Category Archives: Mo Work Comp

By Steven A. Edelman, Attorney

By Steven Edelman

Often in a Missouri workers’ compensation case, the employer/insurer will unjustifiably stop payment of weekly temporary total disability (TTD) benefits to an injured worker. This termination of TTD benefits is sometimes in contradiction to a doctor’s off work order. When a hardship hearing is requested, the court shall set the case for trial on this issue within 30 days of such request. In practice, some judges will have a pre-trial hardship mediation/conference to discuss possible resolution of the matter prior to having a hardship trial.

Under Missouri law RSMo 287.203 states as follows:

287.203.  Termination of compensation by employer, employee right to hearing — assessment of costs. — “Whenever the employer has provided compensation under section 287.170, 287.180 or 287.200, and terminates such compensation, the employer shall notify the employee of such termination and shall advise the employee of the reason for such termination.  If the employee disputes the termination of such benefits, the employee may request a hearing before the division and the division shall set the matter for hearing within thirty days of such request and the division shall hear the matter on the date of hearing and no continuances or delays may be granted except upon a showing of good cause or by consent of the parties.  The division shall render a decision within thirty days of the date of hearing.  If the division or the commission determines that any proceedings have been brought, prosecuted, or defended without reasonable grounds, the division may assess the whole cost of the proceedings upon the party who brought, prosecuted, or defended them. See https://revisor.mo.gov/main/OneSection.aspx?section=287.203

If you’ve been injured at work, then please immediately contact our law firm, and one of our skilled attorneys will be happy to discuss your rights and benefits under workers’ compensation law. Call us for a free consultation: 314-631-6777

Steven Edelman, Attorney

Steven A. Edelman, Attorney

In a Missouri Workers’ Compensation case either the employer or the employee can serve a complete report of their doctor’s rating report on each other at least 60 days prior to a trial/hearing. Service of the complete report removes the necessity for the serving party to incur the costs to take the deposition of their rating doctor. The party receiving the served report then has 10 days to file objection with the court to the other party’s service of complete report.

The requirements to serve a complete report are stated under Missouri law in RSMo section 287.210.7 which states as follows:

“The testimony of a treating or examining physician may be submitted in evidence on the issues in controversy by a complete medical report and shall be admissible without other foundational evidence subject to compliance with the following procedures.  The party intending to submit a complete medical report in evidence shall give notice at least sixty days prior to the hearing to all parties and shall provide reasonable opportunity to all parties to obtain cross-examination testimony of the physician by deposition.  The notice shall include a copy of the report and all the clinical and treatment records of the physician including copies of all records and reports received by the physician from other health care providers.  The party offering the report must make the physician available for cross-examination testimony by deposition not later than seven days before the matter is set for hearing, and each cross-examiner shall compensate the physician for the portion of testimony obtained in an amount not to exceed a rate of reasonable compensation taking into consideration the specialty practiced by the physician.  Cross-examination testimony shall not bind the cross-examining party.  Any testimony obtained by the offering party shall be at that party’s expense on a proportional basis, including the deposition fee of the physician.  Upon request of any party, the party offering a complete medical report in evidence must also make available copies of X rays or other diagnostic studies obtained by or relied upon by the physician.  Within ten days after receipt of such notice a party shall dispute whether a report meets the requirements of a complete medical report by providing written objections to the offering party stating the grounds for the dispute, and at the request of any party, the administrative law judge shall rule upon such objections upon pretrial hearing whether the report meets the requirements of a complete medical report and upon the admissibility of the report or portions thereof.  If no objections are filed the report is admissible, and any objections thereto are deemed waived.  Nothing herein shall prevent the parties from agreeing to admit medical reports or records by consent.”

https://revisor.mo.gov/main/OneSection.aspx?section=287.210

If you’ve been injured at work, then please immediately contact our law firm, and one of our skilled attorneys will be happy to discuss your rights and benefits under workers’ compensation law. Call us for a free consultation: 314-631-6777

Steven Edelman, Attorney

Steven A. Edelman, Attorney 314-631-6777

What are the reporting requirements for an injured worker and the employer in a Missouri Workers’ Compensation Case:

Employee Required to make written report of injury:

The injured worker must make a written report of injury to the employer within 30 days of the work injury. This report of injury in writing should be made to a person in a position of manager, human resources, an owner of the employer, boss or supervisor.

See Missouri law RSMo 287.420 “No proceedings for compensation for any accident under this chapter shall be maintained unless written notice of the time, place and nature of the injury, and the name and address of the person injured, has been given to the employer no later than thirty days after the accident, unless the employer was not prejudiced by failure to receive the notice.  No proceedings for compensation for any occupational disease or repetitive trauma under this chapter shall be maintained unless written notice of the time, place, and nature of the injury, and the name and address of the person injured, has been given to the employer no later than thirty days after the diagnosis of the condition unless the employee can prove the employer was not prejudiced by failure to receive the notice. https://revisor.mo.gov/main/OneSection.aspx?section=287.420

Employer Required to Report work injury to the Court:

The employer then has 30 days file a report of the work injury with the court, which is called the Missouri Division of Workers’ Compensation. The employer’s report of injury to the court is called a Form 1 or WC-1 See RSMo 287.380, which states: “Every employer or his insurer in this state, whether he has accepted or rejected the provisions of this chapter, shall within thirty days after knowledge of the injury, file with the division under such rules and regulations and in such form and detail as the division may require, a full and complete report of every injury or death to any employee for which the employer would be liable to furnish medical aid . . .” https://revisor.mo.gov/main/OneSection.aspx?section=287.380

Extension of Statute of Limitations if Employer fails to make report of injury within 30 days to the Court:

If the employer fails to make a report of injury to the court within 30 days of their knowledge of the work injury, then the statue of limitations to file the injured worker’s workers’ compensation case is extended to 3 years, instead of 2 years.

If you’ve been injured at work, then please immediately contact our law firm, and one of our skilled attorneys will be happy to discuss your rights and benefits under workers’ compensation law. Call us for a free consultation: 314-631-6777

Steven Edelman, Attorney

Steven A. Edelman

The Second Injury Fund (SIF) is a state fund of money that is administered by Missouri State Treasurer and the Missouri Attorney General’s Office (AGO). The SIF is represented by an attorney from the AGO who is called an Assistant Attorney General (AAG). The money that funds the SIF comes from the Missouri State Treasury. The Missouri State Treasurer gets its money to fund the SIF from surcharges on the premiums paid by all Missouri employers when they pay for their workers’ compensation insurance coverage.

The purpose of the SIF is to protect employers from permanent and total disability (PTD) cases when the employee is found to be PTD due to their last work injury at the employer in combination with their pre-existing medical conditions and injuries. See also explanation of the purpose of the SIF by the courts:

“The purpose of the Second Injury Fund is twofold: to encourage the employment of individuals who are already disabled; and to relieve an employer or his insurer of liability for the previously disabled employee’s total and permanent disability where that disability is not specifically attributable to an injury suffered during the period of employment with that employer.” Parker v. Treasurer of the State of Missouri as Custodian of the Second Injury Fund WD83030 (Mo. App. W.D. 2020) citing Hampton v. Big Boy Steel Erection, 121 S.W.3d 220 (Mo. banc 2003)

The injured worker’s pre-existing medical conditions and injuries have to meet specific requirements under Missouri law to be considered to combine with the last work injury at the employer. These requirements are stated in Missouri law under RSMo Section 287.220.3(2)(a) https://revisor.mo.gov/main/OneSection.aspx?section=287.220 which states that after January 1, 2014, all pre-existing injuries to combine against the SIF for PTD must meet the following:

“If any employee who has a preexisting permanent partial disability whether from compensable injury or otherwise, of such seriousness as to constitute a hindrance or obstacle to employment or to obtaining reemployment if the employee becomes unemployed, and the preexisting permanent partial disability, if a body as a whole injury, equals a minimum of fifty weeks of compensation or, if a major extremity injury only, equals a minimum of fifteen percent permanent partial disability, according to the medical standards that are used in determining such compensation, receives a subsequent compensable injury resulting in additional permanent partial disability so that the degree or percentage of disability, in an amount equal to a minimum of fifty weeks compensation, if a body as a whole injury or, if a major extremity injury only, equals a minimum of fifteen percent permanent partial disability, . . .” RSMo 287.220.2

AND

3.  (1)  All claims against the second injury fund for injuries occurring after January 1, 2014, and all claims against the second injury fund involving a subsequent compensable injury which is an occupational disease filed after January 1, 2014, shall be compensated as provided in this subsection.

  (2)  No claims for permanent partial disability occurring after January 1, 2014, shall be filed against the second injury fund.  Claims for permanent total disability under section 287.200 against the second injury fund shall be compensable only when the following conditions are met:

  (a)  a.  An employee has a medically documented preexisting disability equaling a minimum of fifty weeks of permanent partial disability compensation according to the medical standards that are used in determining such compensation which is:

  (i)  A direct result of active military duty in any branch of the United States Armed Forces; or

  (ii)  A direct result of a compensable injury as defined in section 287.020; or

  (iii)  Not a compensable injury, but such preexisting disability directly and significantly aggravates or accelerates the subsequent work-related injury and shall not include unrelated preexisting injuries or conditions that do not aggravate or accelerate the subsequent work-related injury;

https://revisor.mo.gov/main/OneSection.aspx?section=287.220

In summary, the pre-existing injuries or medical conditions that can combine must 1. Meet a 50 week threshold of disability; and be the result of either 2. Active duty military service, or 3. A direct result of a prior compensable work injury; or 4. the prior medical condition and injury must significantly aggravate or accelerate the work injury suffered at the employer.

If an injured worker is found to be PTD against the SIF, then the SIF is liable for paying the PTD value of the case, and the employer will only be liable for the work injury at the employer. An injured worker must file a claim against the SIF when they file the workers’ compensation case against the employer. An injured worker must list out the prior conditions and injuries on the claim that allege are disabling.

If you’ve been injured at work, then please immediately contact our law firm, and one of our skilled attorneys will be happy to discuss your rights and benefits under workers’ compensation law. Call us for a free consultation: 314-631-6777

Steven Edelman, Attorney

By Steven Edelman, Attorney 314-631-6777

Missouri Law

The courts have stated the following:

“Missouri courts have long held a claimant can be compensated when a work injury aggravates a pre-existing condition to the level of disability,” provided there is medical causation of the work injury causing the resultant disability. Harris v. Ralls Cnty., 588 S.W.3d 579, 603 (Mo. App. E.D. 2019)

“The aggravation of a pre-existing condition or its symptoms may constitute a sufficient change in pathology to qualify for compensation . . .” Id.

‘It is well established law that a preexisting but non-disabling condition does not bar recovery of compensation if a job-related injury causes the condition to escalate to the level of disability.’ Id.

“A work accident may be the prevailing factor in causing an injury sustained due to the aggravation of preexisting, asymptomatic degenerative condition.” Id.

If you’ve been injured at work, then please immediately contact our law firm, and one of our skilled attorneys will be happy to discuss your rights and benefits under workers’ compensation law. Call us for a free consultation: 314-631-6777

Steven Edelman, Attorney

By Steven Edelman 314-631-6777

There are two types of Missouri workers’ compensation cases:

1. Permanent Partial Disability (PPD): A PPD case is one where the injured worker is able to return to work. The injured work may not be able to return to their old job due to the work injury, but they are still able to work a different job, whether in a different field or less strenuous position in the same area of work. This type of case is called a permanent partial disability or PPD case. Again, the injured worked is still able to work. Examples of PPD cases are many and can involve any type of injury. A PPD workers’ compensation case is different from a permanent total disability (PTD) case, where the injured worker can not return to work. The courts have defined permanent partial disability (PPD) as: A “permanent partial disability” is “a disability that is permanent in nature and partial in degree.” Cantrell v. Baldwin Transp. Inc. , 296 S.W.3d 17, 20 (Mo. App. 2009). “The level of permanent partial disability associated with an injury cannot be determined until the injury ‘reaches a point where it will no longer improve with medical treatment’ or, in other words, reaches maximum medical improvement.” Id . (quoting Cardwell v. Treasurer of State of Mo. , 249 S.W.3d 902, 910 (Mo.App.2008) ).
2. Permanent and Total Disability (PTD): In a PTD case, the injured worker is so injured that they can not return to their old job to work, nor can they work any other type of job due to their work injury. These types of cases are called PTD cases for short. The courts have defined PTD as the ‘inability to return to any employment and not merely [the] inability to return to the employment in which the employee was engaged at the time of the accident.’ RSMO 287.020.6, See Harris v. Ralls County, 588 S.W.3d 579 (Mo. App. E.D. 2019). ‘Any employee is permanently and totally disabled if no employer in the usual course of business would reasonably be expected to employ the employee in his or her present physical condition.’ Id. The burden is on the claimant to establish that he is permanently and totally disabled. Id. “Whether a claimant is permanently and totally disabled is a factual question, not a legal question. Id.

If you’ve been injured at work, then please immediately contact our law firm, and one of our skilled attorneys will be happy to discuss your rights and benefits under workers’ compensation law. Call us for a free consultation: 314-631-6777

Steven Edelman, Attorney

By Steven Edelman, Attorney (314) 631-6777

Missouri Workers’ Compensation RSMo 287.140

Medical Treatment under Missouri workers’ compensation law is governed by section 287.140 which states:

“[T]he 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.” RSMo 287.140

“Medical aid is one component of the compensation an injured worker is entitled to receive . . . This includes treatment that gives comfort or relief from pain even though a cure is not possible.” See Erwin v. Midway Arms, Inc., (Mo. App. W.D. 2025) citing Abt v. Miss. Lime Co., 420 S.W.3d 689, 704 (Mo. App. E.D. 2014)

Furthermore, medical treatment ‘should not be denied simply because’ and injured worker ‘may have achieved maximum medical improvement.’ Williams v. City of Ave., 982 S.W.2d 307, 311-12 (Mo. App. S.D. 1998) Overruled on other grounds by Hampton v. Big Boy Steel Erection, 121 S.W.3d 220, 226 (Mo. banc 2003).

Medical Treatment

1. As a general rule, the employer controls and pays for the injured worker’s medical treatment.
2. The employee can choose to see their own doctor but will have to pay this medical treatment, and the employer will no longer be liable for the cost of the employee’s medical care.
3. When the employer has notice that the employee needs medical treatment or a demand is made on the employer to provide medical treatment, and the employer refuses or fails to provide the needed medical treatment, then the employer will be held liable for any reasonable and necessary medical treatment that this obtained by the employee. See Lyman v. Mo. Emps. Mut. Ins. Co., 407 S.W.3d 130 (Mo. App. S.D. 2013) citing Poole v. City of St. Louis, 328 S.W.3d 277, 291 (Mo. App. E.D. 2010).

Therefore, to hold the employer liable for repayment of the injured worker’s medical bills, an injured worker must prove that (1) Whether a demand for medical treatment was made to the employer; and (2) Whether the demand was refused or ignored.

NOTE: Under Missouri law there is no requirement by law that the injured worker update the employer on the course of the additional medical treatment. Additionally, no medical evidence is required to accompany a claimant’s demand for further medical treatment. See Nouraie v. Mo. Baptist Med. Ctr., No. 10-111746, 2013 WL 1093332 (Mo. Lab. Ind. Rel. Com. Mar. 13, 2023) which states that an injured worker need not prove the compensability of her injury before the employer has any obligation to provide medical examination or treatment. It is illogical to require an injured worker to obtain unauthorized medical treatment for the purpose of proving to an employer that it must authorize further medical treatment.

Practical Application:

1. It is sometimes necessary to obtain from the workers’ compensation employer and or insurer a written denial letter of medical treatment that the injured worker can show to their own doctor. This denial letter will sometimes help facilitate the employee’s own doctor to bill the employee’ personal health insurance for the medical treatment for the work injury. At the end of the case, the injured worker will seek reimbursement for the costs of this medical treatment from the employer/workers’ compensation insurer and indemnification and protection from their own health insurer for the portion of the medical bills paid by the employee’s health insurer.

If you’ve been injured at work, then please immediately contact our law firm, and one of our skilled attorneys will be happy to discuss your rights and benefits under workers’ compensation law. Call us for a free consultation: 314-631-6777

Steven Edelman, Attorney

By Steven A. Edelman, Attorney (314) 631-6777

Short Answer: When the employer commits outrageous conduct that is clear and egregious.

Missouri Workers’ Compensation RSMo 287.560

Missouri law states that in certain situations the court may assess costs against any party for unreasonable defending or prosecuting a workers’ compensation case. See Revised Statutes of Missouri Section 287.560 which states:

“[I]f the division or the commission determines that any proceedings have been brought, prosecuted or defended without reasonable ground, it may assess the whole cost of the proceedings upon the party who so brought, prosecuted or defended them.” RSMo 287.560

The courts have interpreted RSMo 287.560 as follows:

1. The court has the discretion to assess costs against a party;
2. The Workers’ Compensation Commission should exercise this power to assess costs against a party with great caution and “only when the case for costs is clear and the offense egregious.” See Erwin v. Midway Arms, Inc. (Mo. App. W.D. 2025) and the Missouri Supreme Court in Landman v. Ice Cream Specialties, 107 S.W.3d 220, 224, (Mo. banc 2003)

Examples of Cases when the Court awards Attorney’s fees and or Costs:

1. The Missouri Supreme Court upheld an award of costs and attorney fees against an employer for unreasonably contesting the work-related nature of the employee’s injury. Landman v. Ice Cream Specialties, 107 S.W.3d 220, 224, (Mo. banc 2003)

The employer acted unreasonably when it argued at a hearing before the” judge that the employee’s injury was not work-related. The employer pressed this argument even after its own examining medical doctor concluded that the injury was caused by work; and despite the employer promising to abide by their medical examiner’s conclusion in exchange for the employee not immediately seeking a trial; and despite having no evidence whatsoever to dispute the conclusion of its own medical examiner. Id. at 250

2. The Missouri Court of Appeals reversed the Missouri Workers’ Compensation Commission’s decision to not impose attorney’s fees and costs against the employer. The Missouri Court of Appeals concluded that the employer’s conduct was unreasonable and egregious. See Monroe v. Wal-Mart Assocs., Inc., 163 S.W.3d 501 (Mo. App. E.D. 2005)

In this case, the employee suffered hernia at work while lifting. The employer allowed the injured worker to leave work to go to an emergency room. The employer refused to pay for the emergency room and medical treatment claiming that the injury was not work-related. The employer based its denial on the employee’s prior medical records and an initial intake form from the emergency room visits which indicated that the visit was not work-related. No evidence suggested that the intake form was a medical opinion or that the employee even had an opportunity to review the form to verify its accuracy. The employer then maintained its denial of the work injury despite two doctors’ opinions that the employee’s hernia was work-related. The employer made no meaningful effort to resolve the case until the trial three years later. At trial the employer first admitted that the injury was work-related and provided no medical evidence to justify its years of defending the claim without justification. The court fount the above employer’s behavior was unreasonable and egregious and awarded costs and attorney’s fees against the employer.

If you’ve been injured at work, then please immediately contact our law firm, and one of our skilled attorneys will be happy to discuss your rights and benefits under workers’ compensation law. Call us for a free consultation: 314-631-6777

Steven A. Edelman, Attorney