The Nuts and Bolts of Workers' Compensation
How Does it Work?
By Garrett A. Grellner, VBM Attorney
Article written March 1, 2023
What are you entitled to if you are injured at work in Missouri?
In Missouri, claimants are entitled to three primary benefits, that being medical benefits, temporary total disability, and permanent partial or permanent total disability. These three benefits are guaranteed to a worker who is injured within the course and scope of employment under Section 287 of the Missouri Revised Statutes. Medical benefits are usually the easiest to navigate. Medical benefits are those benefits which are paid for the claimant's authorized treatment for their injuries that occurred while on the job. The employer has the privilege of choosing which healthcare provider will see the claimant and the claimant must go to the provider chosen by the employer in order to have their medical paid for by the employer. If the claimant decides to go elsewhere for treatment outside of the authorized providers by their employer, the claimant must pay out of pocket for those visits and procedures. The claimant's insurance will typically not cover those appointments. It is a risk a claimant must decide whether to take when going outside of the authorized care providers for extended treatment, different treatment, or treatment from an unauthorized care provider. The employer will pay the medical bills of the claimant up until the claimant reaches maximum medical improvement.
Temporary total disability is where the claimant is compensated for lost wages. If a doctor reports that a claimant is unable to return to work due to injuries sustained on the job, you as a claimant are entitled to temporary total disability benefits which are designed to compensate you for lost wages. If a doctor allows the claimant to return to work with restricted duty, the claimant is generally not entitled to recover any temporary total disability benefits because they are still being paid their normal rate at work, however, they are simply performing a different task or role. Temporary total disability benefits cover a claimant from the time they are injured through to when the claimant has reached maximum medical improvement or treatment is concluded.
Permanent partial disability and permanent total disability is designed to compensate the claimant for the lifetime consequences of the injury itself and any disfigurement that may have occurred as a result. Permanent partial disability means that the claimant's injury has affected their ability to work but they are still able to work and perform certain tasks that allow them to still work in some capacity. The benefit here is reflected by a lump sum payment to the claimant. Permanent total disability means that the claimant is no longer able to work at all, which means the claimant may be entitled to weekly or monthly lifetime payments or the claimant can negotiate for a lump sum payment for permanent total disability.
Therefore, the claimant is compensated in three ways:
- By having their medical bills paid for so long as they are from authorized providers;
- By being compensated for time away from work if the claimant is not able to return to work following their injury; and
- By being compensated for their body being permanently disabled in one form of another, being either slight or severe.
How are workers' compensation settlements for permanent partial disability calculated in Missouri?
In Missouri, the body as a whole is designated as 400 weeks. Each specific body part is designated a specific week amount as well. For example, the elbow is 210 weeks, the ankle is 150 weeks, and the hand is 175 weeks. To calculate a compensation amount, the body part that is injured is given a percentage to which it is permanently disabled. Hypothetically, let's say a claimant has an injured elbow at 25% of the 210-week level. You would then multiply .25 by 210 to get 52.5. That number would then be multiplied by the claimant's compensation rate, leading you to the end of the formula. Average weekly wage is calculated by taking the claimant's last 13 weeks of pay and averaging them, then multiplying that number by two thirds will give you the TTD compensation rate. Labor.mo.gov has a great example, which I will share here:
"Remember the formula for a permanent partial disability is: Number of weeks assigned to the part of the body injured –times- the percentage of the disability –times- compensation rate. Again, let’s use the example of a shoulder injury occurring on June 1, 2009 and an average weekly wage of $600.00. Let’s also assume that, in the doctor’s opinion, your permanent disability is 10% of the shoulder. Remembering that 232 weeks have been assigned to the shoulder the formula would be as follows: 232 x 10% x $400.00= $9,280.00. In this example had the doctor determined the disability to be 5% instead of 10% the formula would result in $4,640.00. If the doctor determined your disability to be 15% the formula would result in $13,920.00."
What four type of issues are not covered by workers' compensation?
There are four primary areas that are not covered by workers' compensation. Those areas include an incident that arose out of an act of God, a common, one-time illness such as influenza, conditions that pre-existed the claimant's hiring, and the contracting of an ordinary disease of life. Any complaints arising out of these four areas are not compensable and the employer will not be held responsible for providing workers' compensation benefits.
Does workers' compensation in Missouri pay for pain and suffering?
No. Workers' compensation benefits are limited to those listed above, meaning simply medical benefits, temporary total disability, and permanent partial/permanent total disability. There are no benefits outside of those three areas that a claimant can recover from. A misconception is that a workers' compensation case is similar to a personal injury case where the plaintiff is seeking recovery for pain and suffering amongst other things such as medical bills and emotional distress. In the realm of workers' compensation, the system is designed to streamline benefits to the claimant. By specifically designating the benefits that are available to a claimant and having a formula that is organized to fairly compensate the claimant, the benefits that are open to be used can be made available at a much quicker pace.
If you have any questions about this article or would like to have any questions answered about workers' compensation law in Missouri, please do not hesitate to reach out to our office at 573-777-4488 or email me at Garrett.Grellner@vbmlaw.com.
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