury on the new job that is an industrial impairment, medical condition or disability.
  • The two disabilities when combined must be equal to 70% or more of the total permanent disability.
  • The total disability of both disabilities must be larger than it would be if the only injury to the employee was from the new job.
  • The new work-related injury must also cause at least 35% permanent disability without any form of adjusting factors coming into play.

How Does it Work?

To be eligible, the worker must have had a previous disability and then become injured on the new job. If both disabilities add up to over 70 percent total disability, then the SIBTF will pay for the percentage of disability payments that is equal to the previous injury.

After the second injury, the worker has a deadline to make a claim for SIBTF payments. If this is met, then a committee will decide if the worker qualifies and then will issue an award.

How are the payments made?

They are paid primarily the same as worker’s compensation payments. In a typical WC claim, the worker can be sent a direct deposit from the insurance company for their permanent disability for each week. However, it’s the practice of the industry to seek a final lump sum payment as a way of settling with the insurance company.

The SBITF will do the same. They can pay out for each week for the rest of the worker’s life (or however many WC law allows), or they can pay out in one lump sum and the case is closed.

What if I already received payments for my previous disability?

That’s ok, the fund is designed to address a recent injury, that when combined with the previous injury, would make a permanent disability of over 70 percent. Thus, if you have already settled for the previous injury, you can still be compensated for that portion of a new disability.

What if I’m receiving Social Security Disability, can I still get SIBTF benefits?

The way the fund works is it gives credits for other disability payments received for the same injury, so if you are getting SSID payments, or have a prior award for the old injury, these will be calculated as a credit to the SIBTF and will reduce the amount given to the employee. In most cases it is still worth it to make a SIBTF claim as the credits rarely overcome the award amount.

Do I need an attorney to file an SIBTF claim?

No, the law does not require you to be represented, and if you feel that you can navigate through the deadlines, forms and calculations, then you might be able to accomplish filing a successful claim without having to pay an attorney.

However, nothing can replace experience, and some mistakes can’t be recovered from. You should at least talk to an attorney to find out what you are up against and then you have an attorney that you can call if you feel like you are over your head.

Contact a Sacramento Workers’ Compensation Lawyer Today

In almost all cases when someone is injured on the job, the worker will get the best possible outcome by hiring an experienced workers’ compensation lawyer.

Attorney Alice A. Strömbom focuses exclusively on Workers’ Compensation Law. She is very familiar with the tactics insurance companies use to avoid providing the medical treatment and disability benefits injured workers deserve, and has a recognized track record in combating such issues.

Contact us today for a free, confidential consultation and case evaluation.