Iowa Administrative Code › Agency 781 - Treasurer of State › Chapter 10 - Informal Claims for Second Injury Fund › Rule 781-10.1 - Benefits of Second Injury Fund

Current through Register Vol. 47, No. 3, July 24, 2024
If an employee who has previously lost, or lost the use of, one
						hand, one arm, one foot, one leg, or one eye, becomes permanently disabled by a
						compensable injury which has resulted in the loss of, or loss of use of,
						another such member or organ, the employer shall be liable only for the degree
						of disability which would have resulted from the latter injury if there had
						been no preexisting disability. In addition to this compensation, and after the
						expiration of the full period provided by law for payments by the employer, the
						employee shall be paid out of the second injury fund the remainder of
						compensation payable for the degree of permanent disability involved after
						first deducting the compensable value of the previously lost member or organ.
						Any benefits received by the employee, or to which the employee may be
						entitled, by reason of increased disability from any state or federal fund or
						agency, to which the employee has not directly contributed, shall be regarded
						as a credit to any award made against the second injury fund.
(1)
Informal claims.
Employees with second injuries as covered in Iowa Code sections
					85.63 to
					85.69 and
					rule 10.1(85) may file claims for informal settlements of controversies arising
					in connection with the second injury fund. An informal claim may be filed under
					these rules if the claimant has not previously filed a contested case with the
					industrial commissioner under Iowa Code section
					86.14 and 343-4.1
					(1) and 4.1(2). An informal settlement of a pending contested case is governed
					by 343-6.1 (85,86).
(2)
Tolling of claim.
A claimant's filing of an informal claim
					under these rules shall not toll the applicable statute of limitations and
					filing for informal settlement is not a prerequisite to filing a contested case
					proceeding for second injury fund benefits with the industrial commissioner
					under Iowa Code section
					86.13.
(3)
Filing an informal
					claim.
The claimant shall initiate the procedure if an informal
					settlement is desired by filing a notarized claim for an informal determination
					with the treasurer within two years from the date of the occurrence of the
					injury for which benefits are claimed. The claim shall be filed on the second
					injury fund claim form which is available at the Office of the Treasurer,
					Capitol Building, Des Moines, Iowa 50319. This form must be complete and
					contain all exhibits as specified in subrule 10.1(4). The treasurer may require
					additional documentation. If the treasurer requests additional documentation,
					it must be provided within 60 days of the treasurer's request. The treasurer
					shall issue a written decision to the claimant within 90 days after the day
					that all necessary claim documentation is received by the treasurer.
If a claimant is not satisfied with the decision of the
						treasurer on an informal claim, the claimant may then file a contested case
						proceeding as per Iowa Code section 86.14, if the statute of limitations has
						not tolled for the filing under Iowa Code section 85.26.
(4)
Required claim
					documentation.
Documents required to be filed with the second injury
					fund claim form shall include:
a. All medical
					records and reports concerning the first injury;
b. All medical records and reports concerning
					the second injury;
c. All records
					reflecting any payment of social security benefits for the first or second
					injury;
d. All employer's records
					concerning the second injury including, but not limited to, documents
					reflecting workers' compensation payments and weekly rates of compensation
					following the second injury;
e. All
					records of workers' compensation insurance carriers which covered the second
					injury; and
f. All employer's
					records concerning claimant's employment following the second injury