Limiting Liability - Second Injury, Reopened Cases and Catastrophic Claims Management

The longer a workers’ compensation claim goes on, the more difficult it is to manage. Several sections of the Workers’ Compensation Law (WCL) have a significant impact on the management of a lengthy loss of time claim. With Global Case Management, NYSIF brings all claims expertise to the table to proactively manage lengthy loss of time claims.

What is the Second Injury Fund and how may it affect the final cost of a claim?

What about closed claims that are reopened? How is liability affected by the Fund for Reopened Cases?

How does NYSIF manage catastrophic claims?

Second Injury Fund—Relief Under WCL Section 15-8 WCL

Under prescribed conditions, Section 15-8 of the Workers’ Compensation Law reduces employer liability to specified limits in certain cases of permanent disability. The provisions of this section constitute what is known as the second injury law.

There is no difference whatsoever in the amount of compensation payable to a claimant, or to his or her dependents, when the case comes under the provisions of the second injury law.

The purpose of the law is to facilitate the employment of persons with prior disabilities by relieving employers and carriers of excess compensation costs due to previous permanent physical impairment regardless of knowledge on the part of the employer as to the existence of that impairment. Permanent physical impairment is defined as any permanent condition due to previous accident or disease or any congenital condition that is, or is likely to be, a hindrance or obstacle to employment.

The legislative intent of the second injury law, as stated, deems: every person in this state who works for a living is entitled to a reasonable opportunity to maintain his independence and self-respect through self-support even after he has been physically-handicapped by injury or disease.

If an employee with a pre-existing permanent physical impairment sustains a second injury which itself produces a permanent disability, and if the combined permanent disability resulting from the pre-existing impairment and the subsequent injury is “materially and substantially greater” than that which would have stemmed from the second injury alone, the carrier pays whatever awards are made. The carrier is then entitled to reimbursement from the Second Injury Fund as specified by law.

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Relief Under Section 25-a Fund for Reopened Cases

Payment in certain old and re-opened claims may be made out of a special fund, the Fund for Reopened Cases, to relieve the employer and the insurance carrier of this obligation. Generally, under Section 25-a of the Workers' Compensation Law, eligibility for this relief occurs:

  1. After a lapse of seven years from the date of the injury or death, where claim for compensation previously has been disallowed or the claim has been otherwise disposed of without an award of compensation; or
  2. After a lapse of seven years from the date of the injury or death and also a lapse of three years from the date of the last payment of compensation.

If a claim meets these requirements it is important that the employer consult with NYSIF prior to the payment of wages in lieu of compensation benefits and/or the authorization of medical treatment due to this accident. Failure to do so could result in additional liability that would otherwise have been the responsibility of Special Funds.

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Catastrophic Case Management

All catastrophic or complex injuries are referred to a NYSIF nurse case manager who establishes a rapport with the claimant, the claimant’s family, and medical team to facilitate effective case management. By coordinating services, the nurse case manager’s goal is to assure a smooth transition to rehabilitation, ongoing treatment and, if possible, return to a productive lifestyle for the claimant.

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