The Fund’s compensation schedule

It is the part of Article 3 of Act 45-1935 that fixes, limb by limb, how many weeks of additional compensation a permanent partial disability earns, and the rules that apply where the injury is not in that table.

Article 3(c) treats as permanent partial disability “the loss of a foot or leg, a hand, an arm, an eye, one or more fingers or toes, and any ankylosis or fracture or dislocation where there was rupture of ligaments and where restoration is not complete”. The Act adds that the complete and permanent functional loss of any member affecting the worker’s industrial capacity or earning power shall be treated as total loss of that member, as if it had been amputated.

• That the injury fits the Article 3(c) definition: loss of a limb, finger, toe or eye, or ankylosis, fracture or dislocation with rupture of ligaments where restoration is not complete.Verified against the official source
• For a hernia, proving to the Administrator’s satisfaction and on medical testimony the three things the Act requires, including that an accident occurred which was not a simple effort.Verified against the official source

Information pending verification.

1. 1

   Step 1: How it is calculated: two thirds, and a low ceiling

   Article 3(c) says that for the permanent partial disabilities specified in the table the worker receives “an additional compensation consisting of sixty-six and two thirds (66 2/3) per cent of the wage they earned on the day of the accident… for the number of weeks fixed in the table”. And two limits: “in no case shall the worker be paid more than sixty-five (65) dollars, nor less than twenty (20) dollars per week”. Note the difference: the weekly ceiling here is sixty-five dollars, not the two hundred of the transitory-disability dietas. They are different benefits with different caps.

2. 2

   Step 2: The absolute cap: twelve thousand dollars

   It appears twice in the article, and the second time is worth reading in full: “compensation for any disability recognised in this Act, except as later provided, shall never be more than twelve thousand (12,000) dollars, regardless of the number of accidents the worker suffers”. That last clause is the surprising one: the cap does not reset with each accident.

3. 3

   Step 3: Arms and legs

   Arms: loss of an arm at or above the elbow, three hundred weeks; loss of the right forearm in the upper or lower third, two hundred and twenty-five; loss of the left forearm in the upper or lower third, two hundred — and in cases of losing the left forearm the right-forearm compensation is granted “where that left forearm was the able limb”. Legs: amputation including part of the pelvis or hemipelvectomy, three hundred; disarticulation at the coxofemoral joint, two hundred and seventy-five; amputation through the upper third of the thigh, two hundred and fifty; through the lower third of the thigh, two hundred and twenty-five; at or below the knee with an unsatisfactory stump, two hundred; at or below the knee with a stump satisfactory in length, shape and general condition, one hundred and seventy-five.

4. 4

   Step 4: Feet, ankles and knees

   Loss of a foot by disarticulation at the tibiotarsal joint, one hundred and seventy-five weeks; loss of a foot by amputation at or below the ankle, one hundred and sixty. Knee ankylosed in a defective position, one hundred and fifty; knee ankylosed in a good position, one hundred and twenty. Ankle ankylosed in a defective position, one hundred and twenty-five; ankle ankylosed in a good position, one hundred. Loss of the big toe at the metatarsal-phalangeal joint, thirty; at the second joint, ten. Complete loss of any toe, fifteen.

5. 5

   Step 5: Hands and fingers

   Loss of the right hand at the wrist, two hundred weeks; loss of the left hand at the wrist, one hundred and eighty — and in cases of losing the left hand the right-hand compensation is granted where the left was the able hand. Thumb with the metacarpal bone, seventy-five; second phalanx of the thumb, thirty; first and second phalanges of the thumb, thirty-five. Complete index finger, forty; at the second phalanx, thirty; at the third, twenty. Complete middle finger, thirty; at the second phalanx, twenty; at the third, ten. Ring finger, twenty-five; at the second phalanx, twenty; at the third, ten. Little finger, fifteen; at the second phalanx, ten; at the third, five.

6. 6

   Step 6: Hearing and voice

   The table closes with three short entries: complete loss of hearing, two hundred weeks; complete loss of hearing in one ear only, fifty weeks; complete loss of the voice, two hundred weeks.

7. 7

   Step 7: Sight goes a different route

   Sight is not in the week table. Permanent visual disabilities “shall be determined and valued by the State Insurance Fund Administrator in accordance with the expert opinion of an oculist”. Partial ones are determined by the percentage of total disability they represent, taking into account the industrial visual efficiency of both eyes and applying “factors one and three, for the worse and better eye respectively”, or any future guide that is more liberal. And there is an extra item: loss of the eyeball by enucleation, evisceration or extreme atrophy is indemnified at ten per cent of total permanent disability “in addition to the resulting visual disability”.

8. 8

   Step 8: What is not in the table

   The Act anticipated the case. Compensation for any other unspecified permanent partial disability “shall be graded in accordance with the disability most closely resembling the corresponding disability fixed in the table”. And it gives three specific rules: disabilities from loss of function of three or more fingers, and those of the thumb and/or index — pincer functions — are graded by reflecting them on the hand; those resulting from loss of teeth are graded by reflecting them on the worker’s physiological functions. And if the disability cannot properly be fixed by the table, subsection (d-1) requires reflecting it on the general physiological functions, “and the compensation shall be computed on a base of four hundred and fifty (450) weeks as a maximum and may not be more than twelve thousand (12,000) dollars”.

9. 9

   Step 9: Scars and disfigurement

   It is a separate item and another agency decides it. “In cases where a scar, burn or any change in appearance causes disfigurement of the injured person’s face, head or neck or of one or both hands or arms, at the request of the State Insurance Fund Administrator or of the injured worker the Industrial Commission shall decide, according to the gravity of the injury, how much should be compensated on that account.” The caps: never more than three thousand dollars for disfigurement of the face, head or neck, and never more than one thousand six hundred for hands or arms. For hands or arms it is not compensated if the disfigurement was already taken into account when fixing compensation for disability of that hand or arm. The Industrial Commission grades the figure considering the importance of the disfigurement, the profession and trade and the sex of the injured person.

10. 10

    Step 10: A hernia has three tests

    The Act treats hernia separately because it is the case where causation is most disputed. In hernia cases resulting from an accident in the course of work it must be proved to the Administrator’s satisfaction and on medical testimony: (1) “That an accident occurred which was not a simple effort, which caused or aggravated the hernia.” (2) That the hernia appeared in either of two ways immediately after the accident and as its consequence. (3) That a pre-existing hernia is considered aggravated where the aggravation was produced by direct trauma on the hernia, or by extraordinary effort, or in the case of acute strangulation or incarceration occurring immediately after an accident and as its consequence, and where a pre-existing hernia becomes symptomatic after a work accident.

11. 11

    Step 11: Refusing surgery can cost you half

    This rule decides money and almost nobody knows it. In any compensable case where a surgical operation is necessary, the Administrator has the right to order a medical examination. If the examination shows the worker has a chronic disease or physical conditions that would ordinarily make the operation unsafe, they receive their compensation under the Act’s general conditions “even if they do not undergo that operation”. But if the examination shows no disease or condition revealing danger and the worker, knowing the results, still persists in refusing, “they shall only be entitled to half the compensation ordinarily due them under this Act”.

12. 12

    Step 12: If you need a device, they must provide it

    In permanent partial disability cases where the worker needs a special device or technological assistance equipment prescribed by a CFSE physician, “on issuing the final discharge, the Administrator shall provide that special device or technological assistance equipment”. And it may be replaced or repaired for justified cause “regardless of the date of the disabled worker’s claim”. The Administrator must establish by regulation what causes count as justified and the procedure to request it; we did not read that regulation.

13. 13

    Step 13: If you already had an injury

    Subsection (d-3) resolves three scenarios. If the work accident aggravates a previous disability that did not come from a work accident, the resulting disability is compensated including the previous one. If it aggravates a pre-existing disability caused by an earlier accident for which you already collected, what you received is deducted from the compensation for the resulting global disability. But if the aggravation results in total and permanent loss of the affected member or organ, or of the general physiological functions, “the worker shall be compensated for the total disability without taking the pre-existing disability into account even if compensation was collected for it”. The additional cost of that rule is charged to the catastrophe Reserve Fund and does not count towards the experience-based rating system.

14. 14

    Step 14: How they pay it: fifteen hundred and a hundred and fifty a month

    Subsection (f) sets how the partially disabled worker is paid. “In cases where the compensation is not more than one thousand five hundred (1,500) dollars, it shall be paid in a single payment. If it is more, an initial payment of up to one thousand five hundred (1,500) dollars shall be made to the worker and the balance shall be paid at the rate of one hundred fifty (150) dollars monthly beginning from the date of the decision in the case.” And where the compensation exceeds fifteen hundred, the Administrator has a duty to require the worker to put the amount, wholly or partly, into buying a farm or dwelling, acquiring a profitable business, technological assistance equipment or any other profitable investment; the Administrator investigates the investment and authorises it if shown to be safe and profitable.

Permanent partial disability is determined by the State Insurance Fund Administrator within the already open case, on discharge. Disfigurement is the exception: the Industrial Commission decides it, at the request of the Administrator or of the injured worker. Where minor or incapacitated beneficiaries are involved, the Administrator submits the case for the Industrial Commission to appoint a guardian under Article 13, which we did not read. The Act publishes no addresses or phone numbers in Article 3 and we read none here.

• Reading the table’s figures as dollars: they are weeks, and each week is paid at 66⅔% of the wage with a maximum of sixty-five dollars.
• Confusing this compensation’s weekly ceiling, sixty-five dollars, with the transitory-disability dietas’ ceiling of two hundred.
• Forgetting the twelve-thousand-dollar cap, which the Act applies “regardless of the number of accidents the worker suffers”.
• Not mentioning that the left hand or forearm is the able limb: in that case the Act grants the right-side compensation, which is more weeks.
• Believing you must physically lose the limb: complete and permanent functional loss affecting industrial capacity counts as total loss.
• Looking for sight in the table: it is valued separately, on an oculist’s opinion and with factors one and three for the worse and better eye.
• Not claiming the additional ten per cent for loss of the eyeball by enucleation, evisceration or extreme atrophy.
• Giving up on an injury not in the table: it is graded by the closest one, or reflected on the general physiological functions with a maximum of four hundred and fifty weeks.
• Not requesting a disfigurement assessment: the Industrial Commission decides it, up to three thousand dollars for face, head or neck and one thousand six hundred for hands or arms.
• Refusing an operation after the medical examination found no danger: the Act halves the compensation.
• Leaving final discharge without the prescribed device or technological assistance equipment: the Act requires the Administrator to provide it on issuing that discharge.

These are the government pages this guide is based on.

• Corporación del Fondo del Seguro del Estado (CFSE)

  Fondo del Seguro del Estado

  bvirtualogp.pr.gov