This has been prepared by, DANIEL J. WALKENHORST, Attorney at Law, to help answer many of the frequently asked questions regarding one’s rights under the Missouri Workers’ Compensation Law. Because of the complexity of the law, amendments to the law, and decisions by the courts, it is not intended to be a substitute to one’s right and opportunity to seek competent legal advice to protect one’s rights.
A. The basic benefits you may be entitled to are: medical benefits, temporary total disability benefits (lost wages), and permanent partial/total disability benefits.
A. Immediately report the injury to your employer or supervisor and ask them if they have a specific doctor they want you to see. Give them written notice of the time, place and nature of the injury so that they can arrange for medical treatment and complete the necessary reports.
A. Employee is legally required to provide the employer written notice within thirty (30) days of the date of accident. In many cases oral notice will suffice so long as there is no prejudice to the employer, but it is best to give written notice. Sometimes it is difficult to determine the seriousness of an injury, therefore, it is always best to report all accidents however slight they may be to prevent an employer from disputing whether an injury actually happened at work. It is important to give notice of your accident to someone who is a supervisor or in a management position. Your employer is required to file a Report of Injury with the Division of Workers’ Compensation.
A. Missouri law grants the employer / insurer the right to choose the physicians and other medical providers regarding your care and treatment. An Employer is required to pay such medical benefits without any deductible requirement by the employee. The employee is allowed the right to choose and treat with a physician or provider of their own choice. However, such costs for this medical care will be the employee’s responsibility. There are exceptions, such as emergency medical care where the Employer is not available to direct one to a particular provider, whereby, the employee may go to a provider of their own choice at the Employer’s expense.
A. If this happens, it is best to request the employer to provide a physician for a second opinion or the employee may choose a physician of their own choice in order to convince the Division of Workers’ Compensation that a different recommendation for treatment is more satisfactory.
A. Any employer who has five or more employees will be required to carry MO. Work Comp Insurance. However, an employer with less than five employees may voluntarily elect to be subject to the law by purchasing a MO. Worker Comp insurance policy. Also, all employers involved in the business of construction who have one or more employees are required to carry MO. Work Comp. Insurance.
A. Accidental injuries are usually injuries that occur more suddenly or at one definite point in time whereby occupational disease types of injury are those that usually occur gradually over a period of time. All injuries, whether by accident or by occupational disease, must arise out of and in the course and scope of the employment.
A. Once the employer refuses to offer or provide medical care upon request from the employee, the employer is considered to have waived the right under the law to choose the treating physician and the employee then has the right to arrange for their own medical treatment whereby the employer can then be required by the Division of Workers’ compensation to pay such medical care, provided such medical care was reasonable and necessary as a result of the work-related accident or occupational disease.
A. If an employee feels comfortable, and the facts are not complicated, then they may go ahead and give a statement. However, it is best not to allow a statement to be recorded as the insurance adjuster is generally not looking out for the employee’s best interests. If the facts are complicated or an employee is not comfortable, then they should consult an attorney before giving a statement.
A. Your loss wage benefit is classified as Temporary Total Disability (TTD). It will be two thirds (2/3) of your average gross weekly wages not to exceed the maximum amount allowed by law. Compensation is not paid for the first three (3) regularly scheduled work days the employee is unable to work, unless the employee is unable to work for fourteen (14) days or more in which the first three (3) regularly scheduled work days should also be paid. The TTD (loss wages) is tax free income.
A. TTD payments are to be paid while an employee is unable to work and until the “healing period” comes to an end. The healing period is considered to come to an end when the treating physician releases the employee at medical maximum improvement (MMI) or for full duty work. MMI occurs when a treating physician believes there is nothing, from a medical standpoint, that could be done to improve the employee’s medical condition.
A. An employee should make oneself available for light duty work even if they do not believe that their employer would normally provide them light duty as a result of an injury. In many cases where the injury is work related, an employer will offer light duty work where they normally would not for non-work related injuries. Therefore, it is the obligation of the employee to make themselves available for light duty work according to the doctor’s restrictions. You may refuse such work only if it would pose a danger of injury to yourself or others. If the employer requires the employee to perform light duty work outside of their physical limits per the treating doctors restrictions, they should contact the insurance company adjuster and request that they be returned to the doctor to discuss their light duty status.
A. Medical treatment which includes doctors’ bills, hospital care, lab costs, x-rays, physical therapy, medicine, etc., which has been authorized by the employer or their workers' compensation carrier must be paid by the employer/insurance carrier. There is no deductible to the employee. If an employee receives a bill for such treatment, they should submit the bill to the employer and notify the medical provider of its mistake in billing you for the payment. Medical providers may not demand or require employees to be personally responsible for employer/insurer authorized care provided under the workers’ compensation act. If an employee receives a bill related to authorized care, they should provide such medical provider or collection agency with written notice that the medical services rendered to such employee were due to a work-related injury. The written notice should include the name of the employer, employer’s insurer (if known), employee’s name receiving services, the general nature of injury (if known), whether a claim has been filed and its claim number (if known).
A. Missouri law provides 3 basic types of workers’ compensation benefits; medical care, to cure and relieve the employee’s injury including doctors’ bills, medicines, hospital costs, fees for lab tests, x-rays, crutches, physical rehabilitation, etc. There is no deductible to the employee and all costs are to be paid directly by the employer or their worker’s compensation insurance company. 2. Cash payment for loss wages (also known as TTD). Temporary Total Disability payments are made when the treating physician states that an employee is temporarily unable to work. If a person returns to light duty work they may also be entitled to Temporary Partial Disability payments. TPD payments will be made to employees who have returned to light duty work status and who are not able to make their regular average weekly wage because they are unable to work their regular hours per week or they are paid less than their normal wage pay because of light duty status. 3. If an employee suffers an injury which results in permanent disability, they may be entitled to either permanent partial disability (PPD) or possibly permanent total disability (PTD) depending upon their ability to work in the open labor market. A person may be permanently partially disabled (meaning that they have permanent disability to a body part) however there are still able to work in the open labor market. In this case, an employee should be entitled to a permanent disability payment or settlement. A person may also be entitled to permanent total disability compensation benefits (PTD) if they are not able to work anymore not just at their current job but also in the entire open labor market. In addition, if an injury results in death, compensation as well as burial benefits will be paid to surviving dependents.
A. If you are injured on the job, you must file a claim within two (2) years after the date of injury / accident, death, or last payment made. The payment made is generally construed to mean the last temporary disability payment or last medical treatment payment authorized by the employer/insurer on account of the accident, which ever comes last.
Note: Last payment must be authorized workers’ compensation benefits by the employer/insurer and not compensation from an employer or union health and welfare fund that excludes payments for workers’ compensation injuries. If you have an occupational disease, you must file a claim within two (2) years from the date that it is “reasonably discoverable and apparent” that you have sustained a compensable injury. In addition, if the employer fails to file a report of injury with the Missouri Division of Workers’ Compensation within the required time period, then the time period for filing the claim for compensation may be extended to three (3) years from the date of injury, death, or last payment, if not an occupational disease.
To protect and preserve your rights and benefits for permanent disability, you must file a formal claim on the official state approved form supplied by the MO. Division of Workers Compensation titled “Claim for Compensation”. If this form is not filed in time, you may have waived your right for compensation for permanent disability even though your employer has provided you with proper medical treatment and TTD benefits. Your employer is required to file a Report of Injury with the MO. Division of Workers Compensation, however, this does not constitute a claim for compensation on your behalf. If you do not actively file the claim on the official form in a timely fashion you will risk losing your benefits.
A. There is no set amount as to the value of compensation for any specific injury. The amount and value of compensation you will receive for permanent disability will depend upon several factors including you wage rate, the specific part(s) of your body that are injured and the degree of permanent disability resulting from the accident or occupational disease. Different individuals may suffer injury to the same body part, however, the value of their permanent disability may differ because of the degree and type of injury to that specific body part.
A. If an employee is found to have used non-prescribed drugs or alcohol in the work place they may subject to certain penalties provided that their employer has met certain criteria obtaining to notification of their drug or alcohol policy. If use of alcohol or non-prescribed drugs found to be used in “conjunction” with the work place, they employee may be subject to a 15% reduction in benefits. However, if such use is found to be the direct or “proximate” cause of the injury, the employee may be found to have completely forfeited the benefits. Various arguments arise as between the use of alcohol or drugs in conjunction which is proximate cause of the work place, therefore, even if there is a positive drug test be sure to pursue your benefits. If an employer violates a safety policy they may also be subject to a 15% penalty for benefits.
A. In many cases employees will recover from an accident or occupational disease do not have any permanent disability. However, there are many cases where an employee may be feeling fine for now but in time will begin to incur permanent disability as a result from the injury. If there is any question or doubt, it is always best to file a claim to protect your rights and benefits.
A. If you receive the proper medical care and TTD to which you are entitled, and do not incur any permanent disability, you may not need an attorney. However, if your employer disputes your claim, or proper medical care, or TTD benefits, it is advisable to consult an attorney. If your problem has a simple solution, the attorney may simply advise you of the steps you may take to resolve the matter. However, if the matter is more complicated, you may need an attorney to represent you. In many cases where there is permanent disability, it is advisable to seek representation because you probably will receive larger benefits if your are represented by an attorney even after the attorney receives a fee for representing you.