Benefits available in missouri workers compensation
Medical Benefits
In Missouri, there are four (4) major benefits available in a workers’ compensation case. The first is medical expenses paid by the employer as long as the employee receives treatment from the authorized healthcare provider. If the employee lives outside the metropolitan area of the principal place of employment, the employee would also be entitled to round-trip mileage to and from authorized healthcare providers. An employee can always see their own doctor, but it would be at the employee’s expense.
Temporary Disability Benefits
The second benefit available is temporary disability benefits. These benefits can be either temporary total disability (“TTD”) or temporary partial disability (“TPD”) benefits. Temporary total disability benefits are paid to an employee while the employee is off of work due to injury or has been released to restricted duty, but the employer cannot accommodate the restrictions. TTD benefits are determined by multiplying the gross average weekly wages (“AWW”) earned for the 13 weeks preceding the week in which the injury occurred by 66 ⅔% (subject to the State maximum rate). In many instances, it is necessary to get a wage statement from the employer to determine this amount, as an employee may have earned overtime. There could even be instances where the AWW is determined using less than 13 weeks. For instance, if an employee has missed more than five (5) regularl or scheduled work days during the 13 week period of time or did not work for the employer for 13 weeks, you would use less than 13 weeks to determine the AWW. I suspect most employees who handle a case on their own are not aware of the rules for calculating AWW pursuant to R.S.Mo.'287.250 and may be leaving “money on the table”.
Temporary partial disability (“TPD”) benefits are paid to an employee who has returned to work, but is not able to earn the AWW wage he/she was earning before the injury. In these instances, the employee is due 66 ⅔% of the difference between what he/she would have earned had he/she been back to full time duty and the amount actually being earned performing restricted work. This benefit is rarely paid because once the employee returns to work (even in a restricted job), he/she usually receives the AWW being earned before the injury.
Permanent Disability Benefits
Depending upon the severity of the injury, an employee is entitled to either permanent partial disability (“PPD”) or permanent total disability (“PTD”) benefits. This is the third benefit available. PPD benefits are typically determined using a different compensation rate than PTD benefits because of the maximum compensation rate allowed under State law. These maximums are determined based on the date of the injury. In a PPD case, the maximum compensation rate is substantially less (about 50% of the PTD rate) than the PTD maximum compensation rate. The other variables for determining PPD benefits is (a) the percentage of disability suffered (doctors provide these percentages) and (b) the weeks attributable to the body part injured (this is set out in a statute). The authorized treating doctor will usually provide a disability rating that is advantageous to the employer. The employee should always consider getting a second rating at his/her own expense in order to increase the value of the case. There is no pain or suffering in the work comp system.
The general rule is if an employee can return to some type of job (even if it is not the old job), the employee is considered permanently and partially disabled. If an Employee can no longer work at all in any capacity in the job market, the employee is considered permanently and totally disabled. Obviously, an employee that is permanently and totally disabled is entitled to substantially more disability benefits than an employee who is permanently and partially disabled. Prosecuting a permanent total disability claim requires hiring a doctor to provide opinions about a diagnosis, prognosis, restrictions, and permanent disability to the body part injured, the need for future medical treatment, and the need for medications and the side effects of those medications.. The injured employee will also want the doctor to give an opinion on the ability to perform activities of daily living (i.e. driving). The employee who is claiming to be permanently and totally disabled will also need to have a vocational expert testify about the likelihood of that employee being retrained or reintroduced to the job market. It is critical that this expert be retained and give opinions regarding not only whether the employee can return to some line of work, but whether a reasonable employer could be expected to hire an employee in his/her condition. This expert usually makes or breaks the case. I always remind the employee who may be eligible for PTD benefits to apply for social security total disability benefits, as well. There can be limitations to how much social security total disability benefits an employee can receive when also receiving PTD benefits, but that is for another day.
Future Medical Benefits
Finally, future medical treatment, the fourth benefit, may be awarded if it can be proved that more likely than not an injured employee will require medical treatment in the future. If there is no evidence from a doctor of the need for future medical treatment, the administrative law judge will typically find against the employee on this issue and close the future medical benefits portion of the claim. Thus, it is important that an injured employee have the doctor give an opinion, one way or the other, whether the employee will require future medical treatment. I have always maintained that the “plum” in any workers’ compensation case is the medical treatment because of the enormous cost involved. There are no rights to vocational rehabilitation in Missouri; however, the State does provide vocational retraining for those injured employees who qualify separate from the workers’ compensation system under a program. I always remind the employee who may be eligible for PTD benefits also apply for social security total disability benefits. There can be limitations to how much social security a totally disabled employee can receive, but that communication is for another day.
January 20, 2008
Article Source: Messaggiamo.Com
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