May 5, 2006
OTHER STATES DISCRETIONARY WORKERS' COMPENSATION BENEFITS FOR PERMANENT PARTIAL DISABILITIES
By: John Moran, Principal Analyst
You asked if any of the surrounding states provide “discretionary” workers' compensation (WC) benefits for permanent partial disabilities.
Massachusetts, Maine, New York, and Rhode Island all have statutory provisions to extend WC benefits beyond the standard benefits schedule; in Connecticut this type of benefit extension is known as discretionary benefits. Massachusetts and Maine limit the period of discretionary benefits to 520 weeks; New York and Rhode Island provide indefinite benefit extension. New Hampshire, New Jersey, and Vermont do not permit a discretionary benefit extension.
OVERVIEW OF STATE WC LAWS
State WC laws require no-fault insurance for workers who are injured on the job or contract a job-related disease. Each state's law differs in the amount and duration of benefits, but all require employers to have WC insurance, which is the exclusive remedy for employees seeking compensation (i.e., they cannot seek damages through civil court action).
CONNECTICUT'S DISCRETIONARY BENEFITS
Under law, a workers' compensation commissioner can award additional weeks of benefits for partial permanent disabilities after a claimant exhausts his regular benefits under the statutory schedule. Before granting additional benefits, the commissioner must find that the injury resulted in the claimant's inability to find work, or the new job (that the claimant holds as a result of the disability) pays less than his original job.
But the law limits the length of the additional benefits to the lesser of (1) the statutory duration for the particular partial permanent disability or (2) 520 weeks (10 years) (CGS § 31-308a). For example, if a claimant loses his master hand at or above the wrist the statutory benefit schedule is 168 weeks. Therefore under the discretionary provision, the commissioner could extend the individual's benefits to, at most, an additional 168 weeks.
STATES WITH LIMITED DISCRETIONARY BENEFITS
In Massachusetts, unlike Connecticut, a claimant can qualify for the extended or discretionary period of benefits before he exhausts the standard benefit schedule. The standard benefit schedule is 260 weeks, but the WC judge can rule on the initial application and grant an additional 260 weeks if he finds that the claimant suffers a 75% or greater permanent loss of a bodily function or sense, has developed a permanently life-threatening physical condition, or contracted a permanently disabling occupational disease of a physical nature. If a claimant is not granted the extended benefit period at the initial application, he can apply again when he is reaching the end of the standard 260 weeks of benefits (MGLA 152 § 35).
The WC board, or if it chooses to delegate the case, a hearing officer or panel of three officers, may extend permanent partial disability payments beyond the normal 260 week limit in “cases involving extreme financial hardship due to inability to return to gainful employment.” The board must approve benefit extensions in annual 52-week increments up to a 260-week limit (for a total of 520 weeks of benefits) (39-A MRSA § 213).
STATES WITH UNLIMITED DISCRETIONARY BENEFITS
New York WC law has two forms of permanent partial disability benefits with an unlimited benefit timeframe. The first is for certain injuries with statutory benefit schedules (i.e., arm, leg, hand, or foot). (Other injuries with a statutory schedule, including eye, finger, or toe, do not qualify for a benefit extension.) A WC judge can extend these benefits for an unlimited time if the medical documentation indicates the claimant has lost at least 50% of his function and the injury impairs his earning capacity. This additional benefit is reduced by 50% of any amount the claimant receives in Social Security Disability Insurance benefits. And the additional benefit ends when the claimant is entitled or receives Social Security old age benefits (WKC § 15(v)).
The second unlimited benefit is for injuries to body parts not named in statute, specifically the head, back, and internal organs (i.e., “unscheduled” benefits). These unscheduled benefits have an unlimited timeframe and can be granted for life when medical evidence shows the injury is permanent.
In Rhode Island, a claimant nearing the end of the standard 312 weeks (six years) of benefits can petition for a benefit extension, which can be for an indefinite period. The claimant must show by a preponderance of evidence in WC court that the partial disability poses a material hindrance to obtaining suitable employment. By law, for injuries occurring after July 1, 2005 “material hindrance” is defined as injuries causing greater than 65% degree of functional impairment and/or disability (RI ST § 28-33-18.3).