Puerto Rico's system of workers' compensation is compulsory, meaning that employers are required to provide workers' compensation insurance to their employees. Workers' compensation insurance is provided through a government fund. Waivers are not permitted.
In Puerto Rico, most agricultural workers are entitled to workers' compensation insurance coverage. Casual workers may be excluded from workers' compensation coverage.
In Puerto Rico, full medical benefits are provided to employees entitled to worker's compensation benefits, with no time or monetary limits. Physical rehabilitation benefits are covered under medical services. Vocational rehabilitation benefits are available. The employer normally selects the primary treating physician (PTP) who the injured worker sees during the first thirty days, although in some situations the worker may be able to receive treatment through a predesignated doctor. After thirty days an injured worker can choose a different primary treating physician, although the choice may be limited to participating providers if the worker's employer offers a Health Care Organization (HCO) or medical provider network.
Indemnity benefits are payable to injured workers to help make up for lost income. An injured worker is expected to submit a formal claim within five days of a traumatic injury. For occupational illness, a worker normally has three years to submit a claim form, although that period may potentially be extended for a latent illness that is not detected by the worker at an earlier date.
Benefits available to injured workers include the following:
Temporary Total Disability (TTD)
Temporary total disability (TTD) benefits are paid to workers who are unable to work due to injury, but who are expected to make full or partial recovery such that they may return to work. In Puerto Rico, these benefits are called Dietas. Benefits are based upon the worker's average weekly wage, with a maximum weekly payment of $100. Payments continue until maximum medical improvement, (alta definitive, or alta) or until return to work (condicion trabajar, or CT), but may be paid continuously or intermittently until the maximum benefit has been paid or ITP benefits are awarded. Dietas benefits may be paid for a maximum of 312 weeks.
Permanent Total Disability (ITP)
When a worker is not expected to recover from a total disability caused by a work-related injury, and as a result suffers a total loss of earning capacity, the worker becomes eligible for permanent total disability benefits. In Puerto Rico, these are known as Incapacitado Total Permanente (ITP) benefits. When a worker is determined to be 100% disabled, the worker receives a life pension at a fixed rate. Workers may seek a lump sum payment instead of a life pension.
Permanent Partial Disability (IPP)
Once an injured worker has recovered to the maximum possible extent, the worker may be able to return to employment but nonetheless remain partially disabled, and in most states may potentially qualify for permanent partial disability benefits. In Puerto Rico, these benefits are known as Incapacidad Parcial Permanente (IPP) benefits. IPP benefits are paid based upon the percentage of total disability to the injured worker, funciones fisiologicas generales (FFG). An injured worker may ask for part or all of the IPP benefits to be paid as a lump sum, or "PP Investment" payment.
Scheduled awards are paid in addition to total temporary disability benefits starting upon termination of the termination of the TTD benefits. Scheduled awards are not reduced because of receipt of TTD benefits.
Benefits may be available for disfigurement resulting from serious scars, burns, or changes in the physiognomy of the face, head or neck. Disfigurement of the hands and arms may be compensable if not considered in determining any other compensation.
With certain constraints and filing deadlines, occupational hearing losses may be compensable.
Death benefits are payable to an employee's surviving spouse, or spouse and children, based upon a percentage of the employee's wages, subject to a cap. A minimum benefit is provided regardless of the employee's earnings. A burial allowance is available.
Attorney fees for claimants are approved by the agency on a case-by-case basis. In certain cases, the attorney fee may be added to the award.
This article provides a quick overview of the benefits available to injured workers, but the full formulas used for assessment of benefits, coordination of different types of benefits, and assessment of injuries and disability ratings can quickly complicate the determination of benefits. Also, governments frequently revise their workers' compensation laws. Most workers who suffer a significant injury or wage loss as the result of a workplace injury will benefit from consulting a workers' compensation lawyer.
The agency responsible for workers' compensation is:
Puerto Rico Industrial Commission
Urb. La Riviera Calle 3 SE
311 Bo.Monacillos Rio
Piedras, PR 00936-4466