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New Hampshire Second Injury Fund Employee Information Sheet (Optional)

State:
New Hampshire
Control #:
NH-SKU-1196
Format:
PDF
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Second Injury Fund Employee Information Sheet (Optional)
The New Hampshire Second Injury Fund Employee Information Sheet (Optional) is a document that employers can use to provide additional protection to an employee who has suffered a work-related injury that has caused a disability. This document can help protect the employee from being dismissed or having their wages reduced due to their disability. The information sheet is optional, and employers may choose to use it or not. It includes information about the employee’s disability, the date of the injury, the medical treatment received, and the current status of the employee's disability. There are two types of New Hampshire Second Injury Fund Employee Information Sheets: the Standard Form and the Optional Form. The Standard Form is used if the employee has received disability benefits from the Second Injury Fund and the Optional Form is used if the employee has not received any disability benefits. By providing this additional information, employers can help protect their employees from any further discrimination or unfair treatment due to their disability.

The New Hampshire Second Injury Fund Employee Information Sheet (Optional) is a document that employers can use to provide additional protection to an employee who has suffered a work-related injury that has caused a disability. This document can help protect the employee from being dismissed or having their wages reduced due to their disability. The information sheet is optional, and employers may choose to use it or not. It includes information about the employee’s disability, the date of the injury, the medical treatment received, and the current status of the employee's disability. There are two types of New Hampshire Second Injury Fund Employee Information Sheets: the Standard Form and the Optional Form. The Standard Form is used if the employee has received disability benefits from the Second Injury Fund and the Optional Form is used if the employee has not received any disability benefits. By providing this additional information, employers can help protect their employees from any further discrimination or unfair treatment due to their disability.

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FAQ

Under the New Hampshire Workers' Compensation Law RSA 281-A:5, every employer who has any employees, full or part-time, is required to cover these employees with workers' compensation insurance written by a carrier. It does not matter if they are related, such as daughter, son, husband, etc.

An employee's weekly compensation is 60% of their average weekly wage.

What Does the Second Injury Fund Do? The workers' comp Second Injury Fund assumes liability for compensation benefits attributable to prior injuries or illnesses. This happens when a worker subsequently becomes totally disabled because of a workplace injury.

Workers' Compensation for New Hampshire Workers. If you are hurt at work, workers' compensation (or "workers' comp") pays your medical bills. It also pays 60% of your lost wages after you miss more than three days of work. Workers' compensation is a type of insurance that all employers MUST provide.

Division of Federal Employees', Longshore and Harbor Workers' Compensation (DFELHWC) The Special Fund (also known as the "Second Injury Fund") pays certain types of claims and expenses authorized by the LHWCA.

The only business exempt from the work comp requirement to carry workers' compensation coverage are sole proprietorships (self-employed persons) and corporations which have only three corporate officers and no employees other than these three officers.

Statutes of Limitation for Injured Employees The injured worker has two (2) years from the date of injury to notify the employer of his injury in order to make a claim for benefits.

Under the New Hampshire Workers' Compensation Law RSA 281-A:5, every employer who has any employees, full or part-time, is required to cover these employees with workers' compensation insurance written by a carrier. It does not matter if they are related, such as daughter, son, husband, etc.

More info

Download Second Injury Fund Employee Information Sheet (Optional – Labor (New Hampshire) form. 2nd Injury Fund Forms.Forms and Publications. Woman completing form. Historical data can be found on the last page. Missouri's Second Injury Fund (SIF) can help an injured worker, or the survivors of an employee who lost their life at work, in certain situations. Review your insurance coverage and reporting requirements. ▫ Take steps to prevent injuries and control costs. Call 800-252-7031, option 1. Form nameVersion dateNotesAffidavit of Significant Financial Hardship (AS01)June 2018Legislative changesDisability Status Report (DS01)September 2012Employee's Claim Petition (EC04)June 2018Legislative changes

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New Hampshire Second Injury Fund Employee Information Sheet (Optional)