How Are Personal Injury Settlement Paid Out? Your Complete Guide
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According to the Missouri Department of Labor and Industrial Relations, 7,851 claims for injuries under workers’ compensation were filed in June 2021. Expanded over 12 months, that extrapolates to more than 90,000 workers’ compensation claims a year filed in Missouri.
Even though it’s not uncommon to file a claim in Missouri, when a workplace accident happens to you or someone you love, it can feel completely overwhelming. When you’ve been injured or fallen ill due to workplace conditions in the St. Louis area, including Jefferson County and Charles County, contact Jett Legal. A St. Louis workers’ compensation lawyer can assess your situation, determine your options, and help you with your claim, including the filing of any appeals that become necessary.
Businesses in Missouri that meet certain employee thresholds are required to carry workers’ compensation insurance, or to self-insure when qualified. Certain types of employment, however, are excluded, including agriculture, home-based care providers, real estate agents, postal and maritime workers, and volunteers at a tax-exempt organization. Independent contractors lacking employee status are also exempt.
Workers’ compensation is a no-fault system, in which neither employer nor employee can be assessed fault for any injury or illness that occurs because of work conditions or accidents. Instead, the workers’ compensation system – usually managed by an insurance provider – will field claims and provide benefits as necessary to cover medical expenses and any wages lost due to time off for treatment or recovery.
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.
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:
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.
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.
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.
If you’ve suffered an occupational injury or illness in or around St. Louis, Missouri, contact Jett Legal immediately. Let us evaluate your situation and guide you through the workers’ compensation process to seek the best possible result. We’ll stand by you throughout and help you with any appeals you may need to pursue.
Call now to schedule a free case review.