This article provides statistical information regarding the Vermont workers’ compensation system.  It covers Vermont information including:

-  employment    -  adjusting activities          -  administration
-  work injuries    -  investigations                 -  formal hearing
-  benefits           -  settlements

 Employment1:

 Employers:  23,658    Labor Force:  350,000    Employment:  337,000

 Work Injuries:

 Pursuant to 21 V.S.A. §701, employers are required to report on a Form 1 work injuries that either: require medical attendance; or, result in an absence from work for one day or more.  The following data show Form filings from 1998 – 2001:

1997  -  24,602
1998  -  24,305
1999  -  24,868
2000  -  24,599
2001  -  24,397

Lost Time Injuries:

 A compensation agreement must be filed in a workers’ compensation claim in which the worker is totally disabled from work for three days or more.  The lost time claims figure is based upon filings of compensation agreements.

-         Annual Filings of Lost Time Claims:             5,160
-         Most Frequent Lost Time Injury:                 Low back injury
-         Most frequent cause of lost time injury:       Overexertion; strain

 Wage and Benefit Information:

 There are five different workers’ compensation benefits:

-         Medical;
-         Lost wage compensation;
-         Permanent Impairment;
-         Vocational Rehabilitation;
-         Death

An injured worker may be entitled to one benefit, or several, depending upon the nature and severity of the work injury.

-         Statewide Average Weekly Wage:  $576.00
-         Benefit Rate:  2/3rds of worker’s average weekly wage

 Permanent Partial Disability Benefits:

 Permanent Partial Disability (PPD) benefits are provided to a worker who suffers a work injury that results in a permanent impairment of function.  The worker’s permanency rating must be assessed by a physician.  Vermont law requires that the permanency rating be based upon the AMA Guides to the Evaluation of Permanent Impairment. 

  Annual Permanent Impairment Agreements:  1,500  

 Average PPD Rating:  5.8% whole person impairment for an injury to the spine; or

                                   7.9% whole person impairment for an injury to another body part

Note:  Vermont has a higher frequency of permanent partial disability awards and a lower average award than in neighboring states. 

  Vocational Rehabilitation:

 Vocational Rehabilitation (VR) refers to the services and benefits that can assist an injured worker in returning to suitable work. Vermont has a mandatory vocational rehabilitation system.  An Entitlement Assessment must be performed for an injured worker who is disabled due to a work injury for 90 days, or otherwise identified as being unable to return to suitable employment. 

-         Annual Referrals:  950
-         Average VR Benefit Cost:  $1,800            

  Claims and Costs:

 A “claim” is defined here as any reported work injury with a subsequent filing requiring departmental action.

-         Claims Per Year:  8,000
-         Average Claim Cost:  for 1999: $5,536.; for 2000: $6,604.; for 2001: $8,110.

 Adjusting Activities:

 Employers are represented in a worker’s compensation claim by their workers’ compensation insurance carrier.  Vermont requires that all workers’ compensation adjuster’s be licensed by the state.  Only a licensed adjuster may adjust a claim.  Adjusting activities include but are not limited to: investigation; claim acceptance or denial, form filings; discontinuance of benefits and other adjusting activities.  In Vermont in 2002 we had:

-         429 Vermont licensed workers’ compensation adjusters
-         Denials:  900
-         Form 27, Discontinuance of Benefits:  1,500
-         Form 27 Review by the Department :  Approval:  80%      Rejection:  20%
-         Most Frequent Basis for Discontinuance:  Medical End Result2

 A Form 27 may be filed to discontinue either medical or lost wage benefits. The adjuster must provide evidence supporting discontinuance of the benefit.  

 Workers’ Compensation Administration:

The worker’s compensation division within the Department of Labor & Industry administers the workers’ compensation program.  As a neutral governmental agency it: receives forms that must be mandatorily filed by employers and insurance carriers; reviews wage information to ensure accuracy in benefit computations; mediates disputed and monitors insurance coverage.  Administrative functions annually include:

-         Data entry of 45,000 forms
-         Mediation and/or review of 8,000 claims per year
-         Review and approve 3,700 lost time compensation agreements (Forms 21 and 24)
-         Review and approve 1,500 permanency agreements (Form 22)
-         Review 1,500 discontinuances (Form 27); reject or approve
-         Mediate via conference 900 disputed matters
-         Approve attorney liens; withdrawals; fee requests
-         Monitor provision of vocational rehabilitation benefits
-         Monitor insurance coverage tracking of employers

 Formal Hearing:

 Disputed matters are initially addressed at the informal level.  If the dispute cannot be resolved, any party may request referral to formal hearing.  The Department has one Workers’ Compensation Hearing Officer who presides over the formal hearing.  Either party may appeal the formal hearing decision to court.   Roughly half of cases referred for hearing are resolved between the parties prior to hearing.  Annual data indicates:

-         150 claims are referred to formal hearing
-         60 – 80 formal hearings conducted
-         30% of formal hearing decisions are appealed
-         appeals are filed by claimants and defendants fairly evenly

In addition, the following table indicates the prevailing party over five years:

 Settlement Agreements:

 The parties to a workers’ compensation dispute may enter into a settlement agreement to resolve their dispute(s).  The settlement usually involves payment by the insurance carrier, of a specified sum of money representing payment of disputed benefits to the injured worker.  Once the agreement is signed and agreed to by both parties and approved by the Commissioner, it is enforceable.  The Commissioner may approve an agreement that is in the injured workers’ best interests.  The department annually approves:

-         200 Form 15 (global) settlement agreements
-         50 Form 14 (medical benefits open) agreements

Investigations and Administrative Citations:

The workers’ compensation division performs investigations upon receipt of information indicating a violation of workers’ compensation rules or evidence of fraudulent activity.  The two most common complaints are fraud and failure to maintain insurance coverage.  In the event an investigation supports a violation, the department may issue an administrative penalty.  In 2002 workers’ compensation investigations included:

-         15 Investigations of fraudulent activity

-         Failure to maintain insurance coverage