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This guide will provide the basics of what is needed to prove up your SIBTF case. Please note that SIBTF is very complicated and nuanced. This guide is no substitute for hiring an attorney experienced in handling many SIBTF cases.
SIBTF is the acronym for the State of California Subsequent Injuries Benefits Trust Fund. It is also called SIF for short. The state of California administers this fund of money which is paid from work comp insurance premiums paid by employers. So this is not tax dollars or the “peoples” money. It is virtually unheard of by anyone except those few attorneys that represent injured workers. Even among injured workers attorneys, an extremely small percent have ever handled an SIBTF case or even understand how one successfully qualifies for SIBTF benefits. This fund is misnamed since it does not pay you for the subsequent injury. The subsequent injury is your work comp injury case. This funds should be called the “Preexisting injuries combined with work injuries fund”. But title, like the SIBTF itself, is also confusing
The short answer is you must have a disability that preexists your work injury. It can even be a disability you don’t know you have; what the doctors call”silent pathology”. Like degenerative disc disease you didn’t know existed until the work comp clinic doctor told you. So don’t think your preexisting disability must be labor disabling or cause an actual provable loss of earnings in the past. IT DOES NOT. Any medical condition or injury you have had since birth can and is used to support your SIBTF case. Attorneys typically use past medical records of treatment for hypertension, diabetes, thyroid conditions cancer, prior injuries, ect to help prove the SIBTF case. We then combine that prior disability with the work injury for an overall percentage of disability. Most people don’t know that they can be compensated for having prior conditions or prior injuries through the SIBTF. Most attorneys representing injured workers shy away form cases with preexisting disabilities. That is a mistake. As an example, a simple finger injury causing no more than 5% disability (with a value of a few thousand dollars) can result in a lifetime of payments from the SIBTF (with a value of hundreds of thousands of dollars) if there are preexisting conditions and the SIBTF thresholds are met.
As the title of this guide states, there are two thresholds or hoops you must pass to qualify. The first of the two actually has two parts or two different ways you can meet the first threshold. Remember that earlier I mentioned that the SIBTF case is made up of combining the disability from the work injury (the work injury is the “subsequent” injury) with the preexisting disability. The first threshold focuses on the work injury part and the second threshold, discussed below, focuses on the combined disability. One way to meet the first threshold is to show through doctor reporting that your work injury has caused at least 35% disability after multiplying your medical Whole Person Impairment (WPI) by 1.4. So your minimum disability for your work injury that your work comp doctor provides must be 25% (25% x 1.4 = 35%). if your work injury is 25% WPI or better, congratulations! You meet the first threshold for SIBTF benefits. But what if your disability is less than 25% WPI? Don’t give up hope! The second way to meet the first threshold is to show that you have an injury that affects an eye, arm, hand, leg or foot (an eye or any part of an upper or lower extremity) (the injury does not have to be in that body part) and the effect is a disability of at least 4% WPI (4% x 1.4 = 5.6) The law says a minimum of 5% but that is misleading since the percent must be multiplied by 1.4 to arrive at your minimum of 5%. So the doctor only needs to say at least 4%. Also the work injury (aka subsequent injury) can be a low back injury “affecting” a lower leg causing 2% in the lower leg combined with a 2% old knee injury for a 4% overall which multiplied by 1.4 = 5.6 which rounds to 6% and you have more than the 5% minimum required. But you ask why try to prove the higher percentage of 25% when you can get in with 5%? The answer is that if you go with the lower percentage of 5% overall you must be able to show a preexisting disability in the “opposite and corresponding” extremity or eye. Not all have a work injury affecting a left leg and a preexisting disability to the right leg; or a work injury to the left eye and a preexisting injury to the opposite eye. So we can sum up the two ways to meet threshold number one as 25% or better WPI OR 4% or better to an eye, hand, arm, leg or foot with a preexisting disability to the “opposite and corresponding” eye, hand, arm, leg or foot.
Once you have evidence of a work injury causing disability of 25% or more WPI or 5% or more opposite and corresponding, we move onto the second threshold or hoop to jump through to qualify for SIBTF benefits. This second threshold requires the combined work injury and preexisting disability to add up to at least 70% or more disability. 70% overall disability is the minimum to obtain SIBTF benefits. The preexisting disability is calculated the same way your work injury disability is calculated using the AMA Guides to Impairment, 5th Edition. This is why the SIBTF case is within the expertise of the injured workers attorney, called an Applicant’s Attorney. Sadly most Applicant’s attorneys don’t take the time to learn the SIBTF or to even advise their clients they may have an SIBTF case since it is separate from the regular work comp case.
The same court that oversees your work injury case, the Workers Compensation Appeals Board (WCAB) is where you file your SIBTF application for benefits. This court has jurisdiction over the SIBTF case and will approve your SIBTF settlement or can conduct a hearing to see if you meet the threshold requirements for SIBTF. The SIBTF Application for benefits can be obtained online at the DWC website. Or consult a workers compensation attorney for any work comp or SIBTF forms. The SIBTF Application can be accessed here https://www.dir.ca.gov/dwc/FORMS/EAMS%20Forms/UEF_SIF/SIFApplication.pdf
No you do not have to use the doctors that evaluate you for your work comp case. You can obtain new medical reporting from a doctor who understands SIBTF issues. In most cases you will need to get additional medical reporting apart from your work comp doctors reporting. The SIBTF pays the costs of these evaluations for you whether you qualify or not unless there are some unique issues that don’t apply in most cases.
I would like to be able to give you an exact figure but the value changes and goes up with every percent of disability you have above 70%. I can tell you that if you are 100% disabled in your SIBTF case, you get paid 66% of your earnings which is the same rate of pay when you received temporary disability (TD) from work comp while out of work and recovering from your work injury. However if you are between 70% and 99% there is a sliding scale of payments that increase as the disability increases. A workers compensation attorney who is experienced in SIBTF cases can provide an approximate value based on your disability levels and earnings information.
The Division of Workers Compensation (DWC) of the state of California has some basic information about SIBTF. However you will need a detailed analysis from an experienced work comp attorney that has handled many SIBTF cases. Remember most injured workers attorneys don’t handle SIBTF cases even though it is within the work comp attorney’s field of practice. If your attorney does not, ask him for a referral to a work comp attorney who handles SIBTF cases.