Category Archives: Mo Work Comp

.

MISSOURI WORKERS’ COMPENSATION: SETTLEMENTS AND TRIAL AWARDS EXPLAINED

MISSOURI WORKERS’ COMPENSATION

Settlements and Trial Awards

The third major benefit in Missouri Workers’ Compensation cases is typically a lump sum settlement or a lump sum award from a trial judge to compensate the injured worker for permanent disability as a result of the work injury. 

  1. Settlements:

A settlement in a Missouri Workers’ Compensation case is when the injured worker agrees to accept a lump sum amount of money from the employer and workers’ compensation insurer to close their workers’ compensation.  

NOTE: Settlements must be approved by a workers’ compensation judge, who is referred to as an administrative law judge (ALJ). If a settlement contract is not approved by a judge then the settlement agreement is likely unenforceable, and the injured worker can still proceed forward with their workers’ compensation case. 

The law states under RSMo 287.390 in regards to Missouri Workers Compensation Settlements:

“Parties to claims hereunder may enter into voluntary agreements in settlement thereof, but no agreement by an employee or his or her dependents to waive his or her rights under this chapter shall be valid, nor shall any agreement of settlement or compromise of any dispute or claim for compensation under this chapter be valid until approved by an administrative law judge or the commission, nor shall an administrative law judge or the commission approve any settlement which is not in accordance with the rights of the parties as given in this chapter.  No such agreement shall be valid unless made after seven days from the date of the injury or death.  An administrative law judge, or the commission, shall approve a settlement agreement as valid and enforceable as long as the settlement is not the result of undue influence or fraud, the employee fully understands his or her rights and benefits, and voluntarily agrees to accept the terms of the agreement.

  2.  A compromise settlement approved by an administrative law judge or the commission during the employee’s lifetime shall extinguish and bar all claims for compensation for the employee’s death if the settlement compromises a dispute on any question or issue other than the extent of disability or the rate of compensation.”

  1. Trial Awards:

While many Missouri workers’ compensation cases settle with the employer/insurer, there are still many workers’ compensation cases that proceed to trial. A workers’ compensation case will proceed to trial if the injured worker and the employer and insurer can not agree on settlement terms to settle the workers’ compensation case.  In Missouri workers’ compensation cases trials are referred to as Hearings for a Final Award.

In Missouri workers’ compensation trials, there is no jury. There is only an administrative law judge (ALJ) that awards you money to compensate you for your work injury. 

If you have been hurt on the job and suffered a work injury, please call our office immediately to discuss your rights under Missouri workers’ compensation law. We work to obtain the largest settlement for you. We do not hesitate to proceed to trial if the employer and workers’ compensation insurer are unwilling to settle your case for what is fair and reasonable. 

Please call us if you have been injured on the job and have any questions about potential settlement of your Missouri workers’ compensation case. (314) 631-6777

Steven A. Edelman, Attorney

314-631-6777, Ext. 14

Missouri Workers’ Compensation: Temporary Total Disability (TTD) explained, RSMo 287.170

MISSOURI WORKERS’ COMPENSATION 

TEMPORARY TOTAL DISABILITY

Temporary Total Disability (TTD) is one of the three major benefits that an injured worker receives in a Missouri Workers’ Compensation case. Temporary total disability is referred to as TTD for abbreviation.  

TTD is a check for money which is equal to two-thirds of the gross average weekly wage of the injured worker based on the 13 weeks of gross wages prior to the work injury. The TTD check is typically mailed directly to the injured worker or in some occasions directly deposited to the injured worker’s bank account. Workers’ compensation pays the injured worker TTD for each week of work missed as a result of the work injury either because 

(1) The doctor places the injured worker off work due to the work injury 

OR 

(2) The doctor placed light duty restrictions on the injured worker, and the employer can not provide accommodated light duty work within the doctor’s restrictions; and therefore, the injured worker remains off work. 

Law: (RSMo 287.170) 

Temporary total disability is found in Missouri Law in the Revised Statutes of Missouri, RSMo 287.170 which states, in part, as follows:

“1.  For temporary total disability the employer shall pay compensation for not more than four hundred weeks during the continuance of such disability at the weekly rate of compensation in effect under this section on the date of the injury for which compensation is being made.  The amount of such compensation shall be computed as follows:

. . .

(4)  For all injuries occurring on or after August 28, 1991, the weekly compensation shall be an amount equal to sixty-six and two-thirds percent of the injured employee’s average weekly earnings as of the date of the injury; provided that the weekly compensation paid under this subdivision shall not exceed an amount equal to one hundred five percent of the state average weekly wage;

. . .

Temporary total disability payments shall be made to the claimant by check or other negotiable instruments approved by the director which will not result in delay in payment and shall be forwarded directly to the claimant without intervention, or, when requested, to claimant’s attorney if represented, except as provided in section 454.517, by any other party except by order of the division of workers’ compensation.

  3.  An employee is disqualified from receiving temporary total disability during any period of time in which the claimant applies and receives unemployment compensation.

  4.  If the employee is terminated from post-injury employment based upon the employee’s post-injury misconduct, neither temporary total disability nor temporary partial disability benefits under this section or section 287.180 are payable.  As used in this section, the phrase “post-injury misconduct” shall not include absence from the workplace due to an injury unless the employee is capable of working with restrictions, as certified by a physician.

  5.  If an employee voluntarily separates from employment with an employer at a time when the employer had work available for the employee that was in compliance with any medical restriction imposed upon the employee within a reasonable degree of medical certainty as a result of the injury that is the subject of a claim for benefits under this chapter, neither temporary total disability nor temporary partial disability benefits available under this section or section 287.180 shall be payable.”

Common Problems that Injured Workers have with the Employer and Workers’ Compensation regarding payment of Temporary Total Disability (TTD)

Injured workers regularly have problems with the employer and workers’ compensation insurer paying temporary total disability (TTD). 

Common problems include:

  1. The doctor places an injured worker off work, and workers’ compensation never pays temporary total disability.
  2. The employer/workers’ compensation insurer pay the wrong amount of temporary total disability, which is usually much lower than what you are entitled to receive. 
  3. Workers’ compensation unnecessarily delays payment of TTD.
  4. Workers’ compensation sends TTD checks at sporadic intervals, which cause financial difficulty for the injured worker. 
  5. An injured worker is released to work light duty work, and the employer instructs the injured worker to return to work full duty in contradiction to the doctor’s order of light duty restrictive work. The employer makes the injured worker work full duty instead of sending the injured worker home. In this situation, the injured worker exposes themselves to potential additional injury when they should be receiving TTD because the employer can not provide light duty work. 
  6. The employer fires an injured work for alleged“misconduct,” and therefore stops paying TTD
  7. The employer stops paying the injured worker TTD because they allege the injured worker declined light duty work. 

If you’ve suffered a work injury on the job in Missouri, and you are not receiving temporary total disability (TTD) then call our law office immediately for a free consultation. We pride ourselves on fighting for your rights and getting you the benefits you are entitled to by law.  Please call us immediately at 314-631-6777

Steven A. Edelman, Attorney

314-631-6777

Authorized Medical Treatment Explained in Missouri Workers’ Compensation Cases

MISSOURI WORKERS’ COMPENSATION LAW

Authorized Medical Treatment Explained

Missouri Workers’ Compensation Law in section RSMo 287.140 states:

  1. “In addition to all other compensation paid to the employee under this section, the employee shall receive and the employer shall provide such medical, surgical, chiropractic, and hospital treatment, including nursing, custodial, ambulance and medicines, as may reasonably be required after the injury or disability, to cure and relieve from the effects of the injury. If the employee desires, he shall have the right to select his own physician, surgeon, or other such requirement at his own expense.”

As cited in the above Missouri law, authorized medical treatment under Missouri Workers’ Compensation Law is defined as medical treatment provided to the injured worker at no cost to the injured worker. Under Missouri law, The employer and workers’ compensation insurer get to the choose the doctor and medical providers to provide medical treatment to the injured worker.

The employer’s workers’ compensation insurance company is responsible by law to pay for and provide all types of medical treatment to cure and relieve the effects of your work injury. Medical treatment provided by the employer includes, but is not limited to, x-rays, CT scans, prescription medication, MRI, physical therapy, injections, surgery, EMG Nerve Conduction Studies, psychiatric and medical treatment for mental injuries, pain management, emergency medical treatment, ambulance, prosthetic replacement of injured body parts, canes, walkers, and even in home health care where applicable.

NOTE: The injured worker does not get to choose his own doctor or medical provider. If the injured worker goes to his own doctor or medical provider, then the injured worker is likely solely responsible to pay the medical bills for his own chosen doctor.

MOST COMMON PROBLEMS FOR INJURED WORKERS:

  1. At any time during your workers’ compensation case, the employer and workers’ compensation insurer will unnecessarily delay in providing you medical treatment.
  2. The employer and the workers’ compensation insurer will deny you medical treatment based upon the employer’s workers’ compensation doctor stating that you are released from medical treatment despite the fact that you have continuing, severe symptoms that need further medical treatment.
  3. The employer and the workers’ compensation insurer will deny you medical treatment in contradiction to a doctor’s recommendation for additional medical care.
  4. It is extremely important that you contact our law office immediately to discuss your case with an experienced attorney. One of our top priorities is to get you the medical treatment which you are entitled to by law.

If you’ve been injured at work and the employer is not providing you with authorized medical treatment or the employer and workers’ compensation have unjustifiably denied you medical treatment, please immediately contact our law firm at 314-631-6777.

Steven A. Edelman, Attorney

314-631-6777

Three Major Workers’ Compensation Benefits under Missouri Workers’ Compensation Law

Missouri Workers’ Compensation Benefits:

The Three Major Benefits under Missouri Workers’ Compensation are the following:

  1. Authorized medical treatment paid for by the employer/insurer. In Missouri, the medical provider is chosen by employer/insurer, which is called authorized medical treatment. Authorized medical treatment is explained in Missouri law in the Revised Statutes of Missouri (RSMo) Section 287.140
  2. Temporary Total Disability (TTD): This is a check that you get each week you are off work because of the work injury. TTD checks are equal to two-thirds of your gross average weekly wage (AWW). Temporary total disability is explained in RSMo Section 287.170
  3. Typically a lump sum settlement or a lump sum awarded to you by the trial judge to compensate you for the permanent disability you suffered due to the work injury. See Code of State Regulations (CSR) under 8 CSR 50-1.010 et seq.

Common Problems and Issues for Injured Workers in Missouri Workers’ Compensation Cases:

Employers and workers’ compensation insurance companies often pay injured workers a lower, incorrect amount of temporary total disability (TTD) and under settle cases with injured workers who are not represented by a workers’ compensation attorney. Employers will often terminate medical treatment when it become too expensive despite the fact that you are not finished with medical treatment and require further surgery or evaluation.

Please call our office immediately to discuss your rights and benefits under Missouri law and to protect you from these common Missouri workers’ compensation issues.

Steven A. Edelman, Attorney

Illinois Workers’ Compensation: When do I have a workers’ compensation case in Illinois?

820 ILCS 305. Sec. 1 (b)

You have an Illinois workers’ compensation case if one of the following situations applies to you:

  1. The work injury occurred in Illinois regardless of the state you were hired.
  2. The work injury occurred outside the state of Illinois and your contract for hire was made within Illinois NOTE: If the last act of hiring you occurred in Illinois, then Illinois has jurisdiction, for example- you signed your employment contract in Illinois or completed your work training in Illinois.
  3. Workers whose employment is principally localized within the State of Illinois, regardless of the place of the accident or the place where the contract of hire was made, including non-citizens and minors.

It is very important that you recognize your ability to file your workers’ compensation case in Illinois if one of the above situations applies to you because there are important benefits under Illinois law that you are entitled to. One of these benefits under Illinois law is that you have the right to choose your medical provider to provide you with medical treatment for your work injury. The employer will then have to pay for your chosen medical provider.

If you’ve suffered a work injury in Illinois or you were injured outside the state of Illinois but you were hired in Illinois, call our law office immediately to discuss your rights under Illinois workers’ compensation law.

Work Comp- Increase from Part-time to full-time wage rate

The Kurbursky Case- You get a compensation rate increase to full time Co- Worker
Since both the temporary pay you get from workers compensation when off work, and the final benefit rate is based upon your wages, the calculation of your average weekly wage is a major issue in every claim. Our firm has been aggressive in trying to show the wage rate should be increased per the statute in Workers Compensation. That law is RSMO 287.250. Our firm won a major case on this issue in the Kurbursky decision. SD Court of Appeals Citation 648 SW3d 894 (Mo.App.S.D.).


In that decision, the Court ordered that the Commission must take evidence of a full time co- workers wages, if one exists, to determine the disability permanent partial rate of compensation. Prior to this, if you were a part time worker, the defense and the courts would try to negotiate on the basis of the 30 hour rule, meaning you would get a compensation rate based upon 30 hours of your hourly wage. The result of this decision is to cause, in most circumstances, the injured workers recovery to be increased by 25%. The 25% difference is the difference between using a 30 hour compensation rate and a 40 hour compensation rate. If you are a part time worker, it is important that you record the names and phone numbers of your full time coworkers who work full time. You should be prepared to give this to your attorney when you hire one.

3 Most Searched Questions Online for “Missouri Work Comp”:

Missouri workers on the job working on street

1- How does workman’s comp work in Missouri?

It is supposed to be a no-fault system but there are carve outs for penalties and items you must prove to be successful. Generally, if you are hurt on the job during the course and scope of your employment then you are supposed to report it in writing within 30 day to your employer, ask for treatment, and the employer is supposed to turn it over to their insurance to provide you with benefits. The main benefits are free medical care with the Employer’s selected approved doctors, TTD which is paid time off work while you are under treatment and can’t work, and in the end a lump sum of money if you can go back to work or lifetime weekly payments if you cannot. There are many other benefits but these are the big ones.

Reporting your injury is not the same as filing a claim for compensation. You must file your “Claim for Compensation” which is the actual lawsuit within two years after the date of injury or death, or the last payment made under Chapter 287 on account of the injury or death, except that if the report of the injury or the death is not filed by the employer as required by 287.380, the claim for compensation may be filed within three years after the date of injury, death, or last payment made under chapter 287 on account of the injury or death. (See 287.430). Chapter 287 is the statute on Missouri workers compensation.

I recommend you check out our guide at: Missouri Workers’ Compensation Benefits | Edelman Law Office

2- How are workers comp settlements calculated in Missouri?

This depends on if you can or cannot go back to work in the open competitive labor market.  If you have only seen the work comp doctor then they probably gave you a very low disability percentage or even zero. Value is calculated in part based on percentage of disability. Do not accept the defense doctor disability percentage. We send our clients to an independent doctor who provides the truth as to your percentage of disability.

If you are injured but can go back to work (Permanent Partial Disability) then this is calculated as a lump sum settlement based on your wage rate (2/3 your AWW capped at 55% of the SAWW) multiplied by the number of weeks of disability (% disability x body part involved). You may also be entitled to other benefits like disfigurement, mileage, ttd, penalty, amputation increase, etc.

If you are unable to work (Permanent Total Disability) then the calculation for settlement value can be very complicated based on your life expectancy, wage rate (2/3 your AWW capped at 105% of the SAWW) etc. However, at trial if the Judge finds you PTD then the Judge may award lifetime payments every week for the rest of your life paid at your PTD wage rate.

If you are PTD or die from an occupation disease due to toxic exposure then you may be entitled to additional benefits.

This is not an exhaustive list. There are many case specific benefits that depend on the injury sustained.

3- How do I file for workers compensation in Missouri?

You must file what is called a “Claim for Compensation” with the Division of Workers Compensation using the Division form. The form has been changed and updated throughout the years so verify you have the most updated form first. As of 5/11/2021 the current form is WC-21-A-AI (06-15) for accidents, injuries, or occupational diseases occurring on or after 1/1/2014. You have the right to file it yourself but usually it is done with the assistance of a lawyer.

The Claim for Compensation is the actual lawsuit. A report of injury is not. Be careful because a report of injury does not defeat the statute of limitations.

HOW WAGE RATE IS IMPORTANT IN CALCULATING BENEFITS

YOUR WAGE RATE IS IMPORTANT TO YOUR BENEFITS IN WORKERS COMPENSATION

Work Time Sheet- Time Stamp

“…many times the Employer or their Insurer misrepresent or are incorrect about your average weekly wage. Why do they do this, I suspect it is just to save themselves money.

There are several benefits in workers compensation. Most are tied into the determination of your average weekly wage. The average weekly wage (AWW) is discussed under Missouri law RSMO 287.250. Usually it is based upon the 13 weeks of wages you earn before the date you are injured. You simply add the prior 13 weeks wages and divide by thirteen. Your benefit rate is then determined to be 2/3’s of  the AWW. There are different maximums limits on the rate depending on whether you are getting weekly benefits or a final lump sum for permanency when you return to work.

What is important for you to know is that many times the Employer or their Insurer misrepresent or are incorrect about your wages. Why do they do this, I suspect it is just to save themselves money.  Of course what they do is underestimate the amount you are supposed to get. When you first hire an attorney it is important to give him information to help determine your correct AWW.  Bring your attorney your payroll records. If you are a part-time employee, you may be  entitled to a full time co- worker’s wages that does your same job duties. If you are a minor, you may be entitled to a full time adult co- worker’s wages. There are several ways to bump up the value of your wages to get you more compensation both for weekly stipend to live on while you are healing, for disfigurement, and for permanency compensation rate.  This simple miscalculation by the Employer or their Insurer can cost you thousands, tens of thousands or hundreds of thousands of dollars lost benefits if you let the employer get away with it.  At my firm we address the correct AWW in every case. Just another reason it is important to hire an attorney who is used to addressing this problem. If you have any questions, please call us for a free initial consultation. Ron Edelman

REPORT YOUR WORK INJURY

The clock is ticking! You must report your injury in writing within 30 days of your work injury in Missouri to your Employer. You can do this in any form of writing or you can use the Division provided form  at Report Your Occupational Disease or Repetitive Trauma Injury (mo.gov). You do not have to use the Division form or your Employer’s form or a simple email to your supervisor will work.  Be sure to include a demand for treatment.

WHAT WE SEE HAPPENING:

When you are first injured at work, there is always hesitation to tell anyone. Many of my clients have told me they are conflicted in telling their employer right away.

  • First they are embarrassed as they feel that they caused their own injury.
  • Second, they are hoping that they are not hurt enough to lose work. The employee’s natural inclination is to wait a couple of days or weeks to see if the symptoms from the injury go away.
  • Third, employee is afraid of losing their job.

For the following reasons, I am telling you it is important that you immediately report your injury, in writing, to the employer as soon as possible regardless of your fears.

If you are seriously hurt you may lose your job anyway and be unable to work. Reporting your injury and asking for workers compensation benefits is the only way to support yourself or your family, and get medical treatment during the healing period.

If you fail to give written notice within 30 days of your injury, or reasonable becoming aware that you have suffered a work related occupational injury, you may lose your workers compensation case, and jeopardize your  rights to all benefits.  Although notice to the employer has always been a requirement to getting benefits for work injuries, this provision was made tougher  in the law RSMO 287.127.1(2).

Prior to this provision, actual verbal notice was sufficient. Now you run the risk to lose all benefits if you do not report the injury in writing.  Why is actual notice not good enough now? Because unfortunately some employers lie about you telling them about your injury. They lie when they say you do not get benefits because you caused the accident yourself.

Workers Compensation is a no fault system of compensation. Even though you cause your own injury, you get benefits. They lie when they tell you that you have to use your own medical insurance.  Most group medical carriers exclude paying for work related injury treatment.  They lie to you when they say you are to late in reporting it the same day.  You have up to 30 days to report it.  The employer lies to you  when they say you went to your own doctor and therefore they do not have to provide benefits.  The law allows you emergency care to be covered by the employer, at least one time.  You may only suffer not recovering the cost of the initial medical treatment, but do not lose the entire claim.

These are only a few of the lies my client’s have told me over my 40 plus years of being an attorney.   As soon as an employer starts telling you these lies, you know you immediately need to hire an attorney to represent you.  To avoid jeopardizing your workers compensation benefits ,  this you need to swallow the bullet and be brave enough to report the injury in writing right away. If the employer will not let you do this report of injury, email it, fax it, or mail a certified letter of notice to the Employer and keep a copy.  Even if they send you to authorized medical care right away, do the written report of injury.  If the employer will still not allow you to make the report of injury, you can also call the Missouri  Fraud and Non Compliance unit and report the employer for failing to let you make a report of injury in Missouri. That phone number for the unit is: 800-592-6003. 

The first thing my office does when an injured employee calls us and is within the first 30 days from the date of injury and accident, we advise them to make the report of injury. If they are unable to, we do it for them.

If you have any questions, please call us for a free consultation. Ron Edelman

 

Missouri Supreme Court-Workers Compensation

On 10/24/2018, Marshall Edelman, Attorney, argued in front of the Missouri Supreme Court regarding novel issues in Missouri Workers’ Compensation. He appeared with his father, Ronald D. Edelman, Attorney. This is the first challenge to the interpretation and constitutionality of the 2014 amendment to the Missouri work comp system involving enhanced permanent partial disabilities against the Second Injury Fund.Marshall Edelman

Our office is challenging the law because it is the right thing to do and, if successful, will benefit all Missourians. The Fund has taken the position that injured workers are not entitled to enhanced permanent partial disability benefits from the Fund for primary injuries after 1/1/2014. We disagree. This sends a signal to employers that they have more incentive to discriminate against those persons with preexisting disabilities who can actually work than those that can’t. This is not a rational basis.

The decision in this case, Cosby v. Treasurer of Missouri, SC97317, will affect nearly every employer and employee in Missouri. This case was recently featured in the news. Click here to read the article. Marshall is honored to be featured in Mizzou Law School’s newsletter regarding this. Click here to read Mizzou Law’s newsletter.

This case was also featured twice in the Missouri Lawyers Weekly . Click here for the first article titled, “Injury Fund fix headed to Supreme Court” and click here for the second article titled “Supreme Court asked to untangle Injury Fund fix.” (Subscription newspaper may require login)