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Like other life events and disruptions, becoming sick or injured can cause temporary or even long term additional stressful havoc with your health, income, employability, living situation, plans, day to day events, functional capacity and enjoyment of your social and personal life.

If you have been injured on the job or develop an illness, occupational disease or illness caused by your employment, you may be covered and receive benefits under Missouri’s Workers’ Compensation Law. Workers’ Compensation law and its benefits are also commonly referred to as “work comp”, “workmans comp” or “workmans compensation”, “workers comp”, “workers compensation” or even “work disability” or “workers disability”. Work related Injuries, occupational diseases or illnesses covered exclusively under Federal Law are not covered under Missouri’s Workers’ Compensation Law.

The law of what constitutes a work accident (effective for all Workers’ Compensation injuries, occupational diseases or illness occurring or filed on or after August 28, 2005) has recently been substantially rewritten and tightened. Lawsuits have been filed challenging the new law

The law of what constitutes an accident has been rewritten and tightened.

Workers’ Compensation benefits include reasonable and necessary medical treatment, temporary total disability (TTD) benefits, payment of money for permanent partial disability (PPD) or permanent total disability (PTD). If an injured worker dies as a result of a work-related injury, benefits may be paid to the employee’s spouse or surviving dependents.

Unlike many other types of personal injuries, if an injury arises from or is caused by your employment, Missouri Workers Compensation law provides coverage with or without the fault or negligence of another. Also, unlike other personal injuries, no benefits can be sought for pain and suffering. The issues and choices can be complex and confusing.

Depending on such facts as where you perform your job, the location at the time of injury and the state in which you contracted for hire, you may be entitled to choose to get benefits from another state. The choice of jurisdiction and where you get your benefits may impact the rights and benefits you are entitled to and the options and compensation you are entitled to receive.

If you sustain a work related injury, occupational disease or illness and have pre-existing injuries such as, illnesses, conditions, occupational diseases, substance abuse treatment, birth or congenital defects, whether or not you have received prior compensation, your employer or their insurer may be liable for their aggravation or exacerbation.

Under certain circumstances when the work injury, occupational disease or illness and the pre-existing one(s) are substantial, Missouri’s Second Injury Fund may also provide a monetary benefit.

To protect your rights and obligations under the law, you have a limited time to report your claim and should immediately report any injury or illness you believe may have been caused by your job to your supervisor, preferably in writing. You should also describe what, where, when and how the injury, occupational disease or illness occurred. Always follow up an oral report with a written report as soon as possible and make sure you obtain a copy.

Your employer or their insurer cannot provide you benefits if they have not received notice of your injury. There are legal time limits for notice to your employer or their insurer. Coverage may be disputed, delayed or denied if there is a delay in reporting.

The law has also been tightened and rewritten to allow the employer or their insurer to require that you use your accumulated paid, personal, medical or sick leave to attend treatment or evaluations.

A lawyer can help you through this process and help you get a fair and reasonable resolution of your claim.

Whether or not you believe that you are being treated fairly, you may choose to enforce your rights and benefits under Missouri’s Workers’ Compensation law by filing a claim for benefits. You do not and in most cases cannot file a lawsuit in a civil court. Your claim will be monitored and heard by an Administrative Law Judge in one of the eight local offices of the Division of Workers’ Compensation.

The law and its requirements can be difficult to understand; you may find that you would have gotten better treatment and benefits if you had done things differently; your employer or their insurer can put roadblock after roadblock in your way, denying you rights and benefits that you are entitled to or not advising you of rights and benefits that are available to you. As a result, your rights and recovery of your benefits can be unfairly delayed or denied.

Many workers are afraid to report or seek treatment from their employer or their insurer or to hire lawyers, often out of misplaced loyalty to their employers or fear of retribution or being fired. This is often a mistake that can result in failure to take the necessary steps to protect your rights and benefits, denial or diminution of your claim and benefits by both your employer and their insurer and any health insurer that you may seek coverage from.

If you believe you or someone you know believes they are injured, have an occupational disease or illness as the result of their employment; call the Law Office of Joyce Kramer today (314-361-2000) for personalized help to make it right!

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WORKERS’ COMPENSATION COVERAGE

In Missouri, most employers with certain exceptions are required to carry workers’ compensation insurance if there are five or more employees. If the employer is in the construction industry, just one employee triggers the requirement for coverage.

With certain exceptions and additions, you may be covered anytime you are at work or required to attend or participate in any event, jobsite or place you are required to be by your employer.

Missouri’s Workers’ Compensation law was enacted in 1925. In return for protection from civil lawsuits, employers are required to provide certain benefits to workers who are injured, develop occupational diseases or become ill due to their employment.

Employees who sustain work related injury, occupational disease or illness due to their employment, while required to use the Workers’ Compensation program instead of a civil suit, are in turn relieved from the necessity of providing the proof of negligence that is normally required in a civil suit.

The tradeoff works both ways, sometimes favoring the employer and sometimes the employee, but in the end, both parties are usually spared the costs and rigors of filing a lawsuit and when benefits are fairly made by the employer and not disputed, delayed or denied, the employee does not have the expense of providing his or her own care then fighting in court to be compensated.

That said, there are certain situations that can change your options, your benefits and any recovery due to you, including the opportunity to file a civil suit instead of or as well as a claim under Workers’ Compensation. The issues and choices can be complex and confusing. A lawyer can help you through this process and help you get a fair and reasonable resolution of your claim

The law and its requirements can be difficult to understand; you may find that you would have gotten better treatment and benefits if you had done things differently; your employer or their insurer can put roadblock after roadblock in your way, denying you benefits that you are entitled to or not advising you of rights and benefits that are available to you; and recovery of your benefits can be unfairly delayed or denied.

Many workers are afraid to report or seek treatment from their employer or their insurer or to hire lawyers, often out of misplaced loyalty to their employers or fear of retribution or being fired. This is often a mistake that can result in failure to take the necessary steps to protect your rights and benefits, denial or diminution of your claim and benefits by both your employer and their insurer and any health insurer that you may seek coverage from.

If you believe you or someone you know believes they are injured, have an occupational disease or illness as the result of their employment; call the Law Office of Joyce Kramer today (314-361-2000) for personalized help to make it right!

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REASONABLE AND NECESSARY MEDICAL TREATMENT

Missouri’s Workers’ Compensation law provides that your employer or their insurer has the right to choose your medical treatment and to deny payment for any treatment that has not been authorized by them. They can, but often will not, provide authorization for you to see your own doctor.

If you are unsure as to whether or not your injury, occupational disease or illness is work related, to protect and preserve your rights and benefits, you should promptly notify your employer or their insurer if you obtain evidence or are advised that your injury or illness could be work related. Failure to provide prompt notice can result in denial of liability for medical expenses and, most troubling, denial of payment by your health insurer.

It is important to understand that proof of a work related injury or illness does not require 100% certainty, but rather the much lower standard of whether it is “more probable or not” that that the injury is work-related and is “the prevailing factor in the causing both the resulting medical condition and disability.”

Although each case is fact specific, the law has recently been tightened and made to be strictly construed to enforce the new laws in many ways, including:

  • The definition of what constitutes a compensable accident.
  • Removing the former benefit of the doubt to the employee to now being impartial.
  • To be compensable, the new law now requires that the cause of the injury, occupational disease or illness be the prevailing factor in causing, aggravating or exacerbating the medical condition and disability.

If after proper notice, your employer or their insurer ceases or refuses to provide medical treatment, you may be forced to seek medical treatment through your health insurance or on your own. While remedies for delay are few, if your injury is determined to be work-related, your employer or their insurer may be held liable to pay for paid or unpaid reasonable and necessary medical expenses incurred by you or your health insurer.

It is well known and recognized that there are some employer’s and insurance company doctors who will do anything and everything they can to find that an injury, occupational disease or illness is not work related. Others, if they do find the injury, occupational disease or illness to be work related, may minimize the severity or complexity of the problem, the treatment, tests, the time off work needed or the length of time it will take to fully recover. A lawyer can help you through this process and help you get a fair and reasonable resolution of your claim

The law and its requirements can be difficult to understand; you may find that you would have gotten better treatment and benefits if you had done things differently; your employer or their insurer can put roadblock after roadblock in your way, denying you benefits that you are entitled to; and recovery of your benefits can be unfairly delayed or denied.

Many workers are afraid to report or seek treatment from their employer or their insurer or to hire lawyers, often out of misplaced loyalty to their employers or fear of retribution or being fired. This is often a mistake that can result in failure to take the necessary steps to protect your rights and benefits, denial or diminution of your claim and benefits by both your employer and their insurer and any health insurer that you may seek coverage from.

If you believe you or someone you know believes they are injured, have an occupational disease or illness as the result of their employment; call the Law Office of Joyce Kramer today (314-361-2000) for personalized help to make it right!

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TEMPORARY TOTAL DISABILITY (TTD) BENEFITS

Requirement to pay TTD starts after you are authorized off work for more than three days. You are entitled to compensation for the first three days if you are authorized off work more than ten days up to the maximum amount of coverage.

If you haven’t worked for your employer that amount of time or other reasons make using those figures unfair, there are a few different ways to figure the appropriate amount that should be used. The employer or their insurer doesn’t always provide the records requested or use the correct figures, so, while it is always a good idea to keep records of as many things as you can, it is very important to keep records of you wages.

There are often disputes as to whether or not the employer or their insurer considers the injury or illness work related or whether or not you agree with the employer or their insurers doctor’s assessment of authorized time off work.

You can request that the employer or their insurer provide a second opinion, but it is rare that a second opinion will be voluntarily provided.

If you disagree with the findings of the employer or their insurers’ doctor and a doctor on your behalf says you need more time off, the employer or their insurer may deny TTD for that longer period and you may have to wait until a decision is made or an Administrative Law Judge determines that you are entitled to payment for that time off work.

Under the new law, your employer or their insurer may require you to use any accumulated paid, personal or medical or sick leave to attend treatment or evaluations during work time.

If your employer or their insurer’s doctor releases you to work for “limited” or “restricted” duty, always ask the doctor to specifically list what you are able to do and not do. Even if the doctor does this, and especially if your limited or restricted duty is for more than just a few days, you may have problems either being able to perform or being asked to perform work that clearly is restricted; your coworkers may resent having to do what they believe should be your work; and your employer and/or your coworkers may not believe or care that you are not able to perform. A lawyer can help you through this process and help you get a fair and reasonable resolution of your claim

The law and its requirements can be difficult to understand; you may find that you would have gotten better treatment and benefits if you had done things differently; your employer or their insurer can put roadblock after roadblock in your way, denying you benefits that you are entitled to; and recovery of your benefits can be unfairly delayed or denied.

Many workers are afraid to report or seek treatment from their employer or their insurer or to hire lawyers, often out of misplaced loyalty to their employers or fear of retribution or being fired. This is often a mistake that can result in failure to take the necessary steps to protect your rights and benefits, denial or diminution of your claim and benefits by both your employer and their insurer and any health insurer that you may seek coverage from.

If you believe you or someone you know believes they are injured, have an occupational disease or illness as the result of their employment; call the Law Office of Joyce Kramer today (314-361-2000) for personalized help to make it right!

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PERMANENT PARTIAL DISABILITY (PTD) BENEFITS

When you are released from treatment and are able to return to work, you may be entitled to a recovery for any permanent partial injury to your body that affects your ability to get and keep a job or for any reduced level of functioning that may reduce your ability to earn an income. This includes smaller injuries such as strains and sprains as well as other injuries that leave scars that can be seen (on the head, neck, arms or hands) and those injuries and illnesses that are healed and not painful but may be aggravated or worsen in the future.

If the employer or their insurer’s doctor releases you MMI (maximum medical improvement), your work related injury, occupational disease or illness may take time to fully recover from or you may not be considered to be able to recover sufficiently to get and keep a job for a very extended period of time of you may need future medical care that you are not aware of. These are also factors that should be considered in any settlement of PTD.

It is a good rule to wait a minimum of thirty days and even much more depending on the nature of your injury, occupational disease or illness before you even consider settling your claim. Many times, you are just returning to your full schedule at work as well as your social and personal life and have no idea in advance of what your response will be.

Other times you are still under medication or have had treatments that make you feel back to normal, when in fact time will show that you are not.

You also want to at the very least make an appointment with your own doctor or a specialist on your behalf to make sure that you are cured and relieved of your work related injury, occupational disease or illness and have received all the treatment you need and have been properly appraised of the nature and extent of your injury, occupational disease or illness.

PTD is determined by an assessment of what the percentage disability is to the injured part of the body. This percentage is then compared to your PTD rate which is most often based on the weekly average of two thirds of the gross salary you were paid for the thirteen weeks prior to the week of you work injury, up to a maximum that changes each year, and a settlement amount is calculated.

The assessment of the percentage of disability is often made by the employer or their insurer's adjuster or doctor. Often, the lowest possible percentage is offered. Sometimes, an unfair or even a mistaken or callous and unscrupulously low amount is offered. Sometimes other injuries, occupational diseases or illnesses are overlooked or undiagnosed.

You may also be entitled to other benefits that you were not aware or advised of. These include: future medical care, payment of unauthorized medical; reimbursement of health insurer paid medical expenses; unpaid TTD, co-pays, travel costs and other expenses incurred as a result of your work related injury, occupational disease or illness.

Also, although it is voluntary, if you are not able to return to your normal type of work, your employer or their insurer may offer or be persuaded to provide you with vocational rehabilitation services to help you retrain or learn a new type of work. The SIF may provide you with an additional small stipend if the facility is certified by the Division of Workers’ Compensation.

Prior to the recent changes in the Workers’ Compensation law, where an injured worker was unrepresented by a lawyer, a Legal Advisor or Administrative Law Judge was required to review and approve the amount offered. If the judge believed the amount was not fair, the judge could refuse to settle the claim. Now, if the unrepresented injured worker agrees to the offer, the Administrative Law Judge may not be required to refuse to settle the claim. Legal Advisors have been eliminated under the new law.

This is why it is very important for you to understand the nature of your work related injury or illness and its future impact of your ability to work and keep a job. And also why if is very often in your best interests to seek an opinion from a doctor on your behalf, and/or a specialist, before you settle your claim.

If you are now covered or when you are covered under Medicare, you may be required to repay Medicare and/or be denied future Medicare benefits for work related injuries, occupational diseases or illnesses that have been determined to be so. Medicaid is also entitled to reimbursement of payments made on your behalf.

The law and its requirements can be difficult to understand; you may find that you would have gotten better treatment and benefits if you had done things differently; your employer or their insurer can put roadblock after roadblock in your way, denying you benefits that you are entitled to; and recovery of your benefits can be unfairly delayed or denied. A lawyer can help you through this process and help you get a fair and reasonable resolution of your claim.

Many workers are afraid to report or seek treatment from their employer or their insurer or to hire lawyers, often out of misplaced loyalty to their employers or fear of retribution or being fired. This is often a mistake that can result in failure to take the necessary steps to protect your rights and benefits, denial or diminution of your claim and benefits by both your employer and their insurer and any health insurer that you may seek coverage from.

If you believe you or someone you know believes they are injured, have an occupational disease or illness as the result of their employment; call the Law Office of Joyce Kramer today (314-361-2000) for personalized help to make it right!

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PERMANENT TOTAL DISABILITY (PTD)

What if you are released from treatment and your work related injury or illness is so functionally incapacitating that it is considered permanent? If your work related injury or illness is considered so severe that you will be unable to work or maintain a job for life, either in your area of work or in other jobs that you are qualified or could be qualified for that are regularly available in the open labor marketplace, you may be entitled to either a settlement or lifetime weekly benefit payments and medical care from your employer or their insurer, whether or not you have become eligible for or are receiving social security disability payments.

If you qualify for PTD (the rate is the same one used for TTD), your Social Security Disability benefits may be reduced to account for the additional money received from PTD benefits.

If you are now covered or when you are covered under Medicare, you may be denied Medicare benefits for proven work related injuries, occupational diseases or illnesses that have been determined to be so. Medicaid benefits paid may be required to be reimbursed.

Determination of PTD is usually strongly fought by your employer or their insurer. If you believe your capacity to get and keep a job has been so compromised that you can’t work and the employer or their insurer is saying you can, in addition to getting your own examination of your work related injury or illness and a rating of the percentage disability, you also will want to get an opinion on your behalf of your ability to get and keep a job in the open labor marketplace. A lawyer can help you through this process and help you get a fair and reasonable resolution of your claim.

The law and its requirements can be difficult to understand; you may find that you would have gotten better treatment and benefits if you had done things differently; your employer or their insurer can put roadblock after roadblock in your way, denying you benefits that you are entitled to; and recovery of your benefits can be unfairly delayed or denied.

Many workers are afraid to report or seek treatment from their employer or their insurer or to hire lawyers, often out of misplaced loyalty to their employers or fear of retribution or being fired. This is often a mistake that can result in failure to take the necessary steps to protect your rights and benefits, denial or diminution of your claim and benefits by both your employer and their insurer and any health insurer that you may seek coverage from.

If you believe you or someone you know believes they are injured, have an occupational disease or illness as the result of their employment; call the Law Office of Joyce Kramer today (314-361-2000) for personalized help to make it right!

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DEATH BENEFITS

If a person dies as a result of a covered work related injury or illness, death benefits, including burial expenses and weekly death benefits may be found payable to the worker’s surviving spouse or dependents.

Where it is determined that the employer should have obtained insurance coverage and did not, the SIF could be found liable to pay these benefits. A lawyer can help you through this process and help you get a fair and reasonable resolution of your claim.

The law and its requirements can be difficult to understand; you may find that you would have gotten better treatment and benefits if you had done things differently; your employer or their insurer can put roadblock after roadblock in your way, denying you benefits that you are entitled to; and recovery of your benefits can be unfairly delayed or denied.

Many workers are afraid to report or seek treatment from their employer or their insurer or to hire lawyers, often out of misplaced loyalty to their employers or fear of retribution or being fired. This is often a mistake that can result in failure to take the necessary steps to protect your rights and benefits, denial or diminution of your claim and benefits by both your employer and their insurer and any health insurer that you may seek coverage from.

If you believe you or someone you know believes they are injured, have an occupational disease or illness as the result of their employment; call the Law Office of Joyce Kramer today (314-361-2000) for personalized help to make it right!

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THE SECOND INJURY FUND

Although the purpose of the Second Injury Fund (SIF) (established in 1943) is to encourage employers to hire and keep employees with disabilities, by limiting liability of the employer for subsequent injuries on the job combining with the prior disabilities resulting in permanent total disability, it also functions, with proper notice, in certain cases to provide a partially or totally disabled employee with other monetary benefits, including:

  • Monetary benefits to employees with serious work related injuries, occupational diseases or illnesses that also have other pre-existing problems including: serious illnesses, conditions, occupational diseases, substance abuse treatment, birth or congenital defects, whether or not they have received prior compensation, if they pre-existed the work injury, occupational disease or illness that combines with the current work related injury, occupational diseaseor illness to create an increased combined disability “of such seriousness as to constitute a hindrance or obstacle to employment” or re-employment (the ability of get and keep a job.)
  • Lifetime, weekly PTD benefit payments if the combination of the current and pre-existing disabilities combine to make the employee unemployable in the open labor marketplace.
  • Compensation when the employee has a second job and is unable to work due to a covered work related injury, occupational disease or illness.
  • A very modest weekly stipend for a limited period of time to a seriously injured employee who is going through physical rehabilitation in a Division of Workers’ Compensation certified facility.
  • Payment of medical bills of a worker who sustains a work related injury, occupational disease or illness when the employer was required to obtain workers’ compensation insurance coverage and did not.
  • Payment of burial expenses and weekly death benefits to the surviving spouse or dependents where the employer was required to have workers’ compensation insurance coverage and did not.

A lawyer can help you through this process and help you get a fair and reasonable resolution of your claim.

The law and its requirements can be difficult to understand; you may find that you would have gotten better treatment and benefits if you had done things differently; your employer or their insurer can put roadblock after roadblock in your way, denying you benefits that you are entitled to; and recovery of your benefits can be unfairly delayed or denied.

Many workers are afraid to report or seek treatment from their employer or their insurer or to hire lawyers, often out of misplaced loyalty to their employers or fear of retribution or being fired. This is often a mistake that can result in failure to take the necessary steps to protect your rights and benefits, denial or diminution of your claim and benefits by both your employer and their insurer and any health insurer that you may seek coverage from.

If you believe you or someone you know believes they are injured, have an occupational disease or illness as the result of their employment; call the Law Office of Joyce Kramer today (314-361-2000) for personalized help to make it right!

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©2009 Joyce Kramer Attorney at Law
Office Address (by appointment): 4907 West Pine Blvd., Main Floor. St. Louis, MO 63108
Mailing Address: 4633 Maryland Avenue, St. Louis, MO 63108-1912
Phone: (314) 361-2000 | Fax: (314) 361-2121



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