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
(5) Rescission of informal
claim. A claimant may at any time rescind the informal claim and file
a contested case proceeding as per Iowa Code section
86.14. Filing a
contested case will automatically terminate consideration of an informal claim
filing.
(6)
Payment on
claim by treasurer. If the treasurer determines that the claim should
be paid, the treasurer shall submit recommendation to the industrial
commissioner for authorization and for a written order in accordance with Iowa
Code section
85.67.
This recommendation shall indicate the amount of the weekly compensation to be
paid, number of weeks to be paid, the date when payment shall begin, and the
length of time payments shall be paid.
This rule is intended to implement Iowa Code section
17A.10.
