Voucher Eligibility: A Sixty-Second Seminar in Workers’ Compensation Claims Handling

Most claims professionals are aware that LC §4658.7(g) forbids settlement of a Supplemental Job Displacement Benefit (SJDB) voucher for an admitted industrial injury occurring on or after 1/1/2013. There is however, one exception. Namely, when an affirmative defense is raised, where if litigated the employee may “take nothing,” including the voucher.

The purpose of today’s blog is to remind claims professionals that before injured workers are entitled to a voucher, eligibility requirements must first be satisfied. When a claim settles either by stipulations or C&R, many applicant attorneys expect the claims administrator to automatically send out a voucher, as they inappropriately assume that voucher entitlement is triggered upon settlement. We therefore recommend that voucher eligibility be clearly discussed between the parties beforehand. Misunderstandings over entitlement have been known to cause return trips to the board to address the issue.

To avoid further litigation the parties are encouraged to stipulate whether applicant qualifies for a voucher. When an applicant is ineligible, expect the WCJ to remind everyone that settlement of the voucher is not permitted. Should this occur, it must be politely pointed out the voucher is not being settled. Instead, the parties are simply stating that currently the applicant does not qualify for a voucher. There is a huge legal difference between being “ineligible” for a voucher as opposed to “settling” a voucher dispute.

Should AA disagree concerning voucher entitlement, the employer should make it clear in the settlement documents they do not admit to voucher eligibility because entitlement has not been proven.

As a reminder, when dealing with an accepted injury an employee is ineligible for a $6,000 voucher if any of the following conditions exists:

1. When there is 0% PD
2. When there is 100% PD.
3. There is no lost time from work
4. An offer of a permanent, modified/alternative job lasting at least one year and paying at least 85% of the AWW was timely offered to the injured worker.
5. The employee returned to work at their usual and customary occupation.

Contrary to popular belief, an injured worker is not automatically entitled to a voucher simply because PD exists or when an applicant is no longer employed by the employer. Also, as a matter of course, applicant attorneys will routinely ask for a voucher regardless of whether the injured worker is eligible. Unfortunately, far too many claims administrators hand out vouchers at the time of settlement simply to resolve the claim. We urge those administrators to take a second look at this practice and ask the question: do their clients want to needlessly give away $6,000?