Basic Benefits For Employees Under Missouri Workers' Compensation Law

Basic Benefits For Employees Under Missouri Workers' Compensation Law
The workers' Compensation law provides three types of benefits for a person who is injured while performing work-related duties.

The first, and probably the most important benefit, is that the employee is entitled to receive medical treatment for the work-related injury and does not have to pay for that treatment.  Payment is made by the employer or insurer.  But remember that the employer has the right by law to select the physician.  So if you seek treatment that has not been authorized, you may have to pay for that treatment yourself.

The second benefit is referred to as temporary total disability or TTD, which is compensation for the time the doctor says you are unable to work because of the injury.  You will not receive TTD benefits for the first three regularly scheduled workdays you are off unless you are off for a total of fourteen or more calendar days.  Those benefits are calculated at two-thirds of your average weekly wage not to exceed a maximum rate set by legislature.  Your average weekly wage is determined according to how your wages are fixed, whether by the week, by the month, by the year, o0r by some other method, such as amount of sales.  Temporary total disability benefits cease when the doctor says you are able to return to work.  Although those wages are only two-thirds of your average wage, it is important to remember that they are tax-free.

The third type of benefit is compensation for a permanent disability.  Once a doctor has done all he or she feels can be done medically to help you, and you are not as physically able as you were before the injury, then you have a disability.  And if there isn't anything else the doctor can do to make you any better, your disability will be "permanent", meaning you will suffer the effect of the injury from that point on.  That disability will either be "total" meaning you are unable to perform any work or "partial" which means you are able to work but there are limitations or restrictions as to what you are able to do.  If you are determined to be permanently and totally disabled, your benefits will continue for the rest of your life.  If your disability is a permanent partial disability (PPD), the legislature has established a formula to convert that disability into a dollar amount.  The maximum weekly wage amount for a permanent partial disability is less than the maximum for the temporary total disability because the disability is partial instead of total.  Compensation is for the disability only.  The law does not provide compensation for pain and suffering.
 
What To Do When You Are Injured While Working

Whether or not the employer believes the injury is work-related, prompt reporting to the employer is necessary and required.  Nothing can happen until the employer knows about the injury.  Employees should ensure their rights to benefits by providing the employer a written notice of the injury, no matter how minor.  To do that the employees must:

Report the injury to the employee's supervisor as soon as possible;

Tell the supervisor everything they can about the injury - what, where, when and how it happened;

Get prompt medical care for the injury; and

Inform the employer about the employee's medical condition and when the employee can return to work if injury caused the employee to miss work.  The employer should make sure the injured employee receives immediate medical attention to treat the injury.  The employer must report the injury to the insurance company, or the administrator if self-insured, within five days of the date of the injury or within five days of the date on which the injury was reported to the employer if that is later.  The insurance company or administrator then reports the injury to the division of Workers' Compensation.  If the employer denies the injury is work-related, you should determine through the employer if the injury has been reported.  Then contact the Divisions' Dispute Management Unit at (573) 526- 4950 (if you are not represented.  If you have an attorney, your attorney will handle this for you.)

Medical Benefits Under Missouri Workers' Compensation Law

Medical benefits for an employee who suffers a work related injury include medical treatment to cure the injury.  This is first dollar coverage.  That is, you do not have to pay for any portion of the treatment.  The employer has the right to select the health care provider, such as the doctor, hospital and clinic.  Often, the employer allows the insurance company or third party administrator to make this selection.  If you have problems with a health care provider, let your employer know and request a change be made.  The employer is not required to make a change, but the request will sometimes result in a referral top a different provider or better treatment.  The employer has the final say to the insurance company in the selection of the health care provider.  You can select your own medical provider at your own expense.  If your employer refuses to provide medical treatment, you may receive reimbursement for any medical treatment, which is reasonable and necessary to cure the work-related injury.  If possible, you should obtain a written refusal to provide medical treatment from the employer.

You should not be billed for medical treatment you receive for a work-related injury, unless you select the health care provider.  If you are, you must notify the health care provider that this is a workers' compensation injury, with notice of the name of the employer, the name of the insurer, if known, the general nature of the injury, if known, and if a claim has been filed, the claim number, if known.  This notice must be in writing and should be sent by certified mail.

Temporary Pay Benefits While Off Work Due To A Work Injury

In most circumstances, if you are off work because of a work-related injury, you are eligible to receive temporary total disability benefits to replace your lost wages.  These benefits are often referred to as TTD benefits.  You are eligible if you have missed more than three regularly scheduled workdays.  These are regularly scheduled workdays of your employer.  If you miss more than two weeks, these first three days, referred to as the waiting period, are paid to you.

The amount you receive is based on two-thirds of your average weekly wage, up to the statutory maximum of 105% of the State Average Weekly Wage.  For injuries that occur on or after July 1, 2002, the maximum is &628.90.  For example, if you earn $300.00 per week, your TTD benefits would be $200, that is two-thirds of your average weekly wage.  If you earned $1200.00 per week, 2/3 of your average weekly wage would be $800.00, so your TTD benefit would be limited to $628.90.  The maximum amount is determined by the date of injury.

Your average weekly wage is computed based on your gross wages.  If your wages are fixed by the month, multiply your monthly gross wages by 12 and divide that total by 52 to determine your average weekly wage.  If your wages are fixed semimonthly, multiply your gross wages by 26 and divide that total by 52 to determine your average weekly wage.  If your wages are fixed weekly, that is your average weekly wage.  If your wages are fixed by the hour or some other method such as sales output, take a total of your gross wages for the last thirteen weeks and divide that total by thirteen to determine your average weekly wage.

Your employer has the option to keep you on regular payroll during your time off.  You must agree to this in writing.  Your employer cannot force you to take sick leave or vacation time while you are off work due to a work-related injury.  You can, elect to use sick time or vacation time for the time you miss work.

 Settlement Of The Claim - The Disability Benefit

Before you settle your case, you should have finished medical treatment and been released to return to work by the doctor.  If you have not finished medical treatment, have recently had major treatment such as surgery or if you are still on work restrictions, your case is not ready to settle.  If the work restrictions are permanent, you should have been advised of this fact by the doctor.

The disability benefit that is paid for any permanent residual effect of your injury is called permanent partial disability.  This is a lump sum benefit that is paid to you after the injury has been treated and you have recovered to the fullest extent possible.  The permanent partial disability benefit, often called PPD, is paid to compensate you for that permanent residual effect of the injury.

These payments are based on a weekly schedule of various body parts, the rating of that permanent injury and your average weekly wage.  In order for your case to be settled, the doctor should rate your work-related injury.  This rating is the doctor's opinion on the permanent effect of the injury.  It is usually given as a percentage of a body part such as an arm, leg or finger.  A back or neck injury is rated as a body as a whole injury.  Depending on the body part affected by your injury, there are a number of weeks that are set out for that body part.  For example, the leg at the hip is rated at 207 weeks, the arm at the shoulder at 232 weeks, the index finger at the first knuckle at 45 weeks, and the whole body as a whole at 400 weeks.

Your average weekly wage is calculated the same way as the temporary total disability benefit, that is two-third of your average weekly wage.  However, the maximum limitation is lower at 55% of the State Average Weekly Wage, or since July 1, 2001, $329.42.  The maximum amount is determined by the date of injury.  Your average weekly wage is computed based on your gross wages.

Can My Employer Fire Me While I'm Off Work Because Of My Injury?

The answer is maybe.  An employer cannot discharge or discriminate against you because of your workers' compensation injury.  However, if an employer has a legitimate basis for the discharge, such as disciplinary action or work shortage, that may be legitimate.  The fact that you have been fired does not effect your eligibility for workers' compensation benefits.  If you are unable to work, you should continue to receive your temporary total disability benefits.  If you are receiving medical treatment, this should continue.  If you have a permanent injury, you should receive permanent partial disability benefits in settlement of your case.  The Division does not have jurisdiction over any legal action for your discharge.