Filing a Workers’ Compensation Claim
When you suffer an injury or illness at work, your first step is to report it to your supervisor or your employer. You are required to provide written notice detailing the date, time, place of injury, nature of injury, along with your contact information, including name and address.
After notifying your employer, your employer should arrange for you to receive proper medical treatment and evaluations, and also file the necessary reports to the state Workers’ Compensation Division and notify the insurer.
If the injury or illness requires immediate attention, you should tend to that prior to providing written notice. Note that you have 30 days to file your claim, or it may not be honored.
Basis for a Claim
Missouri law states that the accident at work must be the prevailing – or primary – factor in causing your injury and disability. Likewise, if you fall ill, occupational exposure to the disease must be the prevailing factor in the resulting medical condition and disability.
In addition to medical expense payments, benefits for lost wages are available but depend on how your disability is classified. There are four classifications and resulting payment calculations:
- Temporary Partial Disability: Your disability allows you to continue working but in a lesser capacity. You will be eligible for two-thirds of the difference between the pay for your non-disabled work capacity and your partially disabled work status.
- Temporary Total Disability: Your disability prevents you from working in any capacity. You will be paid two-thirds of your normal weekly wage, not to exceed a maximum amount set by law.
- Permanent Partial Disability: You are eligible to receive two-thirds of your average weekly wage, up to a legal limit, or to receive a lump sum payment.
- Permanent Total Disability: You can receive lifetime payments of two-thirds of your weekly wage, again limited by a legal ceiling. You may also be offered a lump sum.
If you are receiving lost-wages compensation, the first three days you miss from work will not be paid unless and until you miss 14 days off.
If you are permanently and totally disabled due to one or more “occupational diseases due to toxic exposure,” you qualify for enhanced benefits. These diseases include mesothelioma, asbestosis, berylliosis, coal worker's pneumoconiosis, bronchiolitis, obliterans, silicosis, silicotuberculosis, manganism, acute myelogenous leukemia, and myelodysplastic syndrome.
Appealing a Decision
If you disagree with a decision affecting your benefits, or if your claim is denied, there are different levels in the appeal process. The first step is often to appeal the decision to the Missouri Workers’ Compensation Dispute Management Unit. This is a voluntary process involving mediation.
Your other initial option is a conference with an administrative law judge (ALJ). If this conference fails to reach an agreement amenable to all, the next step is to file a Claim for Compensation, which will lead to a hearing by an administrative law judge. The ALJ can issue a Final Award, a Temporary/Partial Award, or an Award on Agreed Statement of Facts.
If any party — insurer or claimant — disagrees with the award by the ALJ, it can appeal to the Labor and Industrial Relations Commission. After that, the only recourse is to the court system: first to the Court of Appeals and finally to the Missouri Supreme Court, which is extremely unlikely to take up a workers’ compensation appeal.
Get The Guidance You Need Today
Navigating the workers’ compensation system is rarely simple and straightforward. Getting what you need and deserve out of the system is sometimes more involved than just filing your initial notice and seeing a doctor.
The insurer can impose hurdles by challenging the cause of your injury or illness – was an accident or occupational exposure truly the prevailing factor? – or by requiring additional documentation and medical evaluation. They may even deny your claim.
At some point, you may need to file an appeal, and in that circumstance, the guidance and representation of an experienced attorney is essential.