STATE INSURANCE FUND CORPORATION.


LEGAL AUTHORITY

Act 45 of April 18, 1935, known as the Workers Compensation Act, as amended, established the State Insurance Fund as a corporation of the Government of Puerto Rico.

MISSION

To promote the safety and well-being of the inhabitants of Puerto Rico by tending occupational accidents, injuries, diseases, or deaths. To offer medical services, rehabilitation and economic compensation to our workers so they may return to their workplace in the least possible time. To manage and to regulate the workers' insurance to which the employers must be subscribed for the compensation of injuries or diseases, as defined by the Workers Compensation Act.

ORGANIZATIONAL STRUCTURE

  • Administration
  • Board of Directors
  • Contract Management
  • Corporate Compliance
  • Corporative Security
  • Finances, Information System and Actuarial Affairs
  • Internal Audit Office
  • Judicial Council
  • Labor Relations and Employment Equality
  • Medical Area
  • Office of the Administrator
  • Operations
  • Public Information
  • Technical Board of Insurance



PROGRAMS

Administrative Services, Workmen's Insurance Affairs and Claims

Program Description

Manages and regulates all aspects of workers insurance, including the processing of claims, administrative functions and support service. The Program is composed by the Offices of the Administrator, Internal Audit, Contract Management, Corporate Security and Public Information; as well as the Areas of Administration, Finances, Information Systems, Actuarial Affairs, and the Legal Department.

Statistical Data 2011 2012 2013

 

Active cases 48,417 48,800 48,671
Cases filed 58,227 57,835 57,265
Cases in arrears 47,889 48,417 48,800
Cases in employment 33,007 33,330 33,242
Cases not working 15,410 15,470 15,429
Closed cases 65,579 65,218 65,046
Complaints investigated 10,182 10,144 10,044
Disability benefit payments ($) 182,200 170,000 169,000
New policies formalized 39,960 40,525 39,850
New policies imposition 37,897 36,478 35,870
Reopen cases 7,880 7,766 7,653
Research and investigations 13,294 13,244 13,114

The statistical data was provided by the Agency during the Fiscal Year 2012-2013 budget formulation process.

Customers

All the employers and workers that file a claim as a consequence of some work related accident whether the employer is insured or not.

Medical Services to injured workers

Program Description

Offers medical examination services to injured workers, ambulatory medical treatment, physical rehabilitation, hospitalization, surgery and social services. Also, it provides rehabilitation services through the Department of the Family.

Statistical Data 2011 2012 2013

 

Admissions 2,308 2,285 2,263
Assessment service to patients in clinics 496,060 495,805 495,549
Average stay 9 9 9
Daily Average Census 57 56 56
Days/Patient 20,737 20,549 20,363
Deaths and Discharges 2,319 2,303 2,287
Hospitalization services to patients in industrial hospital 150,587 145,665 140,904
Number of beds 108 108 108
Occupancy rate 53 52 52

The statistical data was provided by the Agency during the Fiscal Year 2012-2013 budget formulation process.

Customers

Workers injured by some accident or occupational injury



FISCAL YEAR 2012-2013 PROPOSED BUDGET

The proposed consolidated budget for Fiscal Year 2012-2013 amounts to $508,718,000 from Internal Sources generated from private and public employers insurance premiums, as established by Act 45 of April 18, 1935, as amended, known as the Workers Compensation Act.

The Revenues from Internal Sources are distributed as follows: $474,600,000 for operational expenses; $34,118,000 for capital improvements, of which $23,706,000 are for renovation work at the Industrial Hospital and $10,412,000 to refurbish facilities at the central and regional offices.

The Capital Improvement fund reflects a decrease of $19,795,000. This amount was part of the approved 2011-2012 budget for the purchase of two buildings to transfer the Industrial Hospital and the Central Offices.

The proposed budget will allow the Corporation to focus on the quality and effectiveness of the services provided; specifically the physical and mental rehabilitation of injured workers. Resources will be assigned to the following areas: medical evaluations by rehabilitation specialists, hospitalization, surgery, prescriptions, x-rays, and laboratories.

These resources will help the Corporation meet its goals and programmatic commitments; standardization of policies, increase revenues from premiums, faster recoveries and to provide additional services to the Industrial Hospital and other areas of the community. They will also allow the Corporation to comply withits Organic Act and promote the well-being of workers by guaranteeing worker's right to receive quick and efficient medical attention, appropriate compensation and to guarantee an effective administration of the Worker's Insurance Fund.



SUMMARY OF AVAILABLE RESOURCES

Consolidated Budget  (thousands $) 2010 2011 2012 2013

 

Program  
Operational Expenses Actual Actual Budget Proposed
Administrative Services, Workmen's Insurance Affairs and Claims 148,762 139,385 133,957 132,505
Medical Services to injured workers 319,234 288,843 340,648 342,095
Subtotal, Operational Expenses 467,996 428,228 474,605 474,600
 
Capital Improvements
Administrative Services, Workmen's Insurance Affairs and Claims 525 2,648 13,980 10,372
Medical Services to injured workers 65 5,974 39,933 23,746
Subtotal, Capital Improvements 590 8,622 53,913 34,118
Total, Program 468,586 436,850 528,518 508,718
 
Funding Sources  
Operational Expenses  
Revenues from Internal Sources 467,996 428,228 474,605 474,600
Subtotal, Operational Expenses 467,996 428,228 474,605 474,600
 
Capital Improvements  
Revenues from Internal Sources 590 8,622 53,913 34,118
Subtotal, Capital Improvements 590 8,622 53,913 34,118
Total, Funding Sources 468,586 436,850 528,518 508,718
 
Expense Category  
Operational Expenses  
Payroll and Related Expenses 345,103 334,732 339,782 343,381
Rent and Utilities 9,797 10,222 10,749 11,171
Purchased Services 75,316 51,399 72,917 73,088
Donations, Subsidies, and Distributions 1,163 806 1,000 1,000
Transportation Expenses 1,991 1,801 1,749 1,466
Professional Services 3,712 6,179 7,839 7,691
Other Expenses 7,255 2,651 4,476 3,569
Equipment Purchases 1,181 406 14,479 11,620
Office Supplies and other Materials 22,402 20,025 21,564 21,564
Advertising and Media Expenses 76 7 50 50
Subtotal, Operational Expenses 467,996 428,228 474,605 474,600
 
Capital Improvements  
Capital Improvements Program 590 8,622 53,913 34,118
Subtotal, Capital Improvements 590 8,622 53,913 34,118
Total, Expense Category 468,586 436,850 528,518 508,718