Everything you need to know about filing a workers’ compensation claim
The Missouri General Assembly passed the state’s first workers’ compensation law in 1926. The law has grown considerably, but the purpose remains the same: To provide benefits to injured workers and immunity from lawsuits to employers.
If you suffer a workplace injury in Missouri, you should know there are steps you need to take to receive the benefits you deserve. In this guide, we’ll take a look at everything from filing your workers’ compensation to appealing a denied claim.
Workers’ compensation definition
Workers’ compensation is a form of insurance that provides benefits to workers who are injured on the job.
Although the focus of Missouri workers’ compensation laws is on injured workers, the laws provide a benefit to employers as well. Workers’ compensation laws provide employers with a certain level of protection by prohibiting, in most cases, injured employees from suing their employers or co-workers. To put it another way, workers’ compensation is considered an exclusive remedy.
Unlike when you file a personal injury claim, injured workers who file a workers’ compensation claim don’t need to prove that anyone negligently caused their injury in order to receive benefits. In other words, workers’ compensation is no-fault insurance.
Does my employer carry workers’ compensation insurance?
The vast majority of employers in Missouri with five or more employees must carry workers’ compensation insurance unless the employer is in the construction industry, in which case they must carry workers’ compensation insurance if they have one or more employees.
It’s important to recognize that workers’ compensation laws apply to employees, not independent contractors. Missouri courts use the “right to control” test to determine whether a worker is an employee or an independent contractor. In short, independent contractors control the means and methods of their work (when to start, what materials to use, etc.), whereas employees must follow the means and methods of work set by their employers.
To verify whether your employer carries workers’ compensation coverage, contact your state workers’ compensation agency or use the free online verification tool.
What injuries are covered by workers’ compensation insurance?
Most injuries and illnesses are covered by workers’ compensation insurance so long as the injury or illness arose out of the employee’s employment.
An injury arises out of an employee’s employment if it does not come from a hazard or risk unrelated to the employment to which the worker would have been equally exposed outside of employment.
For example, if you have a heart attack while driving an 18-wheeler due to high cholesterol, you probably won’t receive workers’ compensation benefits because the heart attack was caused by a risk unrelated to your employment.
As Gary was driving one morning, he decided to eat a breakfast sandwich. Within a mile, he choked on the sandwich, attempted to slow down, and blacked out. His vehicle collided with a pillar on the side of the road.
Gary suffered contusions to his chest and right flank, along with back pain. He filed a workers’ compensation claim.
The claim was accepted, and Gary’s employer appealed the acceptance. The case went to the Missouri Supreme Court, which explained that Gary was not required by his employer to eat while driving and therefore, no condition of the employment led to the accident. The Missouri Supreme Court denied Gary’s workers’ compensation benefits.
How do I file a workers’ compensation claim in Missouri?
It’s your responsibility to report your workplace injury to your employer as soon as possible. You can use Form WC-280-AI Report Your Workplace Injury to do so. If you don’t report your injury within 30 days, you may not receive workers’ compensation benefits.
Once you’ve reported your injury, it’s your employer’s responsibility to fill out and file Form WC-1 First Report of Injury. This form must be submitted within 10 days of receiving notice of your injury or illness. You can contact the Missouri Workers’ Compensation Division at (800) 775-2667 to confirm that the proper paperwork was submitted.
Workers’ compensation benefits
Missouri workers’ compensation benefits take three main forms:
- Medical expenses
- Wage loss benefits
- Death benefits
Medical expenses
Your employer is required to pay for all “reasonable and necessary” medical treatment related to your workplace injury. This may include ambulance services, doctor’s visits, prescriptions, prosthetic devices, physical therapy, and even psychological counseling.
There is no deductible, and all costs are paid directly by your employer or its workers’ compensation insurance company. You should not receive any bills.
Your employer has the right to choose your treating physician, but emergency care will be covered in most cases regardless of whether you receive the care from the selected physician or not.
Wage loss benefits
You can receive wage loss benefits if you’re unable to return to work or you’re unable to return to the same type of work.
Wage loss benefits in Missouri are calculated according to the nature of the injury, with injuries falling into one of the following categories:
- Temporary partial disability (TPD). If you’re able to return to part-time or light-duty work while you’re recovering but earn less than your normal wages, you may be eligible for TPD benefits. These benefits are typically paid weekly and should be 66 ⅔ percent of the difference between your average earnings prior to your accident and the amount you’re able to earn after your injury.
- Temporary total disability (TTD). If you’re temporarily unable to work, you may be eligible for TTD benefits. These benefits are paid at 66 ⅔ percent of your average weekly wage.
- Permanent partial disability (PPD). If you suffer a permanent injury but are still able to work in some capacity, you may be eligible for permanent partial disability benefits. Your award will be based on the nature and extent of your permanent injury.
- Permanent total disability (PTD). If you’re totally and permanently disabled, you may receive weekly payments for your lifetime. The amount of weekly payments is 66 ⅔ percent of your average weekly earnings at the time of the injury)
All of the weekly wage loss payments above are subject to a maximum amount set by statute.
Death benefits
When an employee dies on the job, the surviving dependents (usually a spouse and children) are entitled to weekly benefits. The weekly death benefit is paid for one year at 66 ⅔ percent of the deceased employee’s average weekly wage prior to the fatal accident.
The workers’ compensation insurer is also responsible for paying funeral expenses up to $5,000.
Is there anything I can do if my workers’ compensation claim is denied?
If your claim is denied or you don’t receive all of the benefits you believe you deserve, you have three options:
- Dispute management services. The Missouri Workers’ Compensation Division offers free alternative dispute resolution through the Dispute Management Unit. The services are designed to help you and the insurer reach an agreement without resorting to litigation.
- Conference with an administrative law judge. You can request a conference through the Missouri Workers’ Compensation Division. A conference is an opportunity for you to meet with the insurer’s attorney to attempt to resolve your case.
- File a claim for compensation. Filing a claim for compensation (Form WC-21-A-AI) will start a formal appeal process that may include a pre-hearing, mediation, and an evidentiary hearing before an administrative law judge.
If you’re still not satisfied after completing the three steps listed above, you can file an Application for Review with the Labor and Industrial Relations Commission. If the Review is unsuccessful, you’ll need to appeal to the Missouri Court of Appeals.
Finding a workers’ compensation attorney in Missouri
You’re not required to hire an attorney to handle your workers’ compensation claim or appeal. However, the appeals process can be very complicated. What’s more, there are strict filing deadlines you must meet or your appeal will be denied. We strongly recommend at least meeting with an experienced Missouri workers’ compensation attorney. Most initial consultations are free.
Here are some tips to help you find the right workers’ compensation attorney.
Did you know that workers' compensation law varies by state?
Need a lawyer?
The basis for personal injury law is fairly straightforward:
If you’re injured because of someone’s negligence, then you’re entitled to recover for your financial losses related to the injury.
The premise for the workers’ compensation system is similar:
Your employer is required to have specific insurance that provides benefits if you’re injured at work.