PROGRAM OPERATIONS MANUAL SYSTEMPart DI – Disability InsuranceChapter 521 – Workers' Compensation/Public Disability Benefit (WC/PDB) OffsetSubchapter 20 – State Specific Workers' Compensation (WC) ProceduresTransmittal No. 24, 11/26/2018
This is a Quick Action Transmittal (QAT). These revisions do not change or introduce new policy or procedure.
Summary of Changes
DI 52120.250 Vermont Workers' Compensation (WC)
The Vermont WC board now uses Form 16 Compromise Agreeements. It replaces Form 15 Settlement Agreement.
Subsection A.5. second bullet Form 15 replaced by Form 16 Comprimise Agreement.
Subsection G.4. Form 15 replaced by Form 16 Compromise Agreement.
Subsection H.fourth bullet - Form 15 replaced by Form 16 Compromise Agreement and new webpage to PDF version.
The Vermont Department of Labor (VDOL) administers the Workers' Compensation program. WC is provided through private carriers but employers may self-insure.
The Vermont statute covering WC payments is Title 21 (‘Labor’) Chapter 9 (‘Employer’s Liability And Workers’ Compensation’) Sections 601-711.
An additional $10 per week per dependent child under 21 is paid with all of the periodic WC types described below (before 07/01/1982, this amount was $5).
All periodic WC is subject to State minimum and maximum amounts. There are 2 State maximums; one for injuries before 07/01/1986 and one for injuries after 06/30/1986. The maximum amounts for the older injuries are smaller.
TT is based on the worker’s pre-injury average weekly wage. For injuries before 07/01/1994, the WC rate was 2/3 of the average weekly wage; for injuries 07/01/1994 or later a more complicated formula is used. Payments continue until maximum medical improvement is reached. A Notice of Intention to Discontinue Payments (Form 27) must be filed before TT payments can be stopped.
TP is paid when the worker is only able to perform part-time work. It is paid at 2/3 of the difference between his full and part time pay. A Notice of Intention to Discontinue Payments (Form 27) must be filed before TP payments can be stopped.
A worker who is found permanently and totally disabled first receives TT payments until a medical end result has been reached or the worker has demonstrated an ability to return to work. A Notice of Intention to Discontinue Payments (Form 27) is then filed. At that point the worker is entitled to a minimum of 330 weeks of PT benefits. After the carrier has paid 330 weeks of benefits:
If the worker is still unable to return to any type of gainful employment, permanent total benefits continue.
If the carrier presents evidence that the worker is working or is capable of obtaining regular gainful employment, they may discontinue benefits by filing a Form 27 Notice of Intention to Discontinue Payments. If the Form 27 is approved then PT benefits may cease.
If a worker is left with a permanent impairment from the work injury, he is entitled to this additional compensation for his permanent loss of function. PP is paid in addition to TT at the end of TT and is not reduced for TT previously paid. In Vermont, WC is only paid for disfigurement when it results in permanent impairment of function.
Injuries before 04/01/1995: PP was calculated according to the specific body part injured. Example: A worker injured a knee and a physician determined that he had a 10 percent impairment of the lower extremity. The PP awarded was based on his percentage loss of function: 21.5 weeks of PP WC (215 weeks based on the body part injured, times 10 percent, equaled 21.5 weeks).
Injuries on or after 04/01/1995: PP is calculated based on the ‘whole person’ impairment. The American Medical Association’s rating system is used, except that spine injuries must be calculated based upon 550 weeks: all other injuries are calculated based upon 405 weeks. Example: 20 percent spine impairments would entitle workers to 110 weeks of PP WC (550 weeks, times 20 percent, equals 110 weeks).
An order for a lump sum payment will usually include a provision accounting for excludable expenses and prorating the remainder of the lump sum payment.
Commuted Awards: Periodic permanent WC benefits may be paid in a lump sum upon written request from the worker. The WC department must be notified as to whether or not the carrier agrees to a lump sum payment and any amount agreed upon. A lump sum may also be ordered without the carrier’s agreement in limited circumstances.
Full and Final Settlement Agreements: Lump sums can also be paid to settle disputes over the compensability of a claim and/or the extent of WC due. Form 16, Compromise Agreement (Full and Final), is used for this purpose. Once executed by the parties and approved by the commissioner, Form 16 agreements relieve the employer of all further liability for WC benefits related to the injury. This form must be accompanied by a letter identifying the disputed issues, detailing the parties' respective positions, and fully explaining the terms of the proposed settlement.
NOTE: Police officers and firefighters who are injured in the line of duty (except for federal employees) ARE covered under Vermont’s WC law.
Anyone receiving periodic WC on July 1 is entitled to an increase in his WC rate, within the limits set by the law governing COLAs (21 V.S.A. 650d, Rule 16) as follows:
TT: The cost of living increase cannot cause the WC to exceed the worker’s average weekly wage or weekly net income, whichever was less.
TP: The cost of living increase must be adjusted weekly if the worker's wages vary from week to week. Dependency benefits are not included in the amount increased.
PP: The cost of living increase cannot cause the WC to exceed the average weekly wage, and dependency benefits are not included in the amount increased.
Minimum or Maximum WC rate being paid: The new minimum and maximum rates are set each year (and are shown on the Form 28).
Attorney fees for claimants are limited by policy to $90 per hour, or to 20 percent with a $9,000 maximum. In some cases the fee may be added to the WC award.
Vermont does not offset their WC for RIB.
A worker has 6 months from the date of injury to file a WC claim. A worker may only pursue a claim after the 6 month limit if he can show that the employer/carrier had knowledge of the accident or was not prejudiced by the delay. In no event may proceedings be started more than 6 years from the date of injury.
Vermont maintains a State file number for each WC claim. If you contact the State about a claim, be sure to give them the State file number. Contact information:
Vermont Department of Labor
Division of Workers' Compensation
Post Office Box 488
Montpelier, Vermont 05601-0488
Phone: (802) 828-2286
Fax: (802) 828-2195
Vermont law requires employers to provide WC insurance. Verification of an employer’s coverage (and insurance carrier) is available online. See the ‘Employers' Workers' Compensation Insurance Coverage Verification’ link under ‘REFERENCES’ below.
Once approved by the WC Division, Vermont WC forms awarding payments become binding agreements and (absent evidence of fraud or material mistake of fact) the parties are deemed to have waived their right to contest them. A claimant's failure or refusal to sign a compensation agreement offered by the employer does not preclude his right to continuing compensation benefits.
Form 2, Denial of Workers’ Compensation Benefits by Employer or Carrier: This form is sent to the worker when his claim is denied, and can be used to appeal that denial.
Form 10/10s, Certificate of Dependency and Employee Exemption Report: This form must be filed by any worker claiming WC indemnity payments, even when he has no dependents. It is used to determine his right to the additional weekly WC of $10.00 for each dependent child under 21.
Form 13, Report of Benefits and Related Expenses Paid: This form is filed on about July 1 each year, and also within 60 days after the final payment of medical or indemnity benefits. It specifically states the WC amounts paid to date.
Agreement (Full and Final): This form is used to settle disputes over the compensability of a claim or the extent of benefits due. Once executed by the parties and approved by the WC commissioner, it relieves the employer of all further liability for WC benefits related to the injury.
Form 21, Agreement for Temporary Total Disability: Used when the worker has been disabled from working for at least three days as a result of his work-related injury or occupational disease. If there has been a gap of more than 6 months between successive periods of disability related to the same injury, a new Form 21 must be filed.
Form 22, Agreement for Permanent Partial Disability: Used when the worker is deemed to have suffered a permanent impairment as a result of his work-related injury or occupational disease.
Form 24, Agreement for Temporary Partial Disability: Used when the worker has missed at least 8 days or parts of days from work as a result of his work-related injury or occupational disease and his average weekly wage is now lower than his pre-injury average weekly wage.
Form 25M, Memorandum of Payment: This form must be filed whenever a worker receives more than 90 calendar days of continuous TT.
Form 27, Notice of Intention to Discontinue Payments: Once the carrier determines that the worker has reached maximum medical improvement and so is no longer entitled to either TT or TP WC, they are required by law to notify both the worker and the WC Department of their intention to discontinue weekly temporary benefits by filing this form. Temporary WC cannot be terminated until this form is received by both the WC commissioner and the claimant. If the claimant is represented by counsel, a copy of the notice must also be sent to his attorney. A determination must then be made within 45 days as to whether the claimant has any permanent impairment as a result of the work injury.
Form 28 and Form 28a, Notice of Change in Compensation Rate: These forms are issued each year for the COLA increases in the weekly WC rates beginning July 1. Form 28 is used for injuries after 7/1/1986 and Form 28a is used for injuries before 7/1/1986.
Form 2, Denial of Workers’ Compensation Benefits by Employer or Carrier: http://labor.vermont.gov/Portals/0/WC/Form02.pdf
Form 10/10s, Certificate of Dependency and Employee Exemption Report: http://labor.vermont.gov/Portals/0/WC/Form10s.pdf
Form 13, Report of Benefits and Related Expenses Paid: http://labor.vermont.gov/Portals/0/WC/Form13.pdf
Form 16, Compromise Agreement: http://labor.vermont.gov/wordpress/wp-content/uploads//Form16Fillin.pdf
Form 21, Agreement for Temporary Total Disability Compensation: http://labor.vermont.gov/Portals/0/WC/Form21.pdf
Form 22, Agreement for Permanent Partial Disability Compensation: http://labor.vermont.gov/Portals/0/WC/Form22.pdf
Form 24, Agreement for Temporary Partial Disability Compensation: http://labor.vermont.gov/Portals/0/WC/Form24.pdf
Form 25M, Memorandum of Payment: http://www.labor.vermont.gov/Portals/0/WC/MOP.pdf
Form 27, Notice of Intention to Discontinue Payments: http://labor.vermont.gov/Portals/0/WC/Form27.pdf
Form 28 & 28a, Notice of Change in Compensation Rate: http://www.labor.vermont.gov/Portals/0/WC/Form28FY08.pdf http://www.labor.vermont.gov/Portals/0/WC/Form28AFY08.pdf
Vermont WC website: http://labor.vermont.gov/Workers/Injured/tabid/110/Default.aspx
Chart of Minimum and Maximum WC Rates: http://labor.vermont.gov/InfoCenter/Rules/WorkersCompensationRules/Rule16HistoricalWageRates/tabid/362/default.aspx
VT WC Law [Vermont Statutes: Title 21 (Labor) Chapter 9 (Employer’s Liability And Workers’ Compensation) Sections 601-711]: http://www.leg.state.vt.us/statutes/sections.cfm?Title=21&Chapter=009
Vermont WC Rules 1-46: http://labor.vermont.gov/Portals/0/WP%20Safety/Rules%201-46%204%2006.pdf
Employers' Workers' Compensation Insurance Coverage Verification: http://labor.vermont.gov/InfoCenter/WorkersCompensationInsuranceCoverageVerificat/tabid/1473/Default.aspx