Missouri Workers' Compensation 101

Missouri Workers’ Compensation 101: A Comprehensive Guide for Injured Workers

Navigating the aftermath of a work-related injury can be overwhelming. Understanding Missouri’s workers’ compensation law is crucial to ensure you receive the benefits you're entitled to. This guide will walk you through the key aspects of Missouri’s workers’ compensation system, from reporting an injury to filing a claim, and the benefits you might receive.

Work-Related Injuries in Missouri

A work-related injury can disrupt your life, but Missouri’s Workers’ Compensation law is designed to provide financial relief and medical support. If you’re injured on the job or suffer from an occupational disease due to your employment, the law mandates that most employers carry insurance to cover medical treatments and lost wages.

Key Point: Workers’ compensation is a streamlined benefits system, but it can impact other benefits such as social security or unemployment. It’s important to consult with a knowledgeable workers’ compensation attorney in Kansas City before making decisions regarding your claim.

Workers Covered Under Missouri Law

Most Missouri employers must carry workers’ compensation insurance:

• Construction Industry: Employers must have coverage if they employ one or more workers.
• Other Industries: Coverage is required for employers with five or more employees.
• Federal Workers: Railroad, postal, and maritime workers are covered under federal laws, not state law.

Exemptions

Not all workers are covered by Missouri’s Workers’ Compensation Law. Exemptions include:

• Farm labor
• Domestic servants in private homes
• Casual labor for private households
• Qualified real estate agents and direct sellers
• Certain volunteers and inmates
• Individuals working for amateur youth programs

Covered Injuries

To be covered under Missouri law, an injury must arise out of and in the course of employment. The injury must meet the standard that the work accident or occupational exposure is the “prevailing factor” causing both the medical condition and the resulting disability. Injuries that happen outside the scope of employment or due to personal conditions generally are not covered.

Steps to Take When Injured on the Job

1. Report Your Injury: Immediately notify your employer or supervisor. Failure to report your injury within 30 days could jeopardize your ability to receive benefits. Use your employer's accident report form or Missouri's Form WC-280 to provide written notice.
2. Seek Medical Treatment: Inform your employer if you need medical care. Under Missouri law, the employer selects the treating doctor. They must also arrange medical treatment and file necessary reports with the Division of Workers’ Compensation (DWC).

Benefits Available Under Missouri Workers' Compensation

Medical Care:

• All authorized medical expenses, including treatment, prescriptions, and medical devices, are covered by your employer’s insurance.
• The employer has the right to choose your treating physician. Unauthorized treatment may not be covered unless explicitly approved by the employer.

Payment for Lost Wages:

• Temporary Total Disability (TTD): If you can’t work due to your injury, you may receive TTD benefits until you can return to work or reach maximum medical improvement (MMI).
• Temporary Partial Disability (TPD): If you return to work at reduced pay, you may receive TPD benefits to cover the difference.
• Permanent Disability: Once MMI is reached, you may be eligible for:some text
  • Permanent Partial Disability (PPD): For injuries that partially impair your ability to work.
  • Permanent Total Disability (PTD): For injuries that prevent you from working in any capacity, potentially entitling you to lifetime weekly payments or a lump sum settlement.

Compensation Rate:

• Your compensation is based on 66 2/3 percent of your average weekly wage at the time of injury, with maximum limits set by law. Workers’ compensation payments are tax-free under federal law.

Survivor Benefits:

• If a work-related injury results in death, dependents may receive death benefits at 66 2/3 percent of the deceased worker's average weekly wage. Funeral expenses up to $5,000 are also covered.

Waiting Period:

• No TTD benefits are paid for the first three days off work unless the total disability exceeds 14 days.

Additional Benefits for Occupational Diseases:

• Enhanced benefits are available for certain diseases caused by toxic exposure, such as mesothelioma or asbestosis, especially if the disease leads to total disability or death.

Second Injury Fund (SIF)

Missouri’s Second Injury Fund provides additional benefits if a current work injury combines with a prior disability to create a greater overall disability. For injuries after January 1, 2014, SIF benefits are limited to physical rehabilitation and permanent total disability.

Problems Receiving Benefits

If you encounter issues receiving benefits:

1. Contact Your Employer or Insurance Company: First, try to resolve the issue directly.
2. Dispute Management Service: If unresolved, consider the DWC’s dispute management service, which offers voluntary mediation.
3. Filing a Claim: If necessary, file a Claim for Compensation with the DWC.

Important: The DWC’s information specialists can provide general guidance but cannot offer legal advice. Consulting with an experienced workers’ compensation attorney in Kansas City is recommended to ensure your rights are protected.

Timeline for Filing a Claim

You must file a claim within:

• Two years from the date of injury or last benefit payment, or
• Three years if the employer failed to file a Report of Injury with the DWC.

What Happens After a Claim is Filed

1. Employer’s Response: The employer and its insurer have 30 days to file an Answer to the Claim for Compensation.
2. Second Injury Fund Claims: The Missouri Attorney General’s Office has the same 30-day period to respond if the Second Injury Fund is involved.
3. Pre-Hearing Conference/Mediation: Any party can request a conference or mediation to resolve issues.
4. Evidentiary Hearing: If issues cannot be resolved, the case goes to a non-jury trial before an Administrative Law Judge (ALJ).
5. Appeals: A party dissatisfied with the ALJ’s decision can appeal to the Labor and Industrial Relations Commission, and further appeals can go to the Missouri Court of Appeals or the Missouri Supreme Court.

Additional Information

For more details, contact your employer, the workers’ compensation insurance representative, or the Missouri Division of Workers’ Compensation (DWC) at 800-775-2667. Remember, the decisions you make regarding your workers’ compensation claim can impact your life significantly, so seeking legal advice from a qualified attorney is often in your best interest.

If you have any further questions or need assistance with your workers’ compensation claim, contact us at (402) 541-5867 or email us at info@ironcladinjurylaw.com. We're here to help you navigate the complexities of Missouri workers' compensation law.

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