FSQ Law - Missouri Benefits

MAXIMUM COMPENSATION RATES:

TTD,TPD,PTD & DEATH / PPD
07/01/96 - 06/30/97		$513.01 / $268.72
07/01/97 - 06/30/98		$531.52 / $278.42
07/01/98 - 06/30/99		$562.67 / $294.73
07/01/99 - 06/30/00		$578.48 / $303.01
07/01/00 - 06/30/01		$599.96 / $314.26
07/01/01 - 06/30/02		$628.90 / $329.42
07/01/02 - 06/30/03		$649.32 / $340.12
07/01/03 - 06/30/04		$662.55 / $347.02
07/01/04 - 07/01/05		$675.90 / $354.05

MAXIMUM BENEFITS:

Disfigurement (287.190.4) - 40 weeks at TTD rate.

- Applies to head, neck, hands and arms.

Death - No limit

Medical – No limit

TTD - 400 week maximum

TPD - 100 week maximum

Burial (287.240.1) -- $5,000.00

WAITING PERIOD:287.160 – No TTD or TPD shall be payable for the first three days or less of disability during which the employer is open for the purpose of operating its business.

MILEAGE : 287.140.1 - Must pay mileage up to two hundred fifty miles each way.

Mileage is currently reimbursed at 0.345 cents per mile irrespective of date of injury.

SCHEDULE OF LOSSES: 287.190	WEEKS
1. Loss of arm at shoulder	232
2. Loss of arm between shoulder and elbow	222
3. Loss of arm at elbow joint	210
4. Loss of arm between elbow and wrist	200
5. Loss of hand at the wrist joint	175
6. Loss of thumb at proximal joint	60
7. Loss of thumb at distal joint	45
8. Loss of index finger at proximal joint	45
9. Loss of index finger at second joint	35
10. Loss of index finger at distal joint	30
11. Loss of either the middle or ring finger at proximal joint	35
12. Loss of either the middle or ring finger at second joint	30
13. Loss of either the middle or ring finger at distal joint	26
14. Loss of little finger at proximal joint	22
15. Loss of little finger at second joint	20
16. Loss of little finger at distal joint	16
17. Loss of one leg at the hip joint	207
18. Loss of one leg at or above the knee	160
19. Loss of one leg at or above the ankle and below knee joint	155
20. Loss of one foot in tarsus	150
21. Loss of one foot in metatarsus	110
22. Loss of great toe of one foot at proximal joint	40
23. Loss of great toe of one foot at distal joint	22
24. Loss of any other toe at proximal joint	14
25. Loss of any other toe at second joint	10
26. Loss of any other toe at distal joint	8
27. Complete deafness of both ears	180
28. Complete deafness of one ear, the other being normal	49
29. Complete loss of the sight of one eye	140

AMPUTATION: 287.190.2If the disability suffered in any of Items 1 through 29 is total by reason of severance or complete loss of use, the number of weeks of compensation allowed in the schedule shall be increased by ten percent (10%).

ACCIDENT AND INJURY: 287.020.2 & .3

The word "accident" means an unexpected or unforeseen identifiable event or series of events happening suddenly and violently, with or without human fault, and producing at the time objective symptoms of an injury. An injury is compensable if it is clearly work related. An injury is clearly work related if work was a substantial factor in the cause of the resulting medical condition or disability. An injury is not compensable merely because work was a triggering or precipitating factor.

The word "injury" means an injury which has arisen out of and in the course of employment. The injury must be incidental to and not independent of the relation of employer and employee. Ordinary, gradual deterioration or progressive degeneration of the body caused by aging shall not be compensable, except where the deterioration or degeneration follows an incident of employment.

An injury arises out of and in the course of employment only if:

(a) it is reasonably apparent, upon consideration of all the circumstances, that the employment is a substantial factor in causing the injury;

(b) it can be seen to have followed as a natural incident of work;

(d) it does not come from a hazard or risk unrelated to the employment to which workers would have been equally exposed outside of and unrelated to the employment in normal non-employment life.

OCCUPATIONAL DISEASE: 287.063 & .067

An occupational disease is compensable if it is clearly work related. An occupational disease is not compensable merely because work was a triggering or precipitating factor.

With regard to occupational disease due to repetitive motion, if the exposure to the repetitive motion which is found to be the cause of the injury is for a period of less than three months and the evidence demonstrates that the exposure to the repetitive motion with a prior employer was the substantial contributing factor to the injury, the prior employer shall be liable for such occupational disease.

JURISDICTION: 287.110.2 - The Missouri Workers' Compensation Act applies to all injuries received and occupational diseases contracted in this state, regardless of where the contract of employment was made, and also to all injuries received and occupational diseases contracted outside of this state under contract of employment made in this state, unless the contract of employment in any case shall otherwise provide, and also to all injuries received and occupational diseases contracted outside of this state where the employee's employment was principally localized in this state.

MENTAL INJURY: 287.120.8 & .9

Mental injury resulting from work related stress does not arise out of and in the course of the employment, unless it is demonstrated that the stress is work related and was extraordinary and unusual. The amount of work stress shall be measured by objective standards and actual events. A mental injury is not considered to arise out of and in the course of the employment if it resulted from any disciplinary action, work evaluation, job transfer, layoff, demotion, termination or any similar action taken in good faith by the employer.

DISPUTE OVER MEDICAL BILLS 287.140.4

If an employer or insurer fails to make payment for authorized medical services provided to the employee, the health care provider may seek to resolve the dispute pursuant to 287.140.4 which requires the Division to promulgate rules to resolve medical fee disputes. These rules are contained within 8 CSR 50-2.030 and provide that the employer shall notify a health care provider in writing of a dispute over the reasonableness of a medical fee. This dispute shall be resolved by either mediation or hearing before the Division. A health care provider whose services are authorized by the employer/insurer may give notice to the Division of any claim for fees and the Division may order direct payment from the proceeds of any settlement or award to the health care provider.

TERMINATION OF WEEKLY COMPENSATION 287.203

Whenever the employer terminates weekly compensation payments, the employer shall notify the employee of the termination and shall advise the employee of the reason for the termination. If the employee disputes the termination, the employee may request a hearing before the Division and the hearing shall be set within sixty (60) days of the request.

CREDIT FOR UNEMPLOYMENT BENEFITS RECEIVED:

287.170.3 - Employer entitled to dollar for dollar credit for unemployment benefits paid to claimant while claimant receiving TTD.

COMPUTING AVERAGE WEEKLY WAGE / COMPENSATION RATE :

The method of computing an injured employee's average weekly earnings shall be as follows:

1. If the wages are fixed by the week, the amount so fixed shall be the average weekly wage;

2. If the wages are fixed by the month, the average weekly wage shall be the monthly wage so fixed multiplied by twelve and divided by fifty two;

3. If the wages are fixed by the year, the average weekly wage shall be the yearly wage fixed divided by fifty two;

4. If the wages were fixed by the day, hour, or by the output of the employee, the average weekly wage shall be computed by taking the wages earned in the last thirteen consecutive calendar weeks immediately preceding the week in which the employee was injured and dividing by thirteen. If the employee was employed by the employer for less than thirteen weeks, then take the wages earned in the period of time actually worked and divide by the actual number of weeks worked. For purposes of computing the average weekly wage in this paragraph, the absence of five regular or scheduled work days, even if not in the same calendar week, shall be considered as absence for a calendar week. If the employee began employment on a day other than the beginning of a calendar week, that calendar week and the wages earned during that week shall be excluded in computing the average weekly wage;

5. If the employee has been employed less than two calendar weeks immediately preceding the injury, the employee's weekly wage shall be considered to be equivalent to the average weekly wage prevailing in the same or similar employment at the time of the injury, except if the employer has agreed to a certain hourly wage, then the hourly wage agreed upon multiplied by the number of weekly hours scheduled shall be the employee's average weekly wage; and

6. If the hourly wage has not been fixed or cannot be ascertained, or the employee earned no wage, the wage for the purpose of calculating compensation shall be taken to be the usual wage for similar services where such services are rendered by paid employees of the employer or any other employer.

PRORATION OF LUMP SUM SETTLEMENT: 287.250.9 – Parties may agree to prorate the settlement over the life expectancy of the claimant.

STATUTE OF LIMITATIONS: 287.430 - No proceedings can be maintained unless a claim is filed with the Division within two years after the date of injury or death, or the last payment made under the Act on account of the injury or death; provided, however, that if the report of injury is not filed by the employer within one month from the date of injury or death, the claim for compensation may be filed within three years after the date of injury, death, or last payment made. This Statute of Limitation shall not begin to run in cases of occupational disease until it becomes reasonably discoverable and apparent that a compensable injury has been sustained (287.063.3).

REACTIVATION OF CLAIM: 287.140.8 – Claimant may reactivate claim after settlement for the payment of medical procedures involving life threatening surgical procedures or if the claimant requires a new or the modification of an existing prosthetic device.

NOTICE : 287.420 – Claimant required to give written notice of injury to the employer not later than 30 days after the injury.

MISSOURI WORKERS' COMPENSATION LAW