Workers’ compensation provides benefits to employees who suffer work-related injuries or illnesses in California. The benefits protect both the employee and the employer from civil court by limiting their liability in the event of a workplace accident. If you qualify for workers’ compensation, you could also qualify for additional compensation through California’s Subsequent Injuries Benefits Trust Fund (SIBTF). These benefits provide additional compensation to injured workers who experience a new work-related injury while already living with a qualifying pre-existing disability or impairment.

To understand your eligibility, the benefits, and how to apply for these benefits, you can seek our assistance at The Workers Compensation Lawyer Law Firm. Our competent attorneys will defend your rights and guide you through all complex processes until you receive the compensation you deserve in Los Angeles.

An Overview of California Workers’ Compensation Benefits

Workplace accidents and injuries are very common and can cost employers and employees considerable time and money to manage. Injured employees need time off work to recover from a workplace injury while seeking workers’ compensation benefits. While this is necessary for the injured employee, it can create a significant strain when an employer is unable or unwilling to offer the full compensation an employee seeks after an injury.

Workers’ compensation is a system that provides legal protection for employers and employees in the event of a workplace injury, accident, illness, or any other loss an employee may suffer while performing their duties. It is a no-fault system in which neither the employee nor the employer is held responsible for the workplace injury. Instead, it offers the compensation an employee needs to recover from their illness or injury.

The system relieves the employee and employer of the burden of proving wrongdoing in the event of a work-related accident or injury. This protects the employer from liability, provided the employer pays the required subscriptions to cover their employees against work-related injuries and illnesses. If an accident occurs, the employee does not have to file a claim against their employer, which is a lengthy, tiring, and sometimes stressful process.

Thus, if you are covered under the Workers’ Compensation system and you sustain a workplace injury, you qualify for compensation according to the nature and seriousness of your injuries. Most workplace injuries are covered under this system, including slip-and-falls, repetitive strain injuries, and vehicle-related accidents.

If you suffer a workplace injury and you are covered under this system, you file for compensation through your workers' compensation insurance. All employers in California are mandated to maintain this insurance coverage, in compliance with the state’s Labor Code. Your employer’s insurance company will review your application and the supporting documents you provide regarding your injury and treatment to provide the benefits you deserve.

An Overview of the Subsequent Injuries Benefits Trust Fund

The Subsequent Injuries Benefits Trust Fund (SIBTF) is a California state fund that offers additional compensation to workers who have suffered a workplace injury that qualifies them for workers’ compensation benefits, but who already have a pre-existing disability or medical condition. These benefits supplement standard workers’ compensation benefits for a pre-existing work-related disability or condition. The fund generally allocates liability between the employer and SIBTF, with the employer being held responsible for the workplace injury or disability. In contrast, the trust fund covers the part of the permanent disability attributable to a pre-existing medical condition.

The primary goal of this trust fund is to increase the likelihood that employees with medical conditions or disabilities will find employment. It does this by eliminating an employer’s worry that they will be held responsible for any injury or medical issue an employee with a pre-existing disability or condition will suffer while at work. Employers can comfortably hire employees living with medical conditions or disabilities without worrying about any additional costs they can incur if such an employee is injured while at work. This trust fund also encourages potential employees with disabilities to find employment.

Therefore, SIBTF is very beneficial because it offers possible additional benefits for work-related injuries suffered by employees living with disabilities. However, you must prove your eligibility to receive benefits from the trust fund. Generally, the qualifying criteria include the following:

  • You must provide medical documents to prove that you had an underlying medical condition or disability when you suffered a workplace injury

  • Your permanent disability should be at least 70% after combining the injury and the existing medical condition. Additionally, the recent workplace injury should account for at least 35% of the resulting disability.

If you meet the qualifying criteria, a skilled workers’ compensation attorney can help you file your claim. They will also help you gather and prepare all supporting documents to increase your chances of receiving the compensation you deserve.

Examples of Pre-Existing Conditions That May Support SIBTF Eligibility

You can qualify for SIBTF benefits if you have a pre-existing injury, disability, developmental, or congenital disease before sustaining a workplace injury. You may also qualify if you have a prior acquired disease or illness, regardless of the source. What matters is that the pre-existing medical condition was there before the workplace injury for which you seek workers’ compensation. Here are some of the most common examples of pre-existing medical conditions that qualify you for subsequent injury benefits:

  • Hypertension and high blood pressure

  • Diabetes

  • Impaired vision

  • Impaired hearing

  • Chronic pain disorder

  • Arthritis

  • Musculoskeletal injury

  • Auto-immune disease

  • Cardiovascular illness

  • Cancer

It is not necessary that you were aware of the pre-existing medical condition when you suffered a workplace injury. You can qualify for subsequent injury benefits even if you did not know of the pre-existing medical condition. What matters is that the condition existed before the work-related injury, and there are medical documents to prove it. Remember that some medical conditions, like degenerative disc disease, may be discovered later after an injury. Thus, it is possible to discover later that you had an underlying medical condition while being examined for a current workplace injury.

Reasons to File for Subsequent Injury Benefits

Subsequent Injuries Benefits Trust Fund offers several benefits to workers and employers that you should be aware of. The most common of these benefits include the following:

It Increases Your Permanent Disability Benefits

If you are already receiving benefits for a pre-existing medical condition or disability, the funds may be insufficient to cover all your financial obligations, especially after sustaining another workplace injury. SIBTF offers additional benefits to ensure you are well covered for your new workplace injury and the existing disability. You can seek adequate medical treatment and address your other financial needs before you recover enough to start earning an income.

It May Qualify you for a Life Pension

A life pension may provide ongoing financial support of a predictable and steady monthly income for the remaining part of your life. It protects you from the risk of running out of your savings and not knowing what to do to cater to your needs when you can no longer earn a living. You can comfortably manage your finances during retirement, including healthcare, food, and housing.

Qualifying for subsequent injury benefits may entitle you to a life pension if the workplace injury makes you permanently unemployable. This can happen if a combination of your prior impairment and the subsequent workplace injury meets the threshold for a life pension. In this case, you can qualify for lifelong payments and not have to worry about supplementing your income.

You Can Qualify Even Without a Prior Work-Related Injury

The prior medical condition or disability that qualifies you for subsequent injury benefits does not have to be work-related. The only proof needed is that you had an underlying medical condition before sustaining a workplace injury. The pre-existing medical condition can be from a past warfare, civil accident, congenital disability, or long-term illness.

SIBTF Can Encourage Employment Opportunities

A pre-existing medical condition or disability can be a serious issue for most employers during the hiring process. This is because of the fear that they could be held liable if the affected employee's condition worsens while at work. SIBTF makes it easy for workers with pre-existing medical conditions to find work to supplement their income. It also gives employers the confidence to hire suitable candidates, regardless of their medical conditions.

If a workplace injury happens, you can receive adequate compensation if you are a worker who has a disability, without experiencing the burden of establishing fault. The combined disability, from your existing medical condition and the current injury, automatically qualifies you for additional funding.

How To File for Workers’ Compensation

If you suffer a workplace injury, there are specific steps you should take to pursue compensation from your workers' compensation insurance. Understanding these steps and completing them will help protect you from potential delays in obtaining the compensation you deserve.

Receive Medical Care

Your first action after a workplace accident or illness is to receive immediate medical care. This should happen regardless of the nature and severity of the illness or injury. Some conditions are difficult to ascertain until after an adequate medical examination. Thus, if you suspect that you have a medical issue or have been injured in a workplace accident, discuss the matter with a healthcare professional first.

Report the Matter to Your Employer

It is important to notify your employer about the illness or injury that you suffered in your workplace. If your employer is not available, report the matter to the on-site supervising manager or to anyone in charge of you at your workplace. Reporting the injury in writing helps create documentation for your records.

File for Workers’ Compensation

Remember that most employers in California are required to maintain workers' compensation insurance for their employees. Thus, it is likely that your employer has a cover for you. In this case, you should file a claim with your employer’s insurance company for compensation for your work-related injury. The claim is generally a notice that you are seeking benefits for your illness or injury.

Hire a Skilled Attorney for Legal Advice and Help

It is beneficial to partner with a skilled workers’ compensation attorney in this process. This is because they understand the laws and processes better than you do. An attorney will provide the right legal advice on how you should approach the case to receive maximum benefits. They will also help you handle complex legal procedures and represent your interests, even through any obstacles you may encounter.

Once you report your workplace injury or file your workers’ compensation claim, the insurance provider may ask for supporting documents to verify your claim. In this case, you should provide your medical records, the accident report, and any other related proof that you sustained an injury and were treated for it.

Remember that filing a workers’ compensation claim is not the same as filing a lawsuit against your employer. This is because you are not required to prove that your employer was negligent and is at fault for your injuries. However, the insurance provider must consider some factors to grant or deny your claim. These factors include the following:

  • The specific nature of your injuries

  • How your injuries affect your short- or long-term ability to work

  • The specific cause of the injuries

The insurance provider can first investigate your claim before responding. They can send an insurance adjuster to gather additional information before reviewing your case. They can also ask for additional information. If, from their findings, the insurer ascertains that you have reached maximum medical improvement, they will grant your claim. This means that they will issue payments for your permanent disability and provide payments for your ongoing medical treatment.

Filing for Subsequent Injury Benefits

If you have a pre-existing disability or medical condition and sustain a workplace injury, you should also file for SIBTF. To do that, you can follow these steps:

Verify Your Eligibility for SIBTF

Before applying for subsequent injury benefits, ensure that you are eligible. Your attorney can help you with this. Generally, you must meet the following thresholds:

  • You must have had a pre-existing medical condition before the most recent workplace injury

  • Your new work injury and permanent disability must account for at least 70% of your total disability rating.

File the Required Forms

If you qualify for SIBTF, your attorney will obtain the forms you need to fill out and file for the compensation you deserve. Applying for SIBTF should be done after filing for the standard workers’ compensation for the new work-related injury. The SIBTF application is filed through the Workers’ Compensation Appeals Board, which handles your workers’ compensation claim.

Prepare the Supporting Documents

You need documents to verify your eligibility for subsequent injury benefits. With the help of your attorney, you can obtain all specialized medical documents to show that you have had a pre-existing medical condition before the current injury. The documents must also show the severity of the medical condition and the approximate time you have had it.

If you recently learned about the prior medical condition, you can provide a document from a medical professional proving the same.

There should also be a medical evaluation showing your disability rating after the current workplace injury. The evaluation, conducted by a skilled medical evaluator, should provide a rating of at least 35% for the current injury and a combined rating of at least 70% (including the rating for the pre-existing medical condition).

Attend Hearings

You may need to attend a hearing to review your application and medical records before your claim is granted.

What is Covered in the Claim?

The benefits you receive are intended to cover the losses resulting from a workplace accident or injury. Benefits may cover or reimburse the following losses and expenses:

Your Medical Costs and Related Bills

These include all costs incurred while seeking medical treatment for a work-related injury. They include hospital bills, medical procedures, doctor visits, medications (including over-the-counter medication purchases), and any follow-up care you received. You can also include ongoing prescriptions, physical therapy, and the cost of medical equipment, like a wheelchair, if needed.

Lost Income

The benefits should also cover any income you lost after a workplace injury. If you took time off work to recover from a workplace injury, you need compensation for the time you could not earn an income. If you sustained a long-term disability, you may qualify for permanent disability benefits.

Find a Competent Workers’ Compensation Lawyer Near Me

The filing process for workers’ compensation in Los Angeles is complex, especially if you have to worry about your SIBTF eligibility. You could make regrettable mistakes or omissions in your applications that can delay your benefits or result in a denied application. You need the assistance of a skilled attorney to understand the process, your requirements, and your rights.

Our skilled lawyers at The Workers Compensation Lawyer Law Firm have been handling such processes for years. We know exactly what is needed and how to handle various claims to meet our clients’ needs. We can help you determine your eligibility and prepare and file your claim to increase your chances of success. We can also defend your rights and fight alongside you until you are satisfied with the outcome. Call us at 424-501-9228 to learn more.