Missouri Workers Compensation Claims: Eligibility, Filing and Appeals

Understand how workers' compensation works in the state of Missouri.

With some minor exceptions, Missouri workers' compensation law provides coverage for all workers injured on the job while working within Missouri. The Workers' Compensation Division of the Missouri Department of Labor and Industrial Relations administers Missouri workers' compensation law.

Employees Covered by Missouri Workers' Comp

If your employer has five or more employees, your employer is required by Missouri law to have workers' compensation insurance, or be "self-insured." But almost all construction companies with one or more employees are required to have workers' compensation insurance.

Like every other state, Missouri exempts federal employees from coverage under Missouri law. Separate federal workers' compensation laws cover federal employees. Similarly, like most states, Missouri exempts a few other types of workers from coverage under Missouri workers' compensation. Excluded workers in Missouri include many agricultural workers, independent contractors, domestic workers, qualified real estate agents, volunteers, inmate workers, and youth sports referees.

Injuries and Illnesses Covered by Missouri Workers' Comp

A workers' compensation claim can be for an injury or occupational disease or illness. Common forms of industrial (work-related) injuries are low back injuries, neck strains/sprains, and shoulder, elbow, and knee conditions. Cuts and scrapes are usually insufficient for a workers' compensation claim unless you require treatment beyond simple first aid. Typical occupational diseases include toxin exposure and carpal tunnel syndrome.

To have a work-related injury for purposes of Missouri workers' compensation, the incident causing the injury must be "the prevailing factor" resulting in the medical condition and/or disability. Further, the injury must "arise out of and in the course of employment," meaning it must have occurred while you were working, not during your commute or lunch hour.

Missouri treats occupational diseases similarly. The occupational environmental conditions or toxic exposure must be the "prevailing factor" that caused the disease or illness.

First Steps After Your Injury

As soon as possible, report your workplace injury or occupational disease to your employer. This could be your immediate supervisor, a human resources manager, or another person of appropriate authority with your employer. You must report your injury within 30 days to ensure that you receive workers' compensation benefits. Your notice to your employer should be in writing, and include your name, the nature of your injury, and the date, time, and place of your injury.

Your employer will then assist you in completing the necessary paperwork to report your injury or occupational disease to the Missouri Workers' Compensation Division. You can confirm your workers' compensation claim was reported by your employer by contacting the Division at (800) 775-2667.

Workers' Compensation Benefits

Workers' comp pays for three main types of benefits: medical treatment, temporary wage replacement while you're off work, and compensation for any remaining permanent impairment or disfigurement.

Reimbursement for Medical Treatment

If your workers' compensation claim is allowed, your employer or its workers' compensation insurance carrier is require to pay for all of your medical treatment necessary to treat your work-related injury or occupational disease. This includes doctor visits, hospitalization, medical devices (for example, canes or wheelchairs), prescription medication, and physical therapy. You should not pay a bill for any claim-related medical treatment.

Your employer may direct that you receive treatment from a specific physician or health care facility. If you want treatment from a different provider, you may do so at your own cost.

While you are recovering, your employer may require that you undergo an independent medical examination to address your progress and assess your current treatment plan. If you believe you are physically unable to return to work, your employer may also demand that you submit to vocational testing to assess your physical ability to work and what jobs you may be able to perform.

Lost Wages

If you are unable to return to work due to your work-related injury or occupational disease for some period of time, you may be eligible to receive temporary total disability benefits. These benefits are two-thirds of your gross average weekly wage at the time of injury, but cannot be more than $911.27 (as of July 2016).

Alternatively, if you return to work for fewer hours or a light-duty job due to your physical conditions, you will receive temporary partial disability benefits. Temporary partial disability benefits are two-thirds of the reduction in your wages.

These benefits continue until you are able to earn your normal wages, or when a doctor determines your industrially related condition has attained maximum medical improvement (MMI). Maximum medical improvement means your condition will not likely get any better, even though you may not have entirely returned to your pre-injury state.

Permanent Disability

Once a doctor determines you have reached maximum medical improvement, your doctor or another doctor will assess whether you have sustained any permanent disability resulting from your injury or illness. If you are permanently and totally disabled, meaning you can't work in any capacity, you will continue to receive benefits at your temporary total disability rate for as long as your disability continues.

Permanent partial disability benefits are more complicated and based on a three-part formula, which considers the body part injured, the severity of injury, and your average weekly wage. There is a schedule listing the number of weeks of permanent disability that will be paid depending on the body part injured. For instance, you will be paid 150 weeks for loss of a foot. If you didn't lose the body part, but you lost partial use of the body part, you will be paid a percentage of the scheduled number of weeks. For instance, if you lost 50% of the use of your foot, you'll be paid 75 weeks of permanent disability payments.

The last part of the formula is your compensation rate. Your compensation rate is two-thirds of your average weekly wage at the time of injury, but this is subject to a weekly cap. For 2017, the cap is $477.33 per week. To continue the example above, if you're entitled to the maximum amount, you would receive $477.33 for 75 weeks, which is a total of $35,799.75.

For permanent partial injuries other than those specified for specific body parts, you will be assigned a percentage of disability for the "body as a whole." The maximum award for the body as a whole that can be awarded is 400 weeks of permanent disability payments.

Missouri also pays additional permanent disability for serious and permanent disfigurement about the head, neck, hands or arms. The maximum period awarded for disfigurement is 40 weeks.

Talk to an Attorney

A Missouri attorney experienced in workers' compensation can be an invaluable asset to your case, especially if you were seriously injured and can't go back to work. You should strongly consider talking to a worker's comp attorney if you need to appeal a denial of your claim and/or your injuries are severe or complex. For more information on appealing your claim, see our article Appealing a Missouri Workers' Compensation Denial.

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