Missouri Workers’ Compensation Law Basics

The following provides a brief discussion of some of the basics of Missouri workers’ compensation law and is largely based on a continuing legal education seminar given by Mr. John Christiansen to the Kansas City Metropolitan Bar Association in June, 2022. For a more detailed discussion and review of your particular case, please call the Law Office of John Adams Christiansen in Kansas City, Missouri at (816) 416-7070.

Definition – Workers’ compensation arises where there is an accidental injury or occupational disease sustained by an employee and arising out of and in the course and scope of the employee’s employment, where the employer and employee were subject to the Missouri Workers’ Compensation Laws.

What law applies? The Missouri Workers’ Compensation Law has undergone substantial changes over the years with the most recent changes taking place for injuries occurring January 1, 2014 and after. The new law, especially as it relates to the Second Injury Fund is still being tested. Be aware that often multiple states can have jurisdiction and cases can be filed in multiple states at the same time for same accident. Work injuries sustained by federal employees are governed by federal workers’ compensation law.

The primary incentive(s) for an injured worker to pursue a workers’ compensation case arises due to the benefits allowed under the law. The Law Office Of John Adams Christiansen, L.C., located in Kansas City and Blue Springs, can help maximize your benefits under the law. Please call us at (816) 416-7070. There are three primary legal benefits to the injured worker and these are as follows:

Basic Benefits:

Medical Treatment – The claimant is entitled to reasonable and necessary medical treatment to cure and relieve the effects of the work injury. The employer/insurer controls and directs treatment. This can be challenged through a hardship process (mediation/hearing).

Temporary Total Disability (TTD) – If the treating doctor has the claimant off work or on such restrictions that the employer is unable to accommodate the restrictions, the claimant is entitled to receive 2/3 of their gross weekly pay, subject to certain maximum limits.

Permanent Disability – The claimant is entitled to money for permanent partial disability. If an employee can never work again, he/she may be entitled to money for permanent total disability which can result in weekly payments for the rest of their life.

Example of how to compute disability:

A claimant sustains a torn rotator cuff injury for which surgery is performed. Claimant has a rating from a doctor of 25% and the employer/insurer has one for 5%. The parties settle for 17.5% disability of the shoulder (232-week level on the chart)

232 multiplied by 17.5% = 40.6 weeks; 40.6 is then multiplied by the compensation rate (let’s say it is $350); 40.6 multiplied by $350 = $14,210.

• Notice that the applicable compensation rate is very significant in a workers’ compensation case as it impacts how much someone is paid while off work and also what a case is worth in terms of permanent disability. There are various rules pertaining to the compensation rate for both TTD and permanent disability. There are maximum rates applicable to both which are listed in chart 1 (see attached materials). One very significant section pertaining to the compensation rate for permanent disability is the “30-hour rule” which is defined in section 287. 250.3 and essentially provides that a worker who is hired for less than the number of hours needed to be classified as a full-time or regular employee shall have their compensation rate for permanent disability based on a rate of not less than thirty hours per week.

Lesser Benefits & Other Potential Benefits, Compensable Issues And Claims:

Disfigurement - scarring on the face, neck, hands or lower arms; 40 weeks is the maximum; this is assessed by the Judge on settlement and awards; the number assigned is multiplied by the permanent partial disability rate to come up with the monetary amount

Second Injury Fund claim (section 287.220). The Second Injury Fund, under current law, only applies to cases of permanent total disability (meaning the claimant can no longer work in the open labor market). The Second Injury Fund, under current law, only applies to cases of permanent total disability where the work injury (often called the “primary injury”) combines with the preexisting condition to render the claimant permanently and totally disabled. The Second Injury Fund is an entity that is within the Missouri State Treasury. It is funded by taxes paid by employers and is essentially a reinsurance entity.

SIF (Second Injury Fund) was created in 1943 to incentivize employers to hire the handicapped and to apportion some of the costs. Stated purpose: “to encourage the employment of individuals who are already disabled from a preexisting injury, regardless of the type or cause of that injury.” To accomplish this goal, SIF was created to relieve an employer (or its insurer) of liability for the employee’s preexisting disability, and limited the employer’s liability to the amount of disability resulting from the last injury.

Claims shall be compensable only when an employee has a medically documented preexisting disability equaling a minimum of fifty weeks of permanent 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 accelerate the subsequent work-related injury..., or (iv) A preexisting permanent partial disability of an extremity, loss of eyesight in one eye, or loss of hearing in one ear, when there is a subsequent compensable work-related injury as set forth in subparagraph b of the opposite extremity, loss of eyesight in the other eye, or loss of hearing in the other ear...”

Attorney John A. Christiansen is a former Assistant Attorney General of Missouri who formerly represented the Second Injury Fund and has significant experience in litigating and handling Second Injury Fund cases. Please call our Kansas City, Missouri office at (816) 416-7070 to see about having your Second Injury Fund case handled by a knowledgeable professional.

mileage – money for mileage is paid if medical treatment is outside the employee’s principle place of employment

medical/prescription expenses: The employee receiving authorized treatment should never be billed. However, there may be situations where there are unpaid medical bills or prescription expenses for which reimbursement has not been made.

Unpaid TTD? : Has the employee received his/her full TTD benefits? Ask for a wage statement from the applicable period of time and make sure they are being paid at the proper rate.

Third Party Personal Injury Claim: Keep in mind that some accidents, typically car wrecks fall under workers’ compensation and personal injury law. The workers’ comp. insurance carrier will have a work comp. lien pursuant to section 287.150 and Ruediger v. Kallmeyer, 501 S.W.2d 56 for benefits paid.

Tips for Pleadings:

Claim For Compensation (www.labor.mo.gov) (Forms)

file immediately; do not wait for statute of limitations date of accident: check if there is an injury report and Injury Number with Division of Workers’ Compensation; may wish to say “culminated” on a particular day or month with repetitive motion injuries be careful to file a claim for each and every accident average weekly wage: may wish to say “maximum under the law” parts of the body: be broad; example: left upper extremity and shoulder; body as a whole (BAW), etc. how injury occurred: be specific, but stress that it was over a substantial and continuous period of time if dealing with repetitive motion injury such as carpal tunnel employer(s): have you named all the employers? Be careful to do so. Additional statements section: may wish to make demand for authorized medical treatment Second Injury Fund: always name them as a party

Defenses and Penalties:

• Not in the course and scope

• Medical causation – the alleged work accident or occupational disease was not the prevailing factor in causing the diagnosed condition(s)

• Failure to give 30 day notice and employer/insurer was prejudiced

• Statute of limitations

• Idiopathic injury – condition that is peculiar or innate to the claimant caused the injury

• Drugs/Alcohol – Section 287.120.6 (1) “Where the employee fails to obey any rule or policy adopted by the employer relating to a drug-free workplace or the use of alcohol or nonprescribed controlled drugs in the workplace, the compensation provided herein shall be reduced fifty percent if the injury was sustained in conjunction with the use of alcohol or nonprescribed controlled substance.” Section 287.120.6 (2) “If however, the use of alcohol or nonprescribed controlled drugs in violation of the employer’s rule or policy is the proximate cause of the injury, then the benefits or compensation otherwise payable under this chapter for death or disability shall be forfeited.”

• Safety Violation – Section 287.120.5: “Where the injury is caused by the failure of the employee to use safety devices where provided by the employer, or from the employee’s failure to obey any reasonable rule adopted by the employer for the safety of employees, the compensation and death benefit provided for herein shall be reduced at least twenty-five but not more than fifty percent...”

• Employer Penalties: Section 287.120.4: “Where the injury is caused by the failure of the employer to comply with any statute in this state or any lawful order of the division or the commission, the compensation and death benefit provided for under this chapter shall be increased fifteen percent.”

Timeline of case (sort of):

Traumatic accident or repetitive motion/occupational disease occurs

Notice of Injury to Employer – Section 287.420

• Written notice within 30 days unless employer not prejudiced

Claim for Compensation

• File immediately almost always

• Effect is to meet statute of limitations

• Gets a lawyer on other side & Administrative Law Judge assigned

Answer

• Due within 30 days

Medical treatment (authorized/unauthorized)

Obtaining what you need and discovery:

• medical records, statements, wage statement, personnel file, prior settlements/records, depositions, IME report

Conference/Pre-Hearing

• Very informal

• Can get things done sometimes

• Usually cancel them because treatment is ongoing or you need mediation conference

Mediation

• Hardship or Regular

• File written request

• Required before you can get a hearing in Kansas CityFor a regular mediation, you want the claimant to be at MMI (maximum medical improvement) and generally have expert medical report

Hearing (Final or Hardship)

• Process: Judge tried case, usually mediated again before hearing, etc.

Appeals

• Labor and Industrial Relations Commission

• Court of Appeals

• MO Supreme Court

Settlement:

• Stipulation for Compromise Settlement

• Must be signed by ALJ (Administrative Law Judge)

• Closes case forever except if it specifically states that medical is being left open and section 287.140.8 which mainly deals with prosthetics.

• Watch out for liens (especially child support liens; attorney liens, etc.)

A Few Other Basic Issues:

Causation standard: Section 287.020.3(1): In this chapter the term “injury” is hereby defined to be an injury which has arisen out of and in the course of employment. An injury by accident is compensable only if the accident was the prevailing factor in causing both the resulting medical condition and disability. “The prevailing factor” is defined to be the primary factor in relation to any other factor, defined to be the primary factor, in relation to any other factor, causing both the resulting medical condition and disability.”

Call the Law Office Of John Adams Christiansen, L.C. in Kansas City and Blue Springs at (816) 416-7070 to discuss your case. There is no charge for the initial consultation.