Now is the Time to Review Files for SIF Recovery in Multiple Employment Cases

The deadline to request reimbursement from the Subsequent Injury Fund of benefits paid due to multiple employment lost time will be here soon. This is a good time for carriers to get their SIF reimbursement requests completed and filed.

SIF recovery in multiple employment cases has been permitted ever since the legislature passed the provision regarding multiple employment. With the passage of that legislation the legislature included a provision for SIF reimbursement. The Division has implemented a rule imposing an annual deadline for such requests.

Reimbursement is automatic when the required documentation is timely submitted to the SIF.  The right to reimbursement is waived if not timely presented.

Carriers have one year from the end of the fiscal year payments to seek SIF reimbursement on multiple employment reimbursement or they will waive their right to that year’s reimbursement. Therefore, carriers have until August 31, 2021 to request reimbursement for payments made to the claimant between September 1, 2019 and August 31, 2020.

The SIF now requires accurate completion of a DWC-97 in connection with these requests. Rule 116.11(e) provides the steps to take and the information required to support such a request.  The rule provides as follows:

These requests shall be filed with the SIF administrator in writing and include:

1. 1. 1. 1. 1. 1. 1. 1. 1. a claim-specific summary of the reason the insurance carrier is seeking reimbursement and the total amount of reimbursement requested;
                        2. a detailed payment record showing the dates of payments, the amounts of the payments, purpose of payments, the payees, and the periods of benefits paid, all PLNs regarding the payment of benefits, as well as documentation that shows that the overpayment was unrecoupable as described in subsection (b) of this section, if applicable;
                        3. the name, address, and federal employer identification number of the payee for any reimbursement that may be due;
                        4. information documenting the injured employee’s average weekly wage amounts paid from all non claim employment held at the time of the work related injury pursuant to §122.5 of this title (relating to Employee’s Multiple Employment Wage Statement); and
                        5. information documenting the injured employee’s average weekly wage amounts paid based on employment with the claim employer.

An insurance carrier seeking reimbursement from the SIF must timely provide all documentation reasonably required by the SIF administrator to determine entitlement to reimbursement or payment from the SIF and the amount of reimbursement to which the insurance carrier is entitled. The insurance carrier must also provide notice to the SIF of any relevant pending dispute, litigation or other information that may affect the request for reimbursement.

If you’d like assistance in requesting SIF reimbursement, we’d be happy to help. Please contact Sharissa Karol, who can direct you to someone who can assist you.