Missouri Benefits
MISSOURI WORKERS’ COMPENSATION LAW SUMMARY

Maximum Compensation Rates

Injury Date TTD,TPD,PTD PPD Qualifying AWW
& DEATH

07/01/08 – 06/30/09 $772.53 $404.66 $1158.80 / $606.99

07/01/09 – 06/30/10 $807.48 $422.97 $1211.22 / $634.46

07/01/10 – 06/30/11 $799.11 $418.58 $1198.67 / $627.87

07/01/11 – 06/30/12 $811.73 $425.19 $1201.10 / $637.79

07/01/12 – 06/30/13 $827.75 $433.58 $1241.63 / $650.37

07/01/13 – 06/30/14 $853.08 $466.85 $1279.63 / $700.28

07/01/14 – 06/30/15 $861.04 $451.02 $1291.56 / $676.53

07/01/15 – 06/30/16 $886.92 $464.58 $1330.38 / $696.87

07/01/16 – 06/30/17 $911.27 $477.33 $1366.91 / $716.00

07/01/17 – 06/30/18 $923.01 $483.48 $1384.52 / $725.22
07/01/18 – 06/30/19 $947.64 $496.38 $1421.46 / $744.57

Maximum Benefits

Disfigurement – 40 weeks at PPD rate 287.190.4

-Applies to head, neck, hands, arms

Death benefits– no limit 287.240

Medical benefits – no limit 287.140.1

TTD – 400 week maximum 287.170

PPD – 400 week maximum 287.190

TPD – 100 week maximum 287.180

Burial – $5,000.00 287.240.1

WAITING PERIOD: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 unless the disability shall last longer than fourteen days in which event payment for the first three days shall be made retroactively to the claimant. 287.160

MILEAGE: Pay up to 250 miles each way when traveling outside local or metro area of employee’s principal place of employment. 287.140.1

As of 07/01/18 reimbursed at 0.542 cents per mile. [Confirm current rate at (573) 751-4231]

ACCIDENT AND INJURY:

Accident :”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. For an injury to be compensable, the accident must be the prevailing factor, which is defined as the primary factor, in relation to any other factor, causing both the resulting medical condition and disability. 287.020.2&3

Idiopathic injuries:”An injury resulting directly or indirectly from idiopathic causes is not compensable.” 287.020.3(3)

Heart Attack: An injury only if the accident “is the prevailing factor in causing the resulting medical condition.” 287.020.3(4)

Going to & From Work: Injuries in company owned vehicles while commuting are not compensable. 287.020.5

Parking Lot:No liability for accidents that occur on customary, approved, etc routes used to get to work. 287.020.5

RECREATIONAL ACTIVITIES: Injury is compensable if employer orders participation, pays wages during participation or injury is due to unsafe employer premises. 287.120.7

ALCOHOL & DRUG USE: – If injury sustained in conjunction with alcohol etc, compensation shall be reduced by 50%.Employee no longer has to have “actual knowledge” of anti-intoxication policy and employer no longer has to make “diligent effort” to apprise of policy. If intoxication is the “proximate cause” of the injury, all benefits are forfeited. If intoxication above legal limit, rebuttable presumption that intoxication was proximate cause. Refusal to take alcohol/drug test results in benefit forfeiture if: (1) employer had cause to suspect usage OR (2) policy requires testing. 287.120.6

Positive test shall give rise to rebuttable presumption if: text within 24 hours; notice to employee within 14 days; employee given opportunity for second test; & testing confirmed by mass spectrometry (2017 amendment)

TEMPORARY TOTAL DISABILITY:

Unemployment compensation: Employee disqualified from TTD if receiving unemployment compensation. 287.170.3

Post injury misconduct: If employee terminated for post injury misconduct, no TTD or TPD if employee could work under restrictions. 287.170.4

Sick leave: Employer may require employee to use personal or sick leave in lieu of TTD for medical treatment, evaluations or P.T. 287.140.14

Resignation: No TTD/TPD if claimant resigns while restrictions being accommodated (2017 amendments) 287.170

STATEMENTS OF INJURED EMPLOYEES: No statement in writing made or given by an injured employee …shall be admissible in evidence …unless a copy thereof is given or furnished the employee … or their attorney, within thirty days after written request …. The request shall be directed to the employer or its insurer by certified mail. 287.215

BURDENS OF PROOF:287.808

Affirmative defense – Burden on employer

Entitlement to compensation – Burden on employee

Facts – must be established as “more likely true than not true”.

PERMANENT PARTIAL DISABILITY: “Disability shall be demonstrated & certified by a physician.” All opinions expressed to a “reasonable degree of medical certainty.” Objective findings [“those findings demonstrable on physical examination or by appropriate tests or diagnostic procedures”] shall prevail over subjective complaints.Compensation reduced to extent pre-existent disability contributed to overall rating. 287.190.6 et seq

DEATH: Dependent defined to mean only spouse & children age 18 or under unless a student or disabled from wage earning. Partial dependents no longer covered. (2017 amendment) 287.240

AMPUTATION:The number of weeks of compensation allowed in the schedule shall be increased by ten percent (10%). 287.190.2

MINIMUM COMPENSATION RATE FOR PPD: The weekly compensation rate shall in no event be less than forty dollars per week.287.190.5(2)

Minimum rate does not apply to TTP or TPD

OCCUPATIONAL DISEASE:287.063 & .067

Employer who last exposed employee to the hazard prior to evidence of disability is liable. 287.063.2

Statute of limitations shall not begin to run until it is reasonably discoverable injury sustained “related to such exposure.” 287.063.3

Injury from occupational disease is compensable only if “occupational exposure was the prevailing factor” in causing the condition. 287.067.2

Injury from repetitive motion is compensable only if “occupational exposure was the prevailing factor” in causing the condition. 287.067.3

Employee who contracts communicable disease from employment shall be eligible for benefits as an occupational disease. 287.067.7

Aging – “Ordinary gradual deterioration … of the body caused by aging … shall not be compensable.” 287.067.2

Three Month Rule – liability only allowed to relate back to the “immediate prior employer.” 287.067.8

NOTICE: Claim barred unless written notice within 30 days unless employer not prejudiced. 287.420

NOTICE: Occupational Disease and Repetitive Trauma cases: Written notice within 30 days of diagnosis of condition 287.420

JURISDICTION: If injury occurs outside of the state, Missouri still has jurisdiction if employment was principally localized in Missouri “within 13 calendar weeks of the injury or diagnosis of the occupational disease.” 287.110.2

SAFETY DEVICES: Failure to use safety devices ”shall” reduce benefits by “at least 25% but not more than 50%.” Employer must only demonstrate “reasonable effort” to ensure employee use of devices and employee’s failure to use no longer need be “willful.” 287.120.5

COMPUTING AVERAGE WEEKLY WAGE / COMPENSATION RATE:287.250

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.

STATUTE OF LIMITATIONS: 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. 287.430 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

OFFERS BEFORE REPRESENTATION: Written settlement offer to pro se claimant filed with division precludes attorney fee on that offer. 287.390.5

FRAUD: It shall be unlawful for any insurance company or self-insurer in this state to knowingly and intentionally refuse to comply with legally indisputable compensation obligations with intent to defraud. 287.128.2; It shall be unlawful for any person to knowingly present multiple claims for the same occurrence with intent to defraud, to assist or conspire with any person who knowingly presents any false claim for the payment of benefits or any person who knowingly presents multiple claims for the same occurrence with an intent to defraud; … knowingly make any false material statement for the purpose of obtaining or denying any benefit 287.128.3

DISCHARGE & DISCRIMINATION: No discrimination or discharge where the “motivating factor” for such is the exercise of W/C rights.”Motivating Factors” shall mean that the exercise of W/C rights actually played a role in and had a determinative influence on the discharge or discrimination.

Copyright Stretz/Quinn, P.C. 2018