I have a Work Comp Injury. What do I need to know?
So you've been hurt at work. This is a guide to your options and strategies to get the best result out of your case.
I was hurt. What do I need to do first?First things first, if you're injured badly enough, get to an emergency room. If you need to, call an ambulance or have a co-worker take you. Get the emergency medical care you need, your employer will have to pay for emergency treatment. If its not an emergency, let someone know about your injury and ask if there is a specific doctor or hospital they want you to go to.
Do I need to tell my employer that I was hurt?Yes. In Missouri, you have 30 days to report your injury to your employer in writing. Write a brief letter to your a manager, your boss, or someone in human resources notifying them of when you were injured.
Who's going to pay for my medical care?Your employer is responsible for paying for authorized medical care for injuries that arise in the course ad scope of your employment with your employer.
So, two things to notice:
1. In Missouri, your employer is able to direct your medical care and choose where you will be seen. If you see a doctor of your own choice, your employer may not be responsible for paying for the care.
2. Your injury must arise in the course and scope of your employment.
You must be working at the time of the injury and the injury must have some connection to your work. Injuries that happen during an unpaid lunch break, off your work site, may not be covered. Likewise, certain idiopathic injuries, like if you stand up from a table and injure your knee, may not be covered. But it's always a good idea to run each case by a lawyer.
My doctor said I'm at MMI. What does that mean?MMI stands for Maximum Medical Improvement. It's a standard that doctors use to assess whether any further medical treatment would benefit you. Again, this is a subjective standard based on the opinion of a doctor hired by your company, and sometimes the doctor is wrong. Consult an attorney if you have questions.
The insurance company denied my claim and is using the term "prevailing factor." What should I do?In Missouri, a work injury is considered valid, or "compensable" if your work injury is the "prevailing factor" in causing your injury and the need for medical care. The "prevailing factor" determination sometimes becomes an issue in these common fact patterns:
1. You've hurt your back at work, but have had prior injuries to your back which may or may not have involved a disc injury.
2. You've injured your knee at work, but you had arthritis in the knee before. Now you need surgery and the doctor says its from your prior arthritis, not your work injury.
3. You have been diagnosed with carpal tunnel syndrome, but the doctor says that having diabetes, being a woman or being overweight are what caused the carpal tunnel, not your work activities.
If the insurance carrier is using the "prevailing factor" determination to deny your claim, you need to consult an attorney.
I've finished my treatment. Is my case done and ready to be closed?No. In Missouri, you are allowed to make a claim for permanent partial disability. Permanent partial disability, or PPD, compensates you for any permanent physical changes or limitations to your body as a result of your work injury. So for example, if your work injury left you unable to do certain things, with a loss of flexibility or with other physical limitations, you are entitled to compensation.
Compensation for your work injury is based on three things:
1. The part of your body that you injured.
2. The amount of money you were making at the time of your injury; and
3. The severity of the disability you sustained.
Missouri uses something I call the "body chart" to determine your disability settlement. See: https://labor.mo.gov/sites/labor/files/pubs_forms/WC-110-AI.pdf
If you are trying to settle your case on your own, be careful. Insurance carriers and their attorneys want to pay you the least amount possible under the law. Consult with an experienced workers' compensation attorney who handles these types of cases every day. Usually, if they have been doing this long enough, they can estimate the exact disability value of your case without too much investigation. In addition, seasoned workers' compensation attorneys know the insurance attorneys well and how to deal with them.
What if I can't go back to work?If you are disabled to the point of being unable to ever return to work, you are eligible to file for Permanent Total Disability, or "PTD" benefits. Permanent total benefits are available to injured workers who are completely unemployable in the open labor market. Basically, you are unable to compete for and hold any job, not just the job you were doing before. This is a high standard to meet, and often unfortunately involves a significant, life-changing injury. If we are able to prove your case, you are eligible to receive lifetime disability benefits under the Missouri Workers' Compensation system. These benefits are some of the most difficult to obtain and there are lots of pitfalls, so consult an attorney if you are in this situation.
Someone told me about the "Second Injury Fund." What is that and am I eligible to make a claim?The Second Injury Fund is a state managed compensation fund for injured workers who have previously sustained significant injuries or illnesses in their lives. The law states that, if you are injured, and your current injury combines with a prior injury or illness to create a more significant disability, you can be eligible to make a Second Injury Fund ("SIF") claim. In recent years, due to financial instability of the Fund, the rules have changed for making a claim. Before, even relatively minor pre-existing injuries could be used to make a SIF claim. For example, if you had a prior shoulder surgery, a prior back surgery or a prior broken bone, you could combine that injury with your current injury to make a SIF claim.
The new law affects injuries that occurred after January 1, 2014. The law eliminates SIF payments for those relatively minor pre-existing injuries and focuses and allows claims for Permanent Total Disability only. In essence, as an injured worker, you are still allowed to make a claim for pre-existing injuries and disability, but those injuries and disability have to combine with your current injury to make you completely and totally disabled and unable to compete for employment. The changes to the law have tightened the claims you can make in order to keep the Fund financially viable.
Second Injury Fund cases can be complex and difficult to understand. Contact an attorney for a consultation to determine whether you have a SIF claim.