Indiana Application for Second Injury Fund Benefits is an application used to apply for financial assistance for employers that have suffered additional costs due to the re-injury or aggravation of an on-the-job injury of an employee. This program is funded by the Second Injury Fund, which is administered by the Indiana Workers' Compensation Board. There are two types of Indiana Application for Second Injury Fund Benefits: the Employer’s Application and the Employee’s Application. The Employer’s Application is used by the employer to submit the claim to the Indiana Workers’ Compensation Board, including details of the prior injury, the new injury, and the estimated costs associated with both. The Employee’s Application is used by the employee to provide information about the current injury and prior injury, and to give their authorization for the Indiana Workers’ Compensation Board to obtain medical records and other information.
Indiana Application for Second Injury Fund Benefits
Description
How to fill out Indiana Application For Second Injury Fund Benefits?
If you’re looking for a way to properly complete the Indiana Application for Second Injury Fund Benefits without hiring a lawyer, then you’re just in the right place. US Legal Forms has proven itself as the most extensive and reliable library of official templates for every private and business situation. Every piece of documentation you find on our online service is drafted in accordance with nationwide and state laws, so you can be certain that your documents are in order.
Follow these straightforward guidelines on how to acquire the ready-to-use Indiana Application for Second Injury Fund Benefits:
- Make sure the document you see on the page complies with your legal situation and state laws by checking its text description or looking through the Preview mode.
- Type in the document title in the Search tab on the top of the page and choose your state from the list to locate another template in case of any inconsistencies.
- Repeat with the content check and click Buy now when you are confident with the paperwork compliance with all the demands.
- ​Log in to your account and click Download. Sign up for the service and choose the subscription plan if you still don’t have one.
- Use your credit card or the PayPal option to purchase your US Legal Forms subscription. The blank will be available to download right after.
- Choose in what format you want to get your Indiana Application for Second Injury Fund Benefits and download it by clicking the appropriate button.
- Add your template to an online editor to fill out and sign it quickly or print it out to prepare your paper copy manually.
Another great advantage of US Legal Forms is that you never lose the paperwork you purchased - you can find any of your downloaded blanks in the My Forms tab of your profile any time you need it.
Form popularity
FAQ
For the employee, Second Injury Funds serve as additional anti-discriminatory support for those with disabilities seeking employment. For the employer, Second Injury Funds can serve as a limitation in liability if the employee is subsequently injured.
Form 29109: Application for Adjustment of Claim The form may be filed by an injured worker who believes that he is entitled to compensation or medical benefits. An employer who believes that compensation should be terminated may also file the form. This form is also used to attempt to re-open a settled claim.
What Does the Second Injury Fund Do? The workers' comp Second Injury Fund assumes liability for compensation benefits attributable to prior injuries or illnesses. This happens when a worker subsequently becomes totally disabled because of a workplace injury.
Benefits. The excess of workers compensation benefits payable due to a second injury resulting in permanent and total disability, over the amounts payable by the employer as defined under IC 22-3-3-13(a).
Under the ?coming and going? rule, generally, if an employee is injured while commuting to and from a fixed site of employment at the beginning or end of his or her shift, this would not be a workers' compensation injury. The ?coming and going? rule ends once the employee reaches the employer's premises.
The Second Injury Fund ("SIF" or "the Fund") is a state operated workers' compensation insurance fund established in 1945 to discourage discrimination against veterans and encourage the assimilation of workers with a pre-existing injury into the workforce.
The objectives of this policy are to provide employers with financial relief when a pre-existing condition enhances or prolongs a work-related disability. It thereby encourages employers to hire workers with disabilities.
(c) If an employee suffers a compensable injury that results in death and the employee is not survived by a widow, widower, child, or dependent relative eligible to receive death benefits under AS 23.30. 215, the employer or insurance carrier shall pay $10,000 to the second injury fund.