There are four main benefits employees may qualify for. These benefits include:
(The definitions of these terms are provided below along with the corresponding Missouri statute sections)
If the insurer considers the injury to be compensable, the insurer will pay medical bills relating to the worker's injury. The caveat to this is that the insurer chooses the medical provider and sets up the appointments. Any medical treatment that the injured worker seeks on his or her own is considered "unauthorized," and the insurer will refuse to pay any bills generated from that appointment. Often times, the insurer will send a nurse case manager to appointments in order to ensure that the employee is complying with the doctor's orders.
If the insurer denies the claim, meaning that the insurer finds that the claim is not compensable, the employee must take the denial letter when seeking medical care on their own. This is because often times, medical providers will refuse to provide unauthorized treatment when the medical provider is aware that the injury is to be covered by a workers' compensation insurer.
Permanent total disability means that the injured worker is no longer able to work at any job. If the last work-related injury alone causes your permanent total disability, the injured worker may be entitled to weekly payments for life from the employer/insurer, or the parties may negotiate a lump-sum settlement instead of the weekly lifetime payment.
Alternatively, if the employee's last work-related injury combined with prior disabilities causes the employee to be permanently and totally disabled, the employer/insurer may only be responsible for permanent partial disability and in order to receive further benefits, the injured worker needs to file a “claim for compensation” against the Second Injury Fund (SIF) to receive any permanent total disability payments.
The SIF is funded by a surcharge paid by employers. The Missouri State Treasurer is the “custodian” of the SIF. The Missouri Attorney General’s Office defends the claims made against the SIF and obtains the Treasurer’s authority to settle cases for the SIF. The Second Injury Fund Unit is responsible for the billing and collection of the Second Injury Fund Surcharge from insurance carriers writing workers’ compensation premiums in Missouri and from self-insurers or group trusts authorized to self-insure in Missouri.
Click on this link for a list of FAQs regarding the SIF from the prospective of the injured worker:
Permanent partial disability (PPD) means that the work injury affects the worker's ability to do certain jobs or work tasks, but the worker is still able to work in some capacity (not necessarily the job you had at the time of your injury). This is the most contested form of benefits because the loss of the use of a body part is hard to quantify in terms of a dollar amount. Because of this difficulty, the workers' compensation has developed a system, which assigns a certain number of "weeks of pay" to each body part. A "week of pay" for each worker is calculated based on that worker's average weekly wage rate. (note: for workers who are employed part-time, a different formula is used - that formula is known as "the 30-day-rule")
A percentage of the body part, also known as a "rating," is assigned for each injury. Doctor experts are hired by each party. The doctors conduct an Independent Medical Evaluation (IME) and provide a PPD rating based on the chart below:
If you return to light or modified duty at less than full pay, the workers’ compensation law requires that temporary partial disability (TPD) benefits be paid to you.
These benefits are generally paid weekly and should be 66 2/3% of the difference between the average earnings prior to the accident and the amount which the employee, in exercise of reasonable diligence, will be able to earn during the period of disability, subject to the maximum TTD rate.
TPD benefits are often brought into the case when the employee receives some type of commission, but was denied that commission due to thie injury. In other words, a special formula is used to calculate the the additional lost compensation that was not factored into the average weekly wage.
Starting January 01, 2014, the employee may be entitled to some enhanced weekly payments if it is shown that an employee is permanently, totally disabled (or has died) due to one or more "occupational diseases due to toxic exposure," which are defined as: mesothelioma, asbestosis, berylliosis, coal worker's pneumoconiosis, brochiolitis, obliterans, silicosis, silicotuberculosis, manganism, acute myelogenous leukemia, and myelodysplastic syndrome.
A $25,000 death benefit must be awarded to the estate of the employee who lost thier life in the line of duty. The death benefit is in addition to any other pension rights, death benefits, or other compensation to which the individual would have been entitled to. In order to claim the $25,000 benefit, the estate of the deceased must file a Claim for Compensation within one year from the date that the employee passed away.