The permanent total disability pension

It is subsection (d) of Article 3 of Act 45-1935: what counts as permanent total disability, how much the Fund pays monthly for it, what may be requested instead of the pension, and the three additional benefits the Act recognises — the payment to whoever cares for the disabled person, the help to adapt the dwelling, and the devices and technological assistance equipment.

The Act treats as total disability “the total and permanent loss of industrial vision in both eyes, the loss of both feet at the ankle or above; the loss of both hands at the wrist or above; the loss of a hand or a foot; total mental disturbances that are incurable, and injuries resulting in the total and permanent incapacity of the worker to do any kind of remunerative work or occupation”. That last clause is the general one: you need not be on the list if the injury leaves the worker unable to do any remunerative occupation.

• That the worker’s case be resolved as one of permanent total disability, per the definition in Article 3(d) itself.Verified against the official source
• To collect a lump sum instead of the pension: requesting it, and justifying an investment the Administrator judges profitable.Verified against the official source
• For the housing benefit of up to two thousand dollars: presenting reliable evidence of the need to carry out the construction or improvements and that you lack the economic resources to pay for it.Verified against the official source
• For the payment to whoever attends the disabled person: that in the Administrator’s judgement their physical or mental condition requires another person’s continuous assistance, and while that need persists.Verified against the official source

Information pending verification.

1. 1

   Step 1: The pension: between a hundred and thirty and four hundred and thirty

   Article 3(d) says that if the worker’s case is resolved as one of permanent total disability, “the worker shall continue receiving a sum equal to sixty-six and two thirds (66 2/3) per cent of the wage they earned on the day of the accident for as long as this total disability lasts, but in no case shall more than four hundred and thirty (430) dollars monthly, nor less than one hundred and thirty (130) dollars monthly, be paid”. Note the unit here is monthly, not weekly: these are the Act’s two benefits counted by month, this one and the death one.

2. 2

   Step 2: Retroactive, but only twelve months

   The same sentence adds a rule worth keeping in mind from the start of the case: “this pension shall be paid retroactive to the date of the accident, but the retroactive payment shall never exceed twelve (12) months”. That is: the pension reaches back to the accident, but the retroactive part is capped at a year, however long the wait for the decision was.

3. 3

   Step 3: Taking it in one go: the investment option

   The Act allows swapping the life pension for a single payment, but not automatically. “At the beneficiary’s request, and instead of the life pension, the Administrator may pay the beneficiary the compensation, in part or in full and at once, provided they justify a profitable investment in the Administrator’s judgement.” The computation runs on a base of five hundred and forty weeks, for a term which, added to what was already collected in monthly payments, does not exceed five hundred and forty; the weeks are computed at sixty-six and two thirds per cent of the weekly wage, “but in no case shall weeks of more than one hundred (100) dollars nor less than thirty (30) dollars be computed”. And the cap: “the total compensation to be paid shall in no case exceed thirty-two thousand four hundred (32,400) dollars”. If a remainder is left after the investment, it is paid at three hundred dollars monthly, unless another investment is chosen.

4. 4

   Step 4: Eighty dollars a month for whoever cares for you

   It is a small benefit in money and a large one in that almost nobody knows it exists. “Where in the Administrator’s judgement the disabled person’s physical or mental condition requires the continuous assistance of another person, the Administrator may authorise the additional payment of no more than eighty (80) dollars monthly in favour of the relative or person who attends the disabled person while the need persists.” The payment goes to whoever provides the care, not to the disabled person. The Act adds that the Administrator “may offer assisted medical equipment, Technological Assistance services and equipment, where deemed pertinent on the corresponding specialised evaluation”.

5. 5

   Step 5: What counts as total disability

   The Act lists and then generalises. “There shall be considered total disability the total and permanent loss of the industrial vision of both eyes, the loss of both feet at the ankle or above; the loss of both hands at the wrist or above; the loss of a hand or a foot; total mental disturbances that are incurable, and injuries resulting in the total and permanent incapacity of the worker to do any kind of remunerative work or occupation.” That last clause is the wide door: if the injury leaves the worker unable to do any remunerative occupation, it is total disability even if it is not on the list.

6. 6

   Step 6: Two thousand dollars to adapt the dwelling

   The Act writes it as a duty, not a power. “Where the injured worker proposes to build a dwelling for their own use specially designed to ease their movement, or to adapt one they own, or to fit out its access for the aforementioned purposes, the Administrator shall grant them as an additional benefit a sum of no more than two thousand (2,000) dollars.” It is granted once per injured worker, provided they present reliable evidence of the need and that they lack the economic resources to pay for it. It may be granted on later occasions if it is shown the residence must be reconditioned because the condition worsened and the worker lacks the resources. The Administrator supervises the investment of that sum.

7. 7

   Step 7: The devices, at final discharge

   The same rule as in permanent partial disability: in permanent total 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”. It may be replaced or repaired for justified cause, regardless of the claim’s date, and the Administrator must set those causes and the procedure by regulation.

8. 8

   Step 8: If you are rehabilitated, you do not lose the pension

   It is the subsection’s most protective sentence and worth reproducing. If a worker totally and permanently disabled by having totally and permanently lost the industrial vision of both eyes; both feet at the ankle or above; both hands at the wrist or above; a hand and a foot; or by having become paraplegic or quadriplegic, or by having permanently lost the functions of both legs such that they must move in a wheelchair, “despite that condition is rehabilitated in any other area of industry, the benefits and compensation they are entitled to for the permanent total disability shall not be suspended, even if the Industrial Commission determines that the disability has ceased”. Going back to work does not take the pension away in those cases.

9. 9

   Step 9: Spinal cord injuries: treatment with no time limit

   The subsection closes by recognising a specific right: “these workers with spinal cord injuries who have been left totally disabled are recognised the right to receive treatment, special devices, technological assistance and spinal cord therapy for as long as is necessary”. There is no ceiling of weeks or years in that sentence: the measure is the need.

10. 10

    Step 10: If the worker dies of another cause

    The Act resolves the case where the worker dies of a cause independent of the injury while a permanent total disability was recognised, or pending recognition. If they had opted for an investment, the remainder of their compensation is paid to the beneficiaries in monthly payments of four hundred and thirty dollars. If they had not opted for an investment, the total compensation is computed by multiplying five hundred and forty weeks by the weekly compensation — with no week computed above a hundred dollars or below thirty, and not exceeding thirty-two thousand four hundred in total — what was already paid to the worker before death is deducted and the remainder goes to the beneficiaries. If what had been recognised was a permanent partial disability, the Administrator must order the unpaid balance paid to those who depended on the worker for their subsistence, including any pending transitory-disability dieta, and those payments are made within a term not exceeding twelve months.

11. 11

    Step 11: The surviving spouse’s investment

    Where there is a remainder to be paid to beneficiaries, the Act lets the Administrator advance the surviving spouse or concubine up to fifty per cent of the total value of their future monthly payments, to make an investment he judges profitable. Once made, the monthly payments against the remainder are reduced proportionally so the payment period stays unchanged, disregarding the Act’s minimum monthly amounts. More than one investment may be authorised to the same spouse or concubine, “but never more than one in a period of three (3) consecutive years”. And the monthly payments against the remainder cease if that person marries, lives in concubinage or dies; if there are dependent minors entitled to benefits, their monthly amount is increased by distributing among them, with preference, what the spouse or concubine was receiving.

Permanent total disability is resolved by the State Insurance Fund Administrator within the case already open for the injury. The lump-sum option, the housing benefit and the monthly payment to whoever attends the disabled person are requested from the Administrator himself, who investigates and authorises. The Administrator’s decisions are appealed to the Industrial Commission. The Act publishes no addresses, phone numbers or forms in Article 3, and we read none here, so we do not invent them.

• Confusing this pension’s monthly caps with the transitory-disability dietas’ weekly caps: they are different scales.
• Expecting the retroactive payment to cover the whole wait: the Act limits it to twelve months even if the decision took longer.
• Requesting the lump sum without a justified investment: the Act conditions it on the beneficiary justifying an investment the Administrator judges profitable.
• Assuming the lump sum equals the pension: it is computed with its own weekly cap of a hundred dollars and an overall ceiling of thirty-two thousand four hundred.
• Not requesting the eighty dollars monthly for the relative or person attending the disabled worker where the condition requires continuous assistance.
• Not requesting the sum of up to two thousand dollars to build or adapt the dwelling: the Act says the Administrator “shall” grant it where the need and lack of resources are proved.
• Believing that housing benefit is once and for all: it may be granted again if the condition worsens and the residence must be reconditioned.
• Leaving final discharge without the prescribed special device or technological assistance equipment.
• Refusing rehabilitation for fear of losing the pension: in the cases the Act lists, the benefits are not suspended even if the Industrial Commission determines the disability has ceased.
• Not knowing that a totally disabled worker with a spinal cord injury has the right to treatment and therapy “for as long as is necessary”.

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