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S.B. 108
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8 LONG TITLE
9 General Description:
10 This bill modifies provisions related to receipt of workers' compensation benefits.
11 Highlighted Provisions:
12 This bill:
13 . removes the offset against permanent total disability compensation for
14 cost-of-living increases in Social Security retirement benefits received by an
15 employee with a permanent total disability;
16 . removes the offset against death benefits for cost-of-living increases in Social
17 Security death benefits;
18 . clarifies its application to persons whose compensation was reduced on or before
19 May 4, 2008; and
20 . makes technical changes.
21 Monies Appropriated in this Bill:
22 None
23 Other Special Clauses:
24 None
25 Utah Code Sections Affected:
26 AMENDS:
27 34A-2-403, as renumbered and amended by Laws of Utah 1997, Chapter 375
28 34A-2-413, as last amended by Laws of Utah 2006, Chapter 295
29 34A-2-702, as renumbered and amended by Laws of Utah 1997, Chapter 375
30
31 Be it enacted by the Legislature of the state of Utah:
32 Section 1. Section 34A-2-403 is amended to read:
33 34A-2-403. Dependents -- Presumption.
34 (1) The following persons shall be presumed to be wholly dependent for support upon
35 a deceased employee:
36 (a) a child under 18 years of age, or over if the child is physically or mentally
37 incapacitated and dependent upon the parent, with whom the child is living at the time of the
38 death of the parent, or who is legally bound for the child's support; and
39 (b) for purposes of payments to be made under Subsection 34A-2-702 (5)[
40 surviving spouse with whom the deceased employee lived at the time of the employee's death.
41 (2) (a) In a case not provided for in Subsection (1), the question of dependency, in
42 whole or in part, shall be determined in accordance with the facts in each particular case
43 existing at the time of the injury or death of an employee, except for purposes of dependency
44 reviews under Subsection 34A-2-702 (5)[
45 (b) A person may not be considered as a dependent unless that person is:
46 (i) a member of the family of the deceased employee;
47 (ii) the spouse of the deceased employee;
48 (iii) a lineal descendant or ancestor of the deceased employee; or
49 (iv) brother or sister of the deceased employee.
50 (3) As used in this chapter and Chapter 3, Utah Occupational Disease Act:
51 (a) "brother or sister" includes a half brother or sister; and
52 (b) "child" includes:
53 (i) a posthumous child; or
54 (ii) a child legally adopted prior to the injury.
55 Section 2. Section 34A-2-413 is amended to read:
56 34A-2-413. Permanent total disability -- Amount of payments -- Rehabilitation.
57 (1) (a) In [
58 accident or occupational disease, the employee shall receive compensation as outlined in this
59 section.
60 (b) To establish entitlement to permanent total disability compensation, the employee
61 must prove by a preponderance of evidence that:
62 (i) the employee sustained a significant impairment or combination of impairments as a
63 result of the industrial accident or occupational disease that gives rise to the permanent total
64 disability entitlement;
65 (ii) the employee is permanently totally disabled; and
66 (iii) the industrial accident or occupational disease [
67 employee's permanent total disability.
68 (c) To establish that an employee is permanently totally disabled the employee must
69 prove by a preponderance of the evidence that:
70 (i) the employee is not gainfully employed;
71 (ii) the employee has an impairment or combination of impairments that limit the
72 employee's ability to do basic work activities;
73 (iii) the industrial or occupationally caused impairment or combination of impairments
74 prevent the employee from performing the essential functions of the work activities for which
75 the employee has been qualified until the time of the industrial accident or occupational disease
76 that is the basis for the employee's permanent total disability claim; and
77 (iv) the employee cannot perform other work reasonably available, taking into
78 consideration the employee's:
79 (A) age;
80 (B) education;
81 (C) past work experience;
82 (D) medical capacity; and
83 (E) residual functional capacity.
84 (d) Evidence of an employee's entitlement to disability benefits other than those
85 provided under this chapter and Chapter 3, Utah Occupational Disease Act, if relevant:
86 (i) may be presented to the commission;
87 (ii) is not binding; and
88 (iii) creates no presumption of an entitlement under this chapter and Chapter 3, Utah
89 Occupational Disease Act.
90 (2) For permanent total disability compensation during the initial 312-week
91 entitlement, compensation [
92 time of the injury, limited as follows:
93 (a) compensation per week may not be more than 85% of the state average weekly
94 wage at the time of the injury;
95 (b) (i) subject to Subsection (2)(b)(ii), compensation per week may not be less than the
96 sum of $45 per week[
97 (A) $5 for a dependent spouse[
98 (B) $5 for each dependent child under the age of 18 years, up to a maximum of four
99 dependent minor children[
100 (ii) the amount calculated under Subsection (2)(b)(i) may not exceed:
101 (A) the maximum established in Subsection (2)(a) [
102 (B) the average weekly wage of the employee at the time of the injury; and
103 (c) after the initial 312 weeks, the minimum weekly compensation rate under
104 Subsection (2)(b) [
105 nearest dollar.
106 (3) This Subsection (3) applies to claims resulting from an accident or disease arising
107 out of and in the course of the employee's employment on or before June 30, 1994.
108 (a) The employer or its insurance carrier is liable for the initial 312 weeks of permanent
109 total disability compensation except as outlined in Section 34A-2-703 as in effect on the date
110 of injury.
111 (b) The employer or its insurance carrier may not be required to pay compensation for
112 any combination of disabilities of any kind, as provided in this section and Sections 34A-2-410
113 through 34A-2-412 and Part 5, Industrial Noise, in excess of the amount of compensation
114 payable over the initial 312 weeks at the applicable permanent total disability compensation
115 rate under Subsection (2).
116 (c) [
117 compensation [
118 overpayment:
119 (i) to the employer or its insurance carrier [
120 [
121 (ii) out of the Employers' Reinsurance Fund's liability to the employee.
122 (d) After an employee [
123 employer, its insurance carrier, or the Employers' Reinsurance Fund for any combination of
124 disabilities amounting to 312 weeks of compensation at the applicable permanent total
125 disability compensation rate, the Employers' Reinsurance Fund shall pay all remaining
126 permanent total disability compensation.
127 (e) Employers' Reinsurance Fund payments shall commence immediately after the
128 employer or its insurance carrier [
129 Section 34A-2-703 .
130 (4) This Subsection (4) applies to claims resulting from an accident or disease arising
131 out of and in the course of the employee's employment on or after July 1, 1994.
132 (a) The employer or its insurance carrier is liable for permanent total disability
133 compensation.
134 (b) The employer or its insurance carrier may not be required to pay compensation for
135 any combination of disabilities of any kind, as provided in this section and Sections 34A-2-410
136 through 34A-2-412 and Part 5, Industrial Noise, in excess of the amount of compensation
137 payable over the initial 312 weeks at the applicable permanent total disability compensation
138 rate under Subsection (2).
139 (c) [
140 its insurance carrier may recoup the overpayment of compensation described in Subsection (4)
141 by reasonably offsetting the overpayment against future liability paid before or after the initial
142 312 weeks.
143 (5) [
144 minimum rate established in Subsection (2), [
145 its insurance carrier, or the Employers' Reinsurance Fund, after an employee [
146 receives compensation from the employer or the employer's insurance carrier for any
147 combination of disabilities amounting to 312 weeks of compensation at the applicable total
148 disability compensation rate, shall [
149 (i) to the extent allowable by law[
150 (ii) by the dollar amount of 50% of the Social Security retirement benefits [
151
152 eligible to receive a Social Security retirement benefit; and
153 (iii) that the employee receives during the same period as the Social Security retirement
154 benefits.
155 (b) (i) An employer, its insurance carrier, or the Employers' Reinsurance Fund may not
156 reduce compensation payable under this section on or after May 5, 2008, to an employee by an
157 amount related to a cost-of-living increase to the Social Security retirement benefit that the
158 employee is first eligible to receive for a four week period, notwithstanding whether the
159 employee is injured on or before May 4, 2008.
160 (ii) For purposes of an employee whose compensation payable is reduced under this
161 Subsection (5) on or before May 4, 2008, the reduction is limited to the amount of the
162 reduction as of May 4, 2008.
163 (6) (a) A finding by the commission of permanent total disability is not final, unless
164 otherwise agreed to by the parties, until:
165 (i) an administrative law judge reviews a summary of reemployment activities
166 undertaken pursuant to Chapter 8, Utah Injured Worker Reemployment Act;
167 (ii) the employer or its insurance carrier submits to the administrative law judge:
168 (A) a reemployment plan as prepared by a qualified rehabilitation provider reasonably
169 designed to return the employee to gainful employment; or
170 (B) notice that the employer or its insurance carrier will not submit a plan; and
171 (iii) the administrative law judge, after notice to the parties, holds a hearing, unless
172 otherwise stipulated, to:
173 (A) consider evidence regarding rehabilitation; and
174 (B) review any reemployment plan submitted by the employer or its insurance carrier
175 under Subsection (6)(a)(ii).
176 (b) Before commencing the procedure required by Subsection (6)(a), the administrative
177 law judge shall order:
178 (i) the initiation of permanent total disability compensation payments to provide for the
179 employee's subsistence; and
180 (ii) the payment of any undisputed disability or medical benefits due the employee.
181 (c) Notwithstanding Subsection (6)(a), an order for payment of benefits described in
182 Subsection (6)(b) is considered a final order for purposes of Section 34A-2-212 .
183 (d) The employer or its insurance carrier shall be given credit for any disability
184 payments made under Subsection (6)(b) against its ultimate disability compensation liability
185 under this chapter or Chapter 3, Utah Occupational Disease Act.
186 (e) An employer or its insurance carrier may not be ordered to submit a reemployment
187 plan. If the employer or its insurance carrier voluntarily submits a plan, the plan is subject to
188 Subsections (6)(e)(i) through (iii).
189 (i) The plan may include, but not require an employee to pay for:
190 (A) retraining[
191 (B) education[
192 (C) medical and disability compensation benefits[
193 (D) job placement services[
194 (E) incentives calculated to facilitate reemployment [
195
196 (ii) The plan shall include payment of reasonable disability compensation to provide
197 for the employee's subsistence during the rehabilitation process.
198 (iii) The employer or its insurance carrier shall diligently pursue the reemployment
199 plan. The employer's or insurance carrier's failure to diligently pursue the reemployment plan
200 [
201 motion to make a final decision of permanent total disability.
202 (f) If a preponderance of the evidence shows that successful rehabilitation is not
203 possible, the administrative law judge shall order that the employee be paid weekly permanent
204 total disability compensation benefits.
205 (7) (a) The period of benefits commences on the date the employee became
206 permanently totally disabled, as determined by a final order of the commission based on the
207 facts and evidence, and ends:
208 (i) with the death of the employee; or
209 (ii) when the employee is capable of returning to regular, steady work.
210 (b) An employer or its insurance carrier may provide or locate for a permanently totally
211 disabled employee reasonable, medically appropriate, part-time work in a job earning at least
212 minimum wage [
213 accept the work to the extent that it would disqualify the employee from Social Security
214 disability benefits.
215 (c) An employee shall:
216 (i) fully cooperate in the placement and employment process; and
217 (ii) accept the reasonable, medically appropriate, part-time work.
218 (d) In a consecutive four-week period when an employee's gross income from the work
219 provided under Subsection (7)(b) exceeds $500, the employer or insurance carrier may reduce
220 the employee's permanent total disability compensation by 50% of the employee's income in
221 excess of $500.
222 (e) If a work opportunity is not provided by the employer or its insurance carrier, a
223 permanently totally disabled employee may obtain medically appropriate, part-time work
224 subject to the offset provisions [
225 (f) (i) The commission shall establish rules regarding the part-time work and offset.
226 (ii) The adjudication of disputes arising under this Subsection (7) is governed by Part
227 8, Adjudication.
228 (g) The employer or its insurance carrier [
229 that medically appropriate part-time work is available.
230 (h) The administrative law judge may:
231 (i) excuse an employee from participation in any [
232 (A) that would require the employee to undertake work exceeding the employee's:
233 (I) medical capacity [
234 (II) residual functional capacity; or
235 (B) for good cause; or
236 (ii) allow the employer or its insurance carrier to reduce permanent total disability
237 benefits as provided in Subsection (7)(d) when reasonable, medically appropriate, part-time
238 [
239 (8) When an employee [
240 possible but the employee has some loss of bodily function, the award shall be for permanent
241 partial disability.
242 (9) As determined by an administrative law judge, an employee is not entitled to
243 disability compensation, unless the employee fully cooperates with any evaluation or
244 reemployment plan under this chapter or Chapter 3, Utah Occupational Disease Act. The
245 administrative law judge shall dismiss without prejudice the claim for benefits of an employee
246 if the administrative law judge finds that the employee fails to fully cooperate, unless the
247 administrative law judge states specific findings on the record justifying dismissal with
248 prejudice.
249 (10) (a) The loss or permanent and complete loss of the use of the following constitutes
250 total and permanent disability that is compensated according to this section:
251 (i) both hands[
252 (ii) both arms[
253 (iii) both feet[
254 (iv) both legs[
255 (v) both eyes[
256 (vi) any combination of two [
257
258 (b) A finding of permanent total disability pursuant to Subsection (10)(a) is final.
259 (11) (a) An insurer or self-insured employer may periodically reexamine a permanent
260 total disability claim, except those based on Subsection (10), for which the insurer or
261 self-insured employer had or has payment responsibility to determine whether the [
262 employee remains permanently totally disabled.
263 (b) Reexamination may be conducted no more than once every three years after an
264 award is final, unless good cause is shown by the employer or its insurance carrier to allow
265 more frequent reexaminations.
266 (c) The reexamination may include:
267 (i) the review of medical records;
268 (ii) employee submission to one or more reasonable medical evaluations;
269 (iii) employee submission to one or more reasonable rehabilitation evaluations and
270 retraining efforts;
271 (iv) employee disclosure of Federal Income Tax Returns;
272 (v) employee certification of compliance with Section 34A-2-110 ; and
273 (vi) employee completion of one or more sworn affidavits or questionnaires approved
274 by the division.
275 (d) The insurer or self-insured employer shall pay for the cost of a reexamination with
276 appropriate employee reimbursement pursuant to rule for reasonable travel allowance and per
277 diem as well as reasonable expert witness fees incurred by the employee in supporting the
278 employee's claim for permanent total disability benefits at the time of reexamination.
279 (e) If an employee fails to fully cooperate in the reasonable reexamination of a
280 permanent total disability finding, an administrative law judge may order the suspension of the
281 employee's permanent total disability benefits until the employee cooperates with the
282 reexamination.
283 (f) (i) [
284 reveals evidence that reasonably raises the issue of an employee's continued entitlement to
285 permanent total disability compensation benefits, an insurer or self-insured employer may
286 petition the Division of Adjudication for a rehearing on that issue. The [
287 self-insured employer shall [
288 supporting the insurer's or self-insured employer's belief that the employee is no longer
289 permanently totally disabled.
290 (ii) If the petition under Subsection (11)(f)(i) demonstrates good cause, as determined
291 by the Division of Adjudication, an administrative law judge shall adjudicate the issue at a
292 hearing.
293 (iii) Evidence of an employee's participation in medically appropriate, part-time work
294 may not be the sole basis for termination of an employee's permanent total disability
295 entitlement, but the evidence of the employee's participation in medically appropriate, part-time
296 work under Subsection (7) may be considered in the reexamination or hearing with other
297 evidence relating to the employee's status and condition.
298 (g) In accordance with Section 34A-1-309 , the administrative law judge may award
299 reasonable [
300 employee's interests with respect to reexamination of the permanent total disability finding,
301 except if the employee does not prevail, the [
302 The [
303 addition to the permanent total disability compensation benefits due.
304 (h) During the period of reexamination or adjudication, if the employee fully
305 cooperates, each insurer, self-insured employer, or the Employers' Reinsurance Fund shall
306 continue to pay the permanent total disability compensation benefits due the employee.
307 (12) If any provision of this section, or the application of any provision to any person
308 or circumstance, is held invalid, the remainder of this section [
309 the invalid provision or application.
310 Section 3. Section 34A-2-702 is amended to read:
311 34A-2-702. Employers' Reinsurance Fund -- Injury causing death -- Burial
312 expenses -- Payments to dependents.
313 (1) (a) There is created an Employers' Reinsurance Fund for the purpose of making
314 [
315 disease occurring on or before June 30, 1994. [
316 section shall be made in accordance with this chapter or Chapter 3, Utah Occupational Disease
317 Act. The Employers' Reinsurance Fund [
318 [
319 (b) The Employers' Reinsurance Fund [
320 previously held in the "Special Fund," the "Combined Injury Fund," or the "Second Injury
321 Fund."
322 (c) The commissioner shall appoint an administrator of the Employers' Reinsurance
323 Fund.
324 (d) The state treasurer shall be the custodian of the Employers' Reinsurance Fund[
325
326 (e) The administrator shall make provisions for and direct [
327 Employers' Reinsurance Fund.
328 [
329 fees may be paid from the [
330 (2) The state treasurer shall:
331 (a) receive workers' compensation premium assessments from the State Tax
332 Commission; and
333 (b) invest the Employers' Reinsurance Fund to ensure maximum investment return for
334 both long and short term investments in accordance with Section 51-7-12.5 .
335 (3) (a) The administrator may employ, retain, or appoint counsel to represent the
336 Employers' Reinsurance Fund in [
337 claim against or on behalf of the [
338 (b) If requested by the commission, the attorney general shall aid in representation of
339 the [
340 (4) The liability of the state, its departments, agencies, instrumentalities, elected or
341 appointed officials, or other duly authorized agents, with respect to payment of [
342 compensation benefits, expenses, fees, medical expenses, or disbursement properly chargeable
343 against the Employers' Reinsurance Fund, is limited to the cash or assets in the Employers'
344 Reinsurance Fund, and they are not otherwise, in any way, liable for the operation, debts, or
345 obligations of the Employers' Reinsurance Fund.
346 (5) (a) If injury causes death within a period of 312 weeks from the date of the
347 accident, the employer or insurance carrier shall pay:
348 (i) the burial expenses of the deceased as provided in Section 34A-2-418 [
349 [
350 (ii) benefits in the [
351
352 [
353 death, the payment by the employer or its insurance carrier shall be:
354 (A) subject to Subsections (5)(b)(i)(B) and (C), 66-2/3% of the decedent's average
355 weekly wage at the time of the injury[
356 (B) not more than a maximum of 85% of the state average weekly wage at the time of
357 the injury per week; and
358 (C) (I) not less than a minimum of $45 per week, plus:
359 (Aa) $5 for a dependent spouse[
360 (Bb) $5 for each dependent minor child under the age of 18 years, up to a maximum of
361 four such dependent minor children[
362 (II) not exceeding:
363 (Aa) the average weekly wage of the employee at the time of the injury[
364
365 (Bb) 85% of the state average weekly wage at the time of the injury per week.
366 (ii) Compensation shall continue during dependency for the remainder of the period
367 between the date of the death and the expiration of 312 weeks after the date of the injury.
368 (iii) (A) The payment by the employer or its insurance carrier to a wholly dependent
369 [
370 described in Subsection (5)[
371 to [
372 reduced by 50% of [
373 wholly dependent [
374 (I) is eligible to receive for a week as of the first day the employee is eligible to receive
375 a Social Security death benefit; and
376 (II) receives.
377 (B) An employer or its insurance carrier may not reduce compensation payable under
378 this Subsection (5)(b)(iii) on or after May 5, 2008, to a wholly dependent person by an amount
379 related to a cost-of-living increase to the Social Security death benefits that the wholly
380 dependent person is first eligible to receive for a week, notwithstanding whether the employee
381 is injured on or before May 4, 2008.
382 (C) For purposes of a wholly dependent person whose compensation payable is
383 reduced under this Subsection (5)(b)(iii) on or before May 4, 2008, the reduction is limited to
384 the amount of the reduction as of May 4, 2008.
385 (iv) The issue of dependency [
386 judge at the end of the initial 312-week period and annually after the initial 312-week period.
387 If in [
388 time, the applicant is no longer a wholly dependent person, the applicant:
389 (A) may be considered a partly dependent or nondependent person; and
390 (B) shall be paid [
391 determines under Subsection (5)[
392 [
393 deceased employee [
394 period from the date of death of the employee. This presumption [
395 the initial 312-week period [
396 (ii) (A) In determining the [
397 the initial 312-week period, the administrative law judge shall exclude 50% of [
398 Social Security death [
399 (I) is eligible to receive for a week as of the first day the surviving spouse is eligible to
400 receive a Social Security death benefit; and
401 (II) receives.
402 (B) An employer or its insurance carrier may not reduce compensation payable under
403 this Subsection (5)(c)(ii) on or after May 5, 2008, to a surviving spouse by an amount related to
404 a cost-of-living increase to the Social Security death benefits that the surviving spouse is first
405 eligible to receive for a week, notwithstanding whether the employee is injured on or before
406 May 4, 2008.
407 (C) For purposes of a surviving spouse whose compensation payable is reduced under
408 this Subsection (5)(c)(ii) on or before May 4, 2008, the reduction is limited to the amount of
409 the reduction as of May 4, 2008.
410 [
411 the payment shall be:
412 (A) subject to Subsections (5)(d)(i)(B) and (C), 66-2/3% of the decedent's average
413 weekly wage at the time of the injury[
414 (B) not more than a maximum of 85% of the state average weekly wage at the time of
415 the injury per week; and
416 (C) not less than a minimum of $45 per week.
417 (ii) Compensation shall continue during dependency for the remainder of the period
418 between the date of death and the expiration of 312 weeks after the date of injury as the
419 administrative law judge in each case may determine. Compensation may not amount to more
420 than a maximum of $30,000.
421 (iii) The benefits provided for in this Subsection (5)(d) shall be in keeping with the
422 circumstances and conditions of dependency existing at the date of injury, and [
423 awarded by the administrative law judge under this Subsection (5)(d) shall be consistent with
424 the general provisions of this chapter and Chapter 3, Utah Occupational Disease Act.
425 (iv) (A) [
426 determine that a person is partly dependent under Subsection (5)[
427
428 dependency existing at the time of the dependency review [
429 (B) The administrative law judge may order that a partly dependent person be paid in
430 an amount not exceeding the maximum weekly rate that a partly dependent [
431 would receive if wholly dependent.
432 (v) [
433 during [
434 [
435 [
436 administrative law judge may apportion the benefits as the administrative law judge considers
437 just and equitable[
438 (ii) The total benefits awarded to all parties concerned [
439 maximum provided for by law.
440 (6) The Employers' Reinsurance Fund:
441 (a) shall be:
442 (i) used only in accordance with Subsection (1) for:
443 (A) the purpose of making [
444 or occupational [
445 this section and Section 34A-2-703 ; and
446 (B) payment of:
447 (I) reasonable costs of administering the Employers' Reinsurance Fund; or
448 (II) fees required to be paid by the Employers' Reinsurance Fund;
449 (ii) expended according to processes that can be verified by audit; and
450 (b) may not be used for:
451 (i) administrative costs unrelated to the [
452 (ii) [
453 (6)(a).
Legislative Review Note
as of 12-20-07 6:49 AM