Appealing a Missouri Workers Compensation Denial
If your Missouri workers’ compensation claim is denied, or you are unsatisfied with a benefits decision in your case, you have a right to appeal that denial or determination.
If your Missouri workers’ compensation claim is denied, or you are unsatisfied with a benefits decision in your case, you have a right to appeal that denial or determination. (For information on the basics, see our article on Missouri worker's comp.)
You should contact an attorney before considering any appeal. An attorney can discuss the appeals process with you and assess your chances of succeeding on appeal. Your attorney can also represent you throughout your workers’ compensation claim to ensure your interests are being adequately protected.
There are multiple levels of appeal in Missouri workers’ compensation, and additional voluntary alternative dispute resolution alternatives. These options are explained in detail below.
Dispute Management Services
The first possible level for you to appeal your case to is the Missouri Workers’ Compensation Division’s Dispute Management Unit. You may contact the Dispute Management Unit to request mediation. Mediation is a voluntary process, so your employer and/or its workers’ compensation insurance carrier will have to agree to participation in the mediation.
If your employer agrees to mediate using Dispute Management Services, a mediator with the Division will contact you by telephone to discuss the case. The mediator will attempt to facilitate negotiations to see if you can reach any sort of agreement. The mediator will not issue a written decision or determination of any kind.
If the mediation is not successful, either party may file a Claim for Compensation with the Division.
One alternative to Dispute Management Services is a Conference with an administrative law judge (ALJ). Like mediation with the Division, the Conference occurs prior to filing a Claim for Compensation.
Either party may contact the Division and request a Conference with an administrative law judge by completing the Request for Conference form available from the Division. You will receive a “Notice for Conference” detailing when and where the Conference will take place.
The Conference is an informal meeting between the parties to see if an agreement can be reached. If you and the insurance company come to an agreement, then the dispute ends at this appellate level. If not, either party may file a Claim for Compensation.
Claim for Compensation
If you did not reach an agreement in either the mediation or Conference, or if you or your employer chose not to participate, you may file a Claim for Compensation. This is a form available from the Division. A Claim for Compensation is the first required, formal level of appeal.
Once you file the Claim for Compensation, you may also file the Request for Pre-Hearing to set a date for a pre-hearing conference. A pre-hearing conference is appropriate if you want another chance for an informal meeting with the employer's insurance company, or you did not have a mediation meeting previously through a Conference or Dispute Management Services.
Request for Mediation
You may also file a Request for Mediation. Formal Mediation is appropriate where there are matters to be addressed prior to your appeal continuing, a final rating report has been issued but you disagree with it or your requests for medical treatment have been denied and your doctor continues to recommend the medical treatment.
Request for Hearing
You must request one of two types of hearings for your appeal: a Hardship Hearing or a Final Hearing. You should request a Hardship Hearing if your doctor has determined you are not yet at maximum medical improvement (MMI) and you need additional medical treatment or temporary total disability benefits. You should request a Final Hearing if you have reached maximum medical improvement and your case is ready for final resolution.
To file a request for your hearing, you should obtain the forms from the Division – either a Request for Hardship Hearing form or a Request for Hearing-Final Award form, depending on the type of hearing you need.
Final or Hardship Hearing and Award
Regardless of which type of hearing you request, an administrative law judge will conduct formal, legal hearing regarding the issues in your case. You should have an attorney to represent you. Your attorney will present evidence on your behalf, including medical evidence, to establish the facts necessary for your particular appeal. Your employer or its insurance company will also have the chance to have an attorney present evidence to the judge.
The administrative law judge will then render one of three types of Awards: a Final Award, a Temporary/Partial Award, or an Award on Agreed Statement of Facts.
A Final Award is just that -- a final determination by the judge of the issues on appeal in your case. This is the final resolution of your case as determined by the administrative law judge. You can further appeal a Final Award to the Missouri Labor and Industrial Relations Commission.
A Temporary/Partial Award is issued usually following a Hardship Hearing and addresses only the medical treatment or benefit issues on appeal. The case remains open until a Final Award can be rendered. You can further appeal a Temporary/Partial Award to the Missouri Labor and Industrial Relations Commission.
An Award on Agreed Statement of Facts is an award addressing only legal issues where the parties agree entirely on the facts.
Appeals to the Labor and Industrial Relations Commission
You or your employer's insurance company may appeal an award from the administrative law judge within 20 days of the issuance of the award. To appeal, you must file an “Application for Review” with the Commission.
The three-member Commission panel will review the transcript of the trial proceedings with the administrative law judge. Both you and your employer will need to submit legal briefs to the Commission, and no new evidence will be allowed. The Commission will issue a written decision either affirming the award or issuing a new award.
Either party may further appeal the Commission’s decision to the Missouri Court of Appeals. The Court of Appeals can reverse the Commission’s decision only if the law was applied incorrectly; the court will not make a new decision on issues of fact. The last level of appeal is to the Missouri Supreme Court, but this level of appeal is rare for workers' comp cases, and the Court’s choice to even consider the appeal is discretionary.