This page provides answers to the following questions:
- I had an accident at work. How do I file a workers compensation claim in my state?
- Should my employer have workers compensation insurance? How do I know I am covered?
- What are the conditions that enable me or prevent me from claiming benefits under my state's law?
- What benefits might I be eligible to receive?
- How much time do I have to file my claim? What are the stages of the claim process? What should I expect?
- If I'm not happy with the determination, how do I appeal?
1. I had an accident at work. How do I file a workers compensation claim in my state?
If you are injured during the course of employment, notify your employer as soon as possible if not immediately. You must report your injury within thirty (30) days in order to best ensure the success of a potential workers' compensation claim. It is best to notify your employer in writing, specifying the details of your injury, including the date, time, the place of the injury, the nature of the injury, as well as your contact information.
After notifying your employer, your employer should arrange for you to receive proper medical treatment or medical evaluation. In addition, your employer is expected to file the proper reports to the Workers' Compensation Division. If your employer or your employer's insurance provider fails to file the proper reports in a timely manner, either party may be subject to certain fines, imprisonment or both.
2. Should my employer have workers compensation insurance? How do I know if I am covered?
Every employer with five or more employees is expected to have some form of workers' compensation coverage through an insurance provider. Missouri Workers' Compensation law does not apply to all types of workers, however. Workers' Compensation Law does not apply to the following: certain construction industry employers; railroad, postal and maritime workers covered by federal law; farm laborers; domestic workers; real estate agents; volunteers of tax-exempt organizations; inmates, patients or residents of the state, county, or municipality; volunteer employees.
Your employer or employer's insurance provider is required to provide for all necessary medical treatments related to treating the injury. The employee will select the medical professional to provide treatment.
3. What are the conditions that enable me or prevent me from claiming benefits under my state's law?
To qualify to claim benefits under the law, the accident must be the prevailing factor causing both the medical condition and injury as well as arising from the course of employment.
4. What benefits might I be eligible to receive?
Your employer is responsible for providing the proper medical benefits should your injury require.
Other benefits may be available as well. These include payments for lost wages, benefit payments, and disability benefits.
- Lost Wages: Upon your physician's determination that you are incapable of returning to work or you are recovering from surgery and can't return to work, you may be entitled to temporary total disability payments. If you are capable of returning to work, even if to a lesser capacity than prior to your injury, you could be entitled to temporary partial disability payment which will compensate you for the difference in wages from your changed work status.
- Benefit Payments: These are payments paid in the event that your work related injury prevents you from returning to work. There are varying scopes of an injury, sometimes even resulting in permanent damage or permanent handicap. Depending on the extent of your injury, you may be entitled to one of these kinds of benefit payments.
- Temporary Partial Disability: these payments are roughly 66.66% of the difference between your wages pre-injury and your wages post-injury, in the event that you are able to return back to work but in a lesser capacity.
- Temporary Total Disability: if you are incapable of returning to work as a result of your injury, you may be entitled to two-thirds (66.67%) of your average weekly earnings as of the date of your injury.
- Permanent Partial Disability: these payments are roughly two-thirds (66.67%) of your average weekly wages as of the date of your injury, but will be capped at a maximum set by law. You may also receive a lump-sum payment for your injury, depending on the nature and extent of disability.
- Permanent Total Disability: this is either one lump sum or weekly payments for your lifetime should you suffer from an injury that causes a permanent and total disability. The weekly payment amount will be calculated as roughly two-thirds (66.67%) of your average weekly earnings at the time of your injury, also to not exceed a maximum amount set by law.
5. How much time do I have to file my claim? What are the stages of the claims process? What should I expect?
After you have notified your employer about your injury and your employer has gone through the necessary measures to consult the employer's insurance provider to review your claim, if you are still unsettled with the benefits determination regarding your injury, you may pursue filing a workers' compensation claim with the Department of Labor & Industrial Relations.'
The Division of Workers' Compensation suggests you exhaust some remediation options prior to filing a claim, including utilizing dispute management services or having a conference with an administrative law judge.
Dispute management services are available to help facilitate a resolution process in lieu of formal litigation. A mediator usually presides over the process at some point prior to a claim filing. No issues will be conclusively decided nor will any decisions be formally made; however the process will help parties work toward a settlement.
The conference with an administrative law judge is held where no compensation claim has been filed. This is an opportunity for the injured employee to work with the employer's representative to come to a settlement if feasible. You may file a Request for Conference with the Division of Workers' Compensation or may be set by the Division should it deem one necessary. Within 120 days of a request or order for a conference, a conference will be scheduled.
Filing a claim for compensation usually involves a number of stages. First, a pre-hearing is scheduled before an administrative law judge to discuss the issues of the case once the claim has been filed. To schedule a pre-hearing, you must file a Request for Pre-Hearing and a Notice of Pre-Hearing will subsequently be sent to both parties. A pre-hearing can be requested when you or your employer wants to present a potential settlement agreement; disputes or issues emerge that need to be resolved; the parties believe the pre-hearing will help to move the case closer towards the settlement or final hearing.
A hardship hearing may be the next step after filing a claim and the pre-hearing conference is made. A hardship hearing is held before an administrative law judge and is often held to resolve a dispute concerning the termination of benefits when you, the injured employee, may have not made a full medical recovery. Often, the employee involved with a claim at this stage is requesting a temporary or partial award of benefits.
A final hearing may also be requested when you have reached maximum medical improvement or the case may reach a final resolution.
6. If I am not happy with the determination, how do I appeal?
If you remain unhappy with the determination of your claim after going through the claims process, you may elect to file an application of review with the Labor and Industrial Relations Commission. You must file this application within 20 days of the award. You may not appeal any agreement of settlement or compromise of dispute that has been approved by an administrative law judge, however.
You may file a first appeal with the Labor and Industrial Relations Commission. The commission is comprised of three panelists who will review your case. The Commission, upon review of your case, may choose to adopt the administrative law judge's award or issue a new one.
A second appeal may be requested after a final award by the Commission to be held with the state Court of Appeals. This is not a new trial, but a review of your case history and the issues of your case. The Court of Appeals can only modify or reverse the Commission's award based on legal issues.
A third appeal may be made to the Missouri Supreme Court; however, appeals to this level are typically very rare.