An Overview of Missouri Workers Compensation
Both Missouri and Arkansas have a workers' compensation statute. The laws of both states vary greatly. The rest of this information focuses upon Missouri law.
Missouri's workers' compensation law is found in Chapter 287 of the Revised Statutes of Missouri. An injured employee is entitled to benefits if the injury or occupational disease is job related and occurred during performance of job related duties or while undertaking other actions for the benefit of the employer. In southeast Missouri, employees often work in the neighboring states of Illinois, Tennessee, Kentucky or Arkansas. Section 287.110 provides that if the employee has a written contract of employment in Missouri, or their employment is principally located in Missouri, a workers compensation claim can be filed in Missouri, even if the injury occurs in another state.
Section 287.430 of the Revised Statutes of Missouri provides a two year statute of limitations for filing a workers' compensation claim. A claim should be filed with the Missouri Division of Workers' Compensation within two years of the injury, or one year from the last date that the employer made a payment related to the work related injuries, whichever is later. The employer does not have a duty to file the claim for the employee, nor does the employer have a duty to tell the employee of the statute of limitations. If a claim is not filed within the statute of limitations, all rights to further medical and monetary benefits, including any permanent partial disability or permanent total disability settlement, will be permanently barred. Any employee should never assume that a claim has been filed for them, even if they have received medical or monetary benefits, or have heard from an insurance adjuster for the workers' compensation insurance company. None of these facts mean that a claim has been filed for the employee.
In many cases, an employee's claim is denied by the employer and insurer because they believe the injury or occupational disease is not work related. Section 287.020(3)(2)(a) provides that work must be the "prevailing factor" in causing the injury or occupational disease. Usually, the employer alleges that the injury occurred at home or while involved in some non-work related activity. An injured employee is entitled to prove that the injury or occupational disease is work related through a hardship hearing or a temporary award hearing before the Missouri Division of Workers' Compensation.
Section 287.140 requires a self-insured employer, or an employer's workers' compensation insurance company, to provide treatment for work related injuries or occupational diseases. The same statute provides that the employer is entitled to choose the medical provider that will provide this treatment. The employee must either accept this treatment or risk being personally responsible for the medical bills. The employer must provide treatment that is "reasonably required to cure and relieve the effects of the injury." This obligation remains until the employee has reached maximum medical improvement, or MMI. Sometimes these benefits are not made available immediately by the employer. The employee may have to seek reimbursement for sums spent out of pocket if this occurs.
An injured employee is entitled to temporary partial or temporary permanent disability benefits while unable to work because of an injury or occupational disease. These benefits are paid weekly (for no more than 400 weeks for temporary total and 100 weeks for temporary partial) and are based upon the employee's average weekly wage. The average weekly wage is determined by taking the employee's actual wages from the thirteen weeks worked prior to injury. The temporary benefit rate is equal to two-thirds of this average weekly wage amount and is subject to a cap. The cap amount is $807.48 per week, through June 30, 2010. There is often a dispute as to the length of time for which benefits are to be paid, and the amount of the compensation rate.
Despite medical care, an employee often fails to make a complete physical recovery. The difference between the pre-injury condition and the post-injury condition is the percentage of disability for which the employee will be compensated. This is a subjective qualification or statement of the employee's condition. The employer's medical provider usually provides a disability rating when releasing the employee from further treatment. That rating is typically unfair to the employee and does not adequately represent the amount of disability. Any employee may obtain a second rating from an independent doctor. A post injury disability may be either partial or total in nature. The employee is entitled to an additional award to compensate for any permanent partial disability. This amount is calculated by multiplying the compensation rate, the disability rating and the number of weeks of healing assigned to the injury by the Division's Permanent Partial Disability Schedule, which is also referred to as "Chart One."
Unfortunately, even after medical treatment, an employee's injuries may preclude them from ever returning to work. Such an employee is entitled to an additional award of permanent total disability. Under Missouri law, permanent total disability benefits are the same amount as the temporary disability benefit, except that the benefit is paid weekly for life and does not terminate upon retirement age. It is sometimes possible to accept this benefit as a lump sum settlement, if the employer and employee can agree to do so. If eligible for federal Social Security Disability benefits, permanent partial or permanent total benefits paid through workers compensation may reduce these social security payments.
If any employee has a pre-existing disability, and suffers a work related injury or occupational disease, Missouri's Second Injury Fund may provide an additional source of settlement funds. The Second Injury Fund provides further monetary assistance to an employee if a prior disability, combines with the current work related disability, to cause a more significant disability than either of the two standing alone. The prior disability does not have to be caused by a work related injury to receive a payment from the Second Injury Fund. It can be any other disease or impairment, provided a certain threshold of disability is met. The amount of benefit available from the Second Injury Fund differs from case to case. The Missouri Second Injury Fund is currently underfunded and the future of these claims is cloudy at best.