2023 Laws of Puerto Rico › TITLE ELEVEN - Workmen’s Compensation (§§ 1 — 268) › Chapter 9 - Temporary Disability Benefits (§§ 201 — 212) › § 205 - Private plans

(a) Right to establish private plans.— Upon the authorization of the Secretary, an employer may establish a private plan to pay his employees the benefits required under this chapter provided that:
(1) The Secretary deems the benefits of the plan are in all respects equal or more beneficial to the employees of said employer than the benefits provided under § 203 of this title;
(2) the Secretary deems that all employees of said employer or a reasonable classification of them, are covered by the plan;
(3) contributions higher than those required under § 208 of this title are not required from the employees under said plan; Provided That in no case shall the contribution to be paid by the employee be higher than the amount to be paid by the employer. Nothing herein provided shall be construed to consider illegal the contributions of the employees, otherwise legal, for other benefits or additional benefits;
(4) the plan is underwritten by a contract with an authorized insurance company or, if not insured, the financial standing of the employer is established to the satisfaction of the Secretary and the employer posts a bond or furnishes a warranty as surety to the financial liabilities of the plan;
(5) should the employees contribute towards the plan, the majority of them should accept the private plan;
(6) to the limit set by the Secretary, the plan pays disability benefits to employees, as well as to its ex-employees for disability periods which begin while they are unemployed or employed in non-insured work;
(7) the plan observes any conditions or pays to the Fund any assessments determined by the Secretary as necessary to avoid an actuarial disadvantage to the Fund due to the establishment of a private plan;
(8) the plan provides for the proportional payment, as determined by the Secretary, for the costs of the disability-benefit payments made by the Fund to the workers who become disabled while unemployed or while employed in non-insured employment and further pays, the proportional expenses of administrating the Fund with regard to the private plans;
(9) the employer furnishes the periodical reports as may be required by the Secretary [, and]
(10) the employer or the insurance company, if an insured plan, serves on each claimant notice of his eligibility or ineligibility, in the blank form and manner required by the Secretary, and said notice includes a statement as to the right of the claimant to appeal to the Secretary.
The Secretary is hereby authorized to prescribe such regulations, rules and/or procedures necessary for the implementation of this section upon the previous holding of public hearings and may, at his discretion, delegate to the Director the application of the regulations, rules and/or procedures to private plans individually.
The insurance company which underwrites a private plan may take in its charge any payments and reports as required by the employer under this section.
(b) Effect of the private plans.— If a duly approved private plan is established, the employer shall not pay the contribution required under § 208 of this title, the workers covered by the plan shall receive the disability benefits to which they are entitled under the plan instead of benefit payments from the Fund, and the contributions of the employees provided under § 208 of this title, may be deducted by the employer and used by him as contributions made to the approved private plan.
(c) Establishment of a private plan.— A private plan may be established from July 1, 1969, upon written application to the Secretary filed not later than February 28, 1969. Subsequently a private plan may be established from July 1 of any year upon written application to the Secretary filed not later than April 30 of said year.
A private plan may be discontinued from July 1 of any year upon written application to the Secretary filed not later than April 30 of said year.
A private plan may be modified at any time upon written application to the Secretary and after having been duly approved by him.
(d) Right to appeal.— A claimant not satisfied with the arrangement of his claim for disability benefits under a private plan shall have the right to appeal from said claim in the same manner as provided in § 204 of this title, on appeals from determinations taken by the Director. In such proceeding, the employer or the insurance company shall be a party for all purposes of law.
(e) [Repealed. Act Dec. 30, 1995, No. 262, § 4, eff. Dec. 30, 1995.].
History —June 26, 1968, No. 139, p. 354, § 5; May 31, 1972, No. 85, p. 204, § 3; Nov. 12, 1975, No. 24, p. 828, § 4; July 1, 1988, No. 51, p. 237, § 5; Dec. 30, 1995, No. 262, § 4.