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Missouri Workers' Compensation: Frequent Issues

This guide explains procedures and practice tips specific to workers' compensation claims in Missouri.

STATUTE INTERPRETATION: POST 2005 - STRICT CONSTRUCTION

Pre - 2005

"The purpose of Workers' Compensation Law is to ‘place upon industry the losses sustained by employees resulting from injuries arising out of and in the course of employment and, consequently, the law should be liberally construed so as to effectuate its purpose and humane design.”’ Rogers v. Pacesetter Corp., 972 S.W.2d 540, 542-43 (Mo.App.1998).

Post-2005

The Missouri Workers’ Compensation Act was amended to require strict construction and to require the evidence to be weighed impartially, without giving any party the benefit of the doubt. Miller v. Missouri Highway and Transportation Commission, 287 S.W.3d 671, at 673.

ISSUES IN DISPUTE & ELEMENTS OF A CLAIM

When a workers' compensation case goes to a final hearing, the Administrative Law Judge often begins the hearing by going through the list of issues in dispute. This page will list the issues, give a brief description of the issue, and provide a statute or leading case that has discussed the issue. 

Here is a list of 10 issues, which are frequently in dispute:​

  1. Notice
  2. Accident/Occupational Disease
  3. Average Weekly Wage & Rate
  4. Medical Causation 
  5. Medical Aid Furnished
  6. Future Medical Care
  7. Temporary Total Disability
  8. Permanent Partial Disability
  9. Permanent Total Disability
  10. Disfigurement

1. Notice

Missouri Workers' Compensation Law requires that 1) written notice of the time, place and nature of the injury, and the name and address of the person injured, and also requires that the notice is 2) given to the employer no later than thirty days after the accident. An exception for the second requirement exists if the employee can prove that the employer was not prejudiced by the failure to receive the notice. However, the exception requires the employee to prove a negative, which is extremely difficult.

2. Accident/Occupational Disease

The word "accident" as used in this chapter shall mean an unexpected traumatic event or unusual strain identifiable by time and place of occurrence and producing at the time objective symptoms of an injury caused by a specific event during a single work shift. An injury is not compensable because work was a triggering or precipitating factor.

"Occupational diseases due to toxic exposure" shall only include the following: mesothelioma, asbestosis, berylliosis, coal worker's pneumoconiosis, brochiolitis obliterans, silicosis, silicotuberculosis, manganism, acute myelogenous leukemia, and myelodysplastic syndrome.

3. Average Weekly Wage & Rates

The average weekly wage rate is used to determine the amount of TTD and PPD benefits. The average weekly wage is determined by using 13 weeks of pay to find the average weekly wage. Then, two -thirds of the average weekly wage is used to determine the weekly wage for PPD benefits. However, the weekly wage amounts for PPD and TTD are limited based on a chart, which provides the maximum amount. 

4. Medical Causation

Pre-2005

The on-the-job injury only needed to be one factor in causing the injury. For example, a person suffering from knee pain due to degenerative changes in the knee goes to work and twists their knee causing more knee pain. The primary cause of their increased knee pain was degenerative changes, not the work related accident. Prior to 2005, this type of injury would have been covered.

Post-2005

The Missouri legislature changed MO workers compensation laws to make it more difficult for employees to obtain workers compensation benefits. The new law requires that the on-the-job injury be the prevailing factor rather than just a factor at all. Many of the legislative changes are still being tested in the court system and the overall affect on premiums is still unrealized.

5. Medical Aid Furnished

Unless the employer/insurer has denied the employee's claim, the insurer is required to provide medical aid to the employee. 

6. Future Medical Care

Usually the issue of future medical care will go along with the issue of medical causation. If the work accident caused the injury, then the employee is likely entitled to future medical benefits. However, if the claim is settled prior to trial, future medical is usually not left open. Furthermore, in order for the employee to prove that s/he is entitled to future medical benefits, s/he must provide the opinion of a medical doctor relating the same. 

7. Temporary Total Disability

The term "total disability" means an "inability to return to any employment and not merely mean inability to return to the employment in which the employee was engaged at the time of the accident.” See Section 287.020 - Definitions

8. Permanent Partial Disability

This is essentially a battle of the experts. Overall, certain body parts and injuries are recognized to be worth a certain percentage. However, exigent circumstances often arise. Judges typically assess PPD in a range that is in the middle of the ratings given by the doctors in the IME reports. 

9. Permanent Total Disability

When an employee asserts that s/he is entitled to PTD benefits, the process becomes long and drawn out. This is because these cases typically involve the Second Injury Fund. Furthermore, these types of cases require vocational expert opinions as well as medical professional opinions.  

10. Disfigurement

Disfigurement is compensation that is awarded based on the severity of the permanent scaring or disfiguring that the injury caused. Disfigurement is left to the discretion of the administrative law judge.