INDEMNITY BENEFITS
Index
Temporary Disability Benefits
Wage Statement
Certificate of Dependency
Temporary Partial Disability
Permanent Partial Disability Benefits
Agreement for Permanent Partial Disability
Lump Sum Requests
Permanent Total Disability
Death Benefits
Agreement for Compensation in Fatal Cases
Annual Adjustment of Weekly Compensation
Notice of Change in Compensation Rate
OVERVIEW:
This section outlines the various indemnity benefits an injured worker may
be entitled to under the Act. It details the specific benefits and proper forms
that must be filed with the Department.
Once a claim has been determined to be compensable and medical evidence
supports disability, the injured worker is entitled to indemnity benefits as
compensation for any resulting disability from work. If the injured worker is
totally disabled from work, he or she is entitled to temporary total
disability (TTD) compensation. If he or she returns to part-time or light
duty employment, is not receiving his or her pre-injury wage and has not
reached a medical end result, he or she is entitled to receive two-thirds of the
difference between the gross wages from the part-time or light duty
employment and the pre-injury average weekly wage. These benefits are
referred to as temporary partial disability compensation (TPD).
If the adjuster determines that the injured worker is no longer entitled to
either temporary total or temporary partial disability benefits for reasons
other than a successful return to work, it is required by law to notify both the
injured worker and the Department of its intention to discontinue weekly
Last revised 10/15/12
indemnity benefits by filing a Notice of Intention to Discontinue Payments
(Form 27). If the adjuster has terminated disability benefits based on a
successful return to work (see Rule 18.1600) DO NOT FILE A FORM 27.
Instead, we recommend that a letter be submitted to the Department, copied
to the injured worker, indicating what the successful return to work date is
for the Department’s file. (See Discontinuance Section of this Manual).
If an injured worker is left with a permanent impairment or loss of function
as a result of the work injury, he or she is entitled to additional
compensation, referred to as permanent partial disability compensation
(PPD). An injured worker who is found permanently and totally disabled
(PTD) is entitled to a minimum of 330 weeks of benefits (See Permanent
Total Disability Section of this Manual). Those benefits continue unless and
until the carrier provides evidence that the injured worker is able once again
to obtain regular, gainful work.
If a work-related injury results in a death, the deceased employee’s
dependants are entitled to death benefits.
An injured worker receiving temporary total, temporary partial, permanent
partial, permanent total, or dependents receiving death benefits on July 1 of
each year may be entitled to an annual increase in the weekly compensation
benefit rate. Notice is given annually by the Department of the July 1
st
adjustment via e-mail, similar to below:
The Form 28 and Form 28A for Fiscal Year 2013 are now
available. You can find them on our forms page:
http://labor.vermont.gov/Default.aspx?tabid=170
Historical wage rates are available here:
http://labor.vermont.gov/InfoCenter/Rules/WorkersCom
pensati
onRules/Rule16HistoricalWageRates/tabid/362/Default.aspx
A Form 28 reflects the adjustment.
Last revised 10/15/12
TEMPORARY DISABILITY BENEFITS:
TEMPORARY TOTAL DISABILITY
Temporary total disability benefits are payable when an injured worker has
been totally disabled for more than three calendar
days, including the
date of injury if he or she was not paid in full by the employer for that date.
The three days need not be consecutive. If the injured worker continues to
be disabled after the third day, for a period of seven consecutive calendar
days or more, he or she shall be entitled to retroactive compensation to
include the first three days. (21 VSA §642
and §650)
Temporary total disability benefits are calculated based on the injured
worker’s average weekly wage and work week. If an injured worker’s work
schedule is five days a week, the daily rate must be calculated based on a
five-day work week. If an injured worker’s work schedule is 5 ½ days a
week, the daily rate must be calculated based on a six-day work week. For
example, an injured worker works 5-½ days a week and becomes
temporarily totally disabled for five weeks and three days. His weekly
compensation rate is $229.00. Temporary total disability compensation
owed would be for the five weeks (5 x $229.00 = $1,145.00) plus the three
days ($229.00 divided by 6 = $38.17 x 3 = $114.51) for a total of $1,259.51.
The injured worker’s weekly indemnity check must be made out in his or her
name and sent to the address he or she has designated.
If there is a lapse of six months or more between the date of injury and the
date of disability, the wages for both the 26 weeks prior to the date of injury
and the date of disability must be requested from the employer and provided
to the Department. These wages must be compared and the higher average
weekly wage shall be used. Different wages also may need to be compared
when there are intermittent periods of disability where temporary disability,
either total or partial, does not occur in a continuous period but occurs in
separate intervals, each resulting from the original injury. If the more recent
wages are lower as a result of the injury, the earlier, higher wages likely will
have to be used.
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The form required by the Department for temporary total disability is the
Agreement for Temporary Compensation (Form 32). In order to prepare the
temporary total agreement, the adjuster must first obtain the following:
- Employer's First Report of Injury (Form 1)[from the employer]
- Wage Statement (Form 25) [from the employer]
- Certificate of Dependency (Form 10) [from the injured worker]
With the above information and forms, the agreement can be completed.
Agreement for Temporary Compensation (For
m 32)
Complete the information in the upper right hand corner of the form. The
state file number must be included on every agreement/document
submitted to the Department. The day of the week that the indemnity
payments are to be mailed or deposited must be indicated on the agreement
as well [21 VSA §650(f)
].
The form must be signed by a VERMONT licensed workers' compensation
adjuster and the injured worker or his/her legal representative. If the injured
worker refuses or fails to sign the Agreement for Temporary Total
Disability, the adjuster should sign and submit the agreement to the
Department along with copies of the correspondence showing that at least
two attempts were made to obtain the injured worker’s signature.
Wage Statement (Form 25)
This form is required to calculate the injured worker's pre-injury average
weekly wage and shall include 26 weeks of gross wages prior to the week
of injury, unless the injured worker was employed for less than 26 weeks
prior to the date of injury. DO NOT INCLUDE WAGES EARNED
DURING THE WEEK OF THE INJURY. If the employer includes the
week of the injury on the Form 25, an additional week of wages must be
requested from the employer to make a total of 26 weeks of wages.
If at the time of the injury, the worker was regularly being paid at a higher
wage rate or grade than formerly during the 26 weeks preceding the injury
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only the larger wages are taken into consideration in computing the average
weekly wage. [See 21 VSA§ 650(a)].
If a worker was employed for less than 4 weeks
you must obtain the wages
of a comparable employee. A comparable employee is someone who worke,
in the 26 weeks prior to the injured worker’s date of injury, in the same
position and at the same rate of pay. Do not combine comparable wages
with the injured worker's actual wages when computing the average weekly
wage. For example, if an injured worker has only been employed for two
weeks at the time of the injury and the average weekly wage cannot be
determined by using the two weeks worked, the 26 weeks of wages from a
comparable injured worker must be requested and used. Do not use the two
weeks of actual wages and 24 weeks of comparable wages.
If there are no comparable employees, the injured worker’s rate of hire will
be used to determine the average weekly wage.
Please remember the intent of the law is to fairly reflect what the injured
worker was earning at the time of the injury.
"EXTRAS
" should always be indicated on the Wage Statement to include any
bonuses and commissions paid to the injured worker. If the injured worker
received room, board, lodging or other extras (electricity, fuel, etc.) during the
26 weeks prior to the date of injury, they should only be included if he or she
does not continue to receive them after the injury. In some instances there
may be other extras that would qualify as wages that may be included in the
wage calculation. Example: A company vehicle is provided for work and
personal use. If, following a work injury the employer takes the company
vehicle away, the injured worker no longer has the benefit of that vehicle for
personal use. Therefore, the value of the vehicle’s usage must be determined
and included in the average weekly wage calculation.
Exclude vacation weeks or other weeks where the injured worker worked
less than half of the normal work week or when the employer had reduced
operations. Example: If the injured worker was hired to work 40 hours a
week and one week on the Form 25 indicates that only 18 hours were
worked, that week would be omitted as it is less than one-half of the hours
the injured worker was hired to work. The remaining weeks would be used
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to calculate the average weekly wage. If an injured worker is scheduled for
a week of vacation, but instead works and receives vacation pay as well as
regular wages for the hours worked, only the regular wages shall be included
in the calculation of the average weekly wage.
Tips
. The Wage Statement must include tips earned during the 26 weeks
prior to the date of injury.
On call, as needed, per diem, and temporary agencies.
When calculating
wages the adjuster must divide the total earned for the 26 weeks prior to the
date of injury by the number of weeks worked. Do not include weeks where
there were no earnings. Example: if the injured worker worked a total of 5
weeks during the 26 weeks prior to the injury, add the earnings and divide
by 5.
For employees of a temporary agency be sure to include all
earnings from all
jobs during the 26 weeks.
In the case of National Guard wages, the adjuster takes the total earnings for
the 26 week period and divides by 26 in every case.
Volunteer rescue, fire, or police personnel
, who are not otherwise employed,
are paid a compensation benefit based on the average weekly wage of a
similar employee in a paid position. The injured volunteer who is employed
elsewhere and is able to continue working his or her regular job would not
be entitled to compensation for the inability to continue the volunteer work.
Commissions
that are actually paid during the 26 weeks prior to the injury
are included in the average weekly wage calculation. Do not include
commissions that the injured worker receives after the injury date, even if
they were earned during the 26 weeks prior.
Concurrent employment
. When an injured worker holds jobs with two or
more employers at the time of injury, the average weekly wage from each
job must first be calculated separately and then added together. If an injured
worker is self-employed, his or her business must be insured for workers’
compensation in order for the wages to be included as concurrent
employment. See 21 VSA §650(a)
.
Last revised 10/15/12
The Form 25 must be marked as concurrent employment and a separate
Form 25 must be completed for each employer.
Certificate of Dependency (Form 10)
For the purposes of paying dependency benefits, a “child” is defined to
include a stepchild, adopted child, posthumous child, grandchild and a child
for whom parentage has been established pursuant to 15 VSA Chapter 5, but
does not include a married child unless the child is a dependent [See 21 VSA
§601(2)].** For example, if an injured worker has a child living at home
who is 19 years old and attending school, the child is considered a
dependent. NOTE: The injured worker is entitled to the dependency
allowance provided the weekly benefits do not exceed 90 percent of the
average weekly wage and provided no other injured worker is receiving
the same benefits on behalf of the dependent child or children.
**For the purposes of death benefits please see 21 VSA §634
.
TEMPORARY PARTIAL DISABILITY
Often an injured worker regains the ability to return to work gradually. An
employer is strongly encouraged to offer reasonable transitional and/or light
duty work to those injured workers. If the work injury results in a reduction
in wages the injured worker is entitled to temporary partial disability
compensation. The Department requires that an Agreement for Temporary
Compensation (Form 32) be filed.
If the injured worker requires continued medical treatment for the work
injury after he or she has returned to work, the employer may not withhold
any wages for his or her absence from work for medical treatment or to
attend a medical examination. The employer may request the injured worker
make reasonable efforts to schedule medical appointments around his or her
light duty work schedule.
The Employer's First Report of Injury (Form 1) and the Wage Statement
(Form 25) must be obtained before completing the Agreement for
Temporary Compensation (Form 32).
Last revised 10/15/12
PERMANENT PARTIAL DISABILITY
Permanent partial disability (PPD) is an additional monetary benefit that the
injured worker may be entitled to under Vermont’s workers’ compensation
act. PPD is intended to compensate an injured worker for any permanent
loss of function that results from the work injury. Compensation is payable
for a specific period of time dependent upon the degree of impairment.
Impairment is assessed when an injured worker reaches a medical end result
(MER) or maximum medical improvement (MMI) for the work injury or
condition. Impairment must be determined by a medical expert and pursuant
to the AMA Guides to the Evaluation of Permanent Impairment (5
th
ed.). It
is the adjuster’s responsibility to take the steps necessary to determine if the
injured worker has a permanent impairment once MER or MMI has been
reached. Benefits are paid in accordance with 21 VSA §648
.
The medical expert providing an impairment rating should always indicate
how it was calculated. For example, the medical expert should specify
which chapter, table and page and/or other specific criteria from the Guides
were followed in arriving at the rating. If no explanation is provided, the
adjuster should request more specific information from the medical expert.
Once the parties have reached an agreement on the percentage of
impairment, they should sign and file an Agreement for Permanent Partial
Disability Compensation (Form 22) with the Department. A Form 22 is not
a final settlement agreement and does not necessarily close out the injured
worker’s right to future medical and/or indemnity benefits.
For all injuries occurring before April 1, 1995 permanent partial disability
benefits must be calculated according to the specific body part injured
.
Example
: An injured worker hurts his knee and is rated with a 10 percent
impairment of the lower extremity, which is equates to a 4 percent whole
person impairment. The permanency benefits to be paid will be based on the
10 percent impairment to the knee, not the 4 percent whole person
impairment. Thus, the injured worker is entitled to 21.5 weeks (215 weeks x
Last revised 10/15/12
10% = 21.5 weeks) (see Rule 11). Whole person ratings do not apply to
injuries before April 1, 1995.
For all injuries occurring on or after April 1, 1995 permanent partial
disability benefits must be calculated using the whole person rating system
.
Spine injuries must be calculated based upon 550 weeks. All other injuries
are calculated based upon 405 weeks.
Vermont’s workers’ compensation statute, 21 VSA §648(d)
, requires
apportionment of impairment where a prior impairment of the same body
part/system has been both rated and paid. Absent those specific
circumstances, the Commissioner retains discretion whether to apportion or
not.
IMPORTANT: If you have evidence that the injured worker had a prior
injury to the same body part or system that was rated and paid, you should
provide the medical expert who is assessing permanent impairment with that
information so that the apportionment issue can be considered and
addressed.
To calculate the number of weeks due for a spine injury together with an
injury to another body part, the whole person rating for the spine must first
be multiplied by 550 weeks. Then the whole person rating for the other body
part is multiplied by 405 weeks and the two are added together. (For
example, 15% whole person impairment for the spine x 550 weeks = 82.5
plus 20 percent whole person impairment for the lower extremity x 405 =
81, for a grand total of 163.5 weeks of permanent partial disability benefits
due the injured worker. See Rule 11a.
The insurer must inform the injured worker of his or her right to obtain at
least one permanency examination and impairment rating, at the carrier’s
expense. See Rule 11.2400 (for injuries prior to 4/1/95 Rule 11.1530
applies). The insurance carrier may request that the injured worker attend an
examination with its own medical expert at reasonable times and places.
The 90 percent compensation rate applies ONLY to temporary total
disability benefits. If the injured worker’s temporary total compensation rate
Last revised 10/15/12
is 90 percent of his or her average weekly wage, the permanent partial
disability benefits must be recalculated to reflect the appropriate permanent
partial compensation rate instead. For example, the average weekly wage is
$200.00 and the injured worker is receiving 90 percent compensation rate of
$180.00 for temporary total purposes. Permanent partial benefits would be
paid at the rate of $200.00. If the average weekly wage is $500.00, the
permanent partial disability compensation rate would be paid at the current
minimum compensation rate in effect or two-thirds of the average weekly
wage, whichever is higher. See Rule 15.0000.
Permanent partial disability benefits should be initiated after the injured
worker has reached medical end result and permanent impairment has been
assessed. If the injured worker lost time from work, has reached a medical
end result and a Notice of Intention to Discontinue Payments has been
properly filed, temporary total disability benefits cease and permanent
partial benefits begin.
When paying permanent partial disability benefits through July 1 of each
year, the compensation rate must be adjusted to reflect the annual cost of
living adjustment (COLA) on the Notice of Change in Compensation Rate
(Form 28).
Example
: Permanent partial benefits begin on May 1, 2010, for a total of 25
weeks. On July 1, 2010, the compensation rate would increase by the annual
COLA and the remaining weeks are paid at the new rate. (21 VSA §650(d)
,
Rule 16.0000) See memorandum from J. Stephen Monahan dated June 3,
2011, see also Theresa Morin v. Essex Optical Opinion No. 03-502 (Jan. 28,
2005).
Prior to preparing the Agreement for Permanent Partial Disability (Form 22),
the following Forms must be sent to the Department:
For “no lost time” claims, it is necessary to have the Employer's First
Report of Injury (Form 1), Wage Statement (Form 25) and the medical
documentation supporting the percentage of permanent impairment.
For lost time claims, it is necessary to have the Employer's First Report of
Injury (Form 1) and the appropriate forms submitted for lost time wages,
Last revised 10/15/12
which may include the Certificate of Dependency (Form 10), Wage
Statement (Form 25), Agreement for Temporary Compensation (Form 32),
Notice of Change in Compensation Rate (Form 28), as well as the medical
documentation supporting the percentage of permanent impairment. If
temporary disability ended for any reason other than a successful return to
work then the effective date of the Notice of Intention to Discontinue
Payments (Form 27) must be noted. Please note that if the Department has
not approved the Form 27 then we cannot approve the Form 22.
Agreement for Permanent Partial Disability (Form 22)
Complete the information in the upper right hand corner of the form. The
State File Number must be included on every agreement or document
submitted to the Department. The day of the week that the indemnity
payments are to be mailed or deposited must be indicated on the agreement
21 V.S.A § 650(f)
.
Note
: In the event there is more than one injury in the claim it is important to
specify each injury. Even if there is more than one injury only one
Form 22
is filed. The form should specify the different injuries and permanency for
each.
In the section marked "PERMANENT PARTIAL DISABILITY,” enter the
beginning date of permanency benefits. This will either be a full duty return
to work date or the effective date of the approved Notice of Intention to
Discontinue Payments (Form 27).
The form must be signed by a licensed workers' compensation adjuster and
the injured worker or his/her legal representative. If the injured worker fails
or refuses to sign the agreement, the insurance carrier needs to submit an
agreement with the adjuster’s signature, along with copies of the
correspondence showing the two attempts made to obtain the injured
worker’s signature. NOTE: If the injured worker fails to sign the
agreement, the carrier must continue payments up to the amount that it
deems correct. Generally this is the amount of permanency determined by
the insurer’s independent medical examiner.
Last revised 10/15/12
LUMP SUM REQUESTS: Upon written notice from the injured worker
permanent disability benefits may be paid in a lump sum. See 21 VSA §652
and Rule 19.0000.
The injured worker’s request should specify the benefit, the lump sum amount
requested and the reason(s) for the request. Rule 19 details when lump sum
awards are approved. All parties must have an opportunity to be heard on this
issue. The adjuster should write to the Department and indicate whether or not
the carrier agrees to a lump sum payment and the amount agreed to. The
Department generally approves of lump sum payments when both parties are in
agreement.
A lump sum may be ordered
without the carrier’s agreement in limited
circumstances. Factors that are positively considered include:
1. the injured worker (or his or her household) has another regular
source of income;
2. the lump sum can hasten or improve the injured worker’s
rehabilitation or recovery;
3. the lump sum can hasten or improve the injured worker’s return to
employment;
4. the lump sum is otherwise deemed to be in the injured worker’s best
interest.
If the injured worker dies from any cause other than the accident, the
remaining permanent partial benefits due shall be paid to his or her
dependents, as defined in 21 VSA §§635
and 636. If there are no
dependents, the remaining amount, but not exceeding $5,500.00 for burial
and funeral expenses and expenses for out-of-state transportation of the
deceased to the place of burial, not exceeding $1,000.00, shall be paid in a
lump sum to the proper person.
If the injured worker dies from any cause other than the accident during the
period of temporary total disability, and if the injured worker’s physician is
able to determine a percentage of permanent impairment resulting from the
Last revised 10/15/12
work-related injury, the injured worker’s dependents as defined in VSA 21
§§635 and 636 are entitled to the payment of permanent partial disability
benefits.
PERMANENT TOTAL DISABILITY
Benefits for permanent total disability are automatically payable for the
following injuries under 21 VSA §644
:
1. total and permanent loss of sight in both eyes;
2. loss of both feet at or above the ankle;
3. loss of both hands at or above the wrist;
4. loss of one hand and one foot;
5. injury to the spine resulting in permanent and complete paralysis of
both legs or of both arms or of one leg and of one arm; and
6. a head injury resulting in “incurable imbecility or insanity.”
The Commissioner shall consider other specific characteristics of the injured
worker, including the injured worker’s age, experience, training, education
and mental capacity when determining a claim for permanent total disability.
Permanent total disability benefits may be payable for other injuries if
the
injury or the combination of the injury and other characteristics render the
injured worker unable to perform regular gainful employment
(See Rule
11.3100 for Odd Lot Doctrine). A vocational rehabilitation assessment and
a functional capacity examination typically are required to establish that the
disability is total. An injured worker who is found permanently totally
disabled (PTD) is entitled to a minimum of 330 weeks of benefits.
After
the carrier has paid 330 weeks of benefits it may obtain an evaluation
of the injured worker’s medical condition and/or vocational prospects. If the
carrier obtains evidence that supports the injured worker is now capable of
obtaining regular gainful employment it may discontinue benefits by filing a
Last revised 10/15/12
written request with the Department and attaching its supporting evidence.
Copies must be submitted to the injured worker and his or her representative.
DEATH BENEFITS:
If a work-related injury results in death, the employer shall pay
compensation to the dependents as defined in 21 VSA §634
. The employer
shall file the Employer's First Report of Injury (Form 1), Report of Fatal
Accident (Form 4) and the Wage Statement (Form 25).
If there are no dependents, the personal representative shall receive burial
and funeral expenses not to exceed $5,500.00 and expenses for out-of-state
transportation of the deceased to the place of burial, not to exceed $1,000.00.
(See 21 VSA §632
& §635).
If there are dependents, benefits are paid as follows:
1. To the spouse, if there are no dependent children, sixty-six and
two-thirds percent (66-2/3 percent);
2. To the spouse, if there is one
dependent child, seventy-one and
two-thirds percent (71-2/3 percent); or if there are two or more
dependent children, seventy-six and two-thirds percent (76-2/3
percent);
3. If there is no spouse, but a dependent child or children, then to
the child or children, the amount or amounts payable to a
spouse with the same number of dependent children, to be
divided equally among the children if more than one;
4. If there is neither spouse or child, but there is a dependent
father or mother, then to the parent, if wholly dependent, thirty
percent (30 percent) or if partially dependent, twenty percent
(20 percent) or if both parents are dependent, then half of the
foregoing compensation to each of them. If there is no such
parent, but a dependent grandparent, then to every such
grandparent the same compensation as to a parent;
Last revised 10/15/12
5. If there is neither dependent spouse, child, parent nor
grandparent, but there is a dependent grandchild, brother or
sister, or two or more of them, to the dependents fifteen percent
(15 percent) for one dependent and five percent (5 percent)
additional for each additional dependent, with a maximum of
twenty-five percent (25 percent) to be divided equally between
the dependents if more than one.
Compensation shall be payable during the following periods:
1. Compensation shall be paid to the spouse until the age of 62 if
at that time the spouse or reciprocal beneficiary is entitled to
benefits under the Social Security Act;
2. until remarriage; or
3. until death, whichever occurs first; however, in no event shall
the spouse receive less than a sum equal to 330 times the
maximum weekly compensation at the time of the death except
when compensation terminates due to death of the beneficiary.
Example
. A spouse who is 30 years old at the time of the
injured worker’s death and never remarries. The spouse
receives death benefits of 66-2/3 percent of the average weekly
wage until he or she reaches age 62 and is entitled to benefits
under the Social Security Act. However, in no event shall the
spouse receive less than a sum equal to 330 times the maximum
weekly compensation rate at the time of the death except when
compensation terminates by reason of death of the beneficiary.
4. to a child, during dependency as defined in 21 VSA §634
;
Example
. A spouse 30 years old at the time of the injured
worker’s death has two dependent children and remarries five
years after the accident. Death benefits are paid at the rate of
76-2/3 percentof the average weekly wage until the remarriage.
However, if the spouse has not received an amount equal to 330
times the maximum weekly compensation rate, a lump sum
Last revised 10/15/12
payment of the remaining amount (330 times the maximum
compensation rate at the time of death) shall be paid to the
spouse. The two dependent children continue to receive death
benefits at the rate of 76-2/3 percent until they are no longer
dependent as defined in 21 VSA §634
.
Another example would be a spouse or reciprocal beneficiary of
a deceased injured worker who has two dependent children and
one of the children continues on to college following high
school and the other child only completes high school. Death
benefits will be paid at the rate of 76 2/3% of the average
weekly wage until the child who completes only high school
and reaches the age of 18 and is no longer dependent as defined
in 21 VSA §634
, at which time death benefits will decrease to
71 2/3% of the average weekly wage.
5. to a parent or grandparent, during the continuation of a
condition of actual dependency, but in no case to exceed two
hundred and sixty-four (264) weeks; and
6. to a grandchild, brother or sister during dependency as defined
in 21 VSA §634
, but in no case to exceed two hundred and
sixty-four (264) weeks.
Agreement for Compensation in Fatal Cases (Form 23)
Complete the information in the upper right hand corner of the form. The
State File Number must be included on every agreement and document
submitted to the Department. The day of the week that the indemnity
payments are to be mailed or deposited shall be indicated on the agreement
21 V.S.A § 650(f)
.
The form must be signed by a Vermont licensed workers' compensation
adjuster and the deceased's dependent or his or her legal representative.
NOTE: Death benefits must be updated each July 1 in accordance with a Form
28, with cost of living adjustments, death benefits can exceed the injured
workers average weekly wage as of the date of injury.
Last revised 10/15/12
ANNUAL ADJUSTMENT OF WEEKLY COMPENSATION (COLA):
The annual adjustment of weekly compensation is designed to reflect cost of
living increases that occur after the injury, so that such compensation
continues to bear the same percentage relationship to the average weekly
wage in the state as before.
On or before July 1 annually, the Commissioner shall announce the annual
change in compensation rate and new minimum and maximum rates for the
coming fiscal year. Any injured worker receiving temporary total,
temporary partial, permanent partial or permanent total disability benefits or
dependents receiving death benefits, on July 1
st
, shall be entitled to an
increase in the compensation rate in accordance with 21 VSA §650(d)
and
Rule 16.0000. Temporary total or temporary partial disability compensation
shall first be adjusted on the first July 1
st
following the receipt of 26 weeks
of benefits.
Prior to preparing the Notice of Change in Compensation Rate (Form 28),
the following forms should already have been filed with the
Department
but if not, you must submit
the Employer's First Report of Injury (Form 1)
and the appropriate forms submitted for lost time wages, which may include:
Certificate of Dependency (Form 10)
Wage Statement (Form 25)
Agreement for Temporary Compensation (Form 32)
Agreement for Permanent Partial Disability Compensation (Form 22)
Agreement for Permanent Total Claims (modified Form 22)
Agreement in Regard to Compensation in Fatal Cases (Form 23).
Notice of Change in Compens
ation Rate (Form 28 )
Complete the information in the upper right hand corner of the form. The
state file number must be included on every agreement or document
submitted to the Department.
Last revised 10/15/12
Last revised 10/15/12
Note:
Temporary Total Benefits: The cost of living increase is applicable to all
compensation rates (including the 90 percent compensation rate) but only
insofar as it does not cause the compensation rate to exceed the average
weekly wage.
Temporary Partial Benefits: The cost of living increase must be adjusted
weekly if the injured worker's wages vary from week to week. Do not
include dependency benefits in these calculations.
If the injured worker is receiving either the minimum or maximum rate, it is
not necessary to use the multiplying factor when determining the cost of
living increase. The new minimum and maximum rates are set by the
Commissioner each year and will be indicated on the Form 28.
In cases where death benefits are being paid, the benefits CAN exceed the
average weekly wage.
In cases involving death benefits, when a child is no longer considered a
dependent as defined in 21 VSA §634
, the rate needs to be recalculated and
reflected for each year that an annual increase has occurred since the date
benefits commenced. For example, consider a spouse with two dependents
who are 15 years old and 8 years old at the time of the injured worker’s
death on June 15, 1994. Over the course of the next three years, annual
increases are received on July 1
st
. On July 1, 1997 the older child turns 18
and is employed. As of July 1, 1997 that child is no longer dependent and
the spouse and one remaining dependent will begin to receive 71-2/3 percent
of the average weekly wage. The adjuster needs to complete and file new
Forms 28 for the years beginning July 1, 1994 - July 1, 1996 to reflect the
new rate of 71-2/3 percent to be paid beginning July 1, 1997 for the spouse
and one dependent.
The form must be signed by a Vermont licensed workers' compensation
adjuster.
