by | General Liability, Small Business, Workers Compensation |

The New Hampshire Second Injury Fund (NHSIF) was established in 1975 as a mechanism to promote the hiring of individuals with pre-existing conditions, injuries or disabilities.  The NHSIF provides employers and their insurance carriers with limited liability for subsequent injuries that are sustained by such individuals in the course & scope of employment by reimbursing the insurers for certain monetary outlays.  The NHSIF is funded by carriers and self-insurers.  Their contribution to the fund is based on a percentage of the premium they write in New Hampshire.

Requirements:

There are several criteria that must be met in order for a claim to be considered eligible for NHSIF reimbursement:

  • The employer must have written knowledge of the prior injury/impairment and must have made some form of accommodation to the employee as a result of the prior injury/impairment;
  • Written knowledge must pre-date the subsequent injury;
  • Notice to the NHSIF must be provided within 100 weeks from the date of the subsequent injury; and
  • Various items of “proof” are required:
    • Medical information to establish that the pre-existing impairment was permanent and serious enough to constitute a hindrance to employment
    • Medical information to establish a subsequent work related compensable injury and disability
    • Medical opinion in terms of the specifics of the pre-existing impairment/condition, the scope of the impairment and how a reasonable employer would look at it in terms of employability
    • Medical opinion substantiating the combination of the pre-existing condition and the subsequent injury has resulted in a greater disability
    • Copies of the employer’s written record to establish employer awareness of pre-existing impairment/condition

Reimbursement of Benefits:

Here are some of the ways the NHSIF can help defray the monetary impact to a responding insurer for such claims:

  • Once the $10,000 threshold is met, the carrier/self-insurer may make a claim for eligible benefits paid over the threshold;
    • Eligible benefits include medical expenses & indemnity payments; ineligible benefits include nurse case management fees & permanent impairment awards
    • Benefits paid up to and including the 104th week of disability are reimbursed at 50%;
    • Benefits paid beyond the 104th week of disability are reimbursed at 100%;
    • Reimbursement is for eligible benefits paid in the prior calendar year (i.e., 2011 benefits must be requested by 9/1/2012 and will be reimbursed in 2013, usually first quarter);
    • Lump Sum Settlements (LSS) must be consented to by the NHSIF prior to being approved by the New Hampshire Department of Labor; and
    • LSS for future indemnity benefits are reimbursable at 52 weeks per year and claim for reimbursement continues until LSS is recovered.

Additional Benefits:

Not only does the NHSIF portion of the NH Workers’ Compensation Statute provide the above benefits, it also allows employers to request 50% reimbursement (up to $5,000 annually) for job modifications that they make to accommodate an employee’s existing impairment or condition.

Moreover, the NHSIF provides reimbursement to carriers and self-insurers for increased wages paid on a Workers’ Compensation claim as a result of an injured employee’s concurrent employment with another New Hampshire insured employer.

The NHSIF’s complicated process has been described as a potential deterrent to employers or insurers filing notice and requesting reimbursement from the Fund.  For that reason, there may be some companies who do not take full advantage of the fund.  Here at Acadia Insurance we have taken a different approach.  We have partnered with a law firm that has resources dedicated to perfecting NHSIF claims.  They assist our claim representatives in ensuring that opportunities are not missed and that all eligible payments are requested and reimbursed.

If you have any questions concerning the NH’s Second Injury Fund or the process, please feel free to contact Carolyn Collova in our Bedford, NH claim office at 603-656-1320.  Free on-site training sessions can be arranged for Acadia insureds upon request.

 

Acadia is pleased to share this material with its customers.  Please note, however, that nothing in this document should be construed as legal advice or the provision of professional consulting services.  This material is for general informational purposes only, and while reasonable care has been utilized in compiling this information, no warranty or representation is made as to accuracy or completeness.  Distribution of this information does not constitute an assumption by us of your obligations to provide a safe workplace. Maintaining a safe workplace in accordance with all laws is your responsibility. We make no representation or warranty that our activities or recommendations will place you in compliance with law, relieve you of potential liability or ensure your premises or operations are safe. We exercise no control over your premises or operations and have no responsibility or authority to implement loss prevention practices or procedures.

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