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Chapter Three what to do if you’re injured on the job

“Workers’ Compensation in Missouri: Succeeding in Your Injury Claim”

What To Do If You’re Injured on the Job

First, make sure of two things:

  • a. That you were hurt at work (not going to or coming from work) and that it was a sudden occurrence that happened at a specific place on at date and at a time (this is important information you need to make a claim and fill out a claim for compensations).
  • b. That the work incident is what caused your injury and not something else. This can be a more complex question than it might appear at first. What about hearing loss, carpal tunnel syndrome, and degenerative back disease of a claim that occurs over time? The work has to be the “prevailing cause” of the injury. Further, sometimes injuries that have occurred on the job were caused by the negligence of another employee of the company, or by a third party not employed by the company. If that is the case, then you may be entitled to a recovery under both a worker’s compensation and civil claim. If the negligence of the employer allowed the third party to create a situation that led to your injury, then that injury was both work related and caused by civilly compensable negligence.

Then, do the following:

1. File an Injury Report

No matter how badly you are injured, the first thing that you must do is file an injury report. A sample injury report is attached as Appendix 1. This is usually made to your supervisor or manager. It must be made to either your employer or its insurance company, or one of their representatives. One thing to remember is that in the special case of an occupational disease – such as mesothelioma – you must report the diagnosis along with your belief that the diagnosis was caused by your on the job exposure – within 30 days of the diagnosis. If you don’t, you will lose your claim.

Remember also that you can have a family member report your injury if you are not able to. The important thing is to make sure that the employer is put on notice of the claim – if you do not, the claim will be forever barred, and you will have no recovery for your on the job injury!

When reporting the injury, you should always ask that a written report be made of the injury report or provide your employer with a written notice, including your name and the time, place and nature of the injury, including all body parts affected by the injury. And follow up with the Division of Workers compensation to check to see your employer reported the injury and you learn your “injury number.”

Note that your employer is required by law to fill out and file an injury report. R.S.Mo § 287.380. So, that might have occurred without your knowledge. Once an injury report is filed the Division of Workers’ Compensation assigns an injury number to the report regardless of whether a claim has been filed.

2. Get Medical Treatment

If you have an on the job injury, remember that the Missouri Workers’ Compensation statute requires that your employer provide you with medical treatment. Even in the event that your injury manifests itself as being an occupational disease resulting from long term exposure to pollutants or repetitive tasks, the employer is still required to provide this medical care.

Medical care encompasses a lot. It includes medical, surgical, chiropractic or hospital treatment, in addition to doctors, nurses, physician assistants, physical therapists, tests, x rays and MRIs, custodial care, ambulance transportation, medicines, crutches, x-ray or nearly anything else that may be reasonably required after your injury or disability to cure and relieve the effects of the injury. Many times, you do not know all that will be needed – the extent and nature of your injury reveals itself over time.

Your employer and/or insurer is required to pay for all reasonable medical care needed to treat the injury. R.S.Mo § 287.140. They cannot require or try to get you to put in on your health insurance. In fact, your health insurance company has a provision that excludes coverage for on the job injuries (as does your car insurance). The employer/insurer has separate workers’ compensation insurance to pay for that medical care.

In Missouri, the employer/insurer gets to control where, with whom and when you get your medical care. R.S.Mo § 287.140. They can send you to conservative medical treatment before MRIs, other diagnostic tests, shots, pain management, physical therapy, and surgery are done. Their medical providers typically get significant business from the particular insurance company so they have an incentive to get you back to work and to rate your disability low. But an employer cannot act unreasonably in providing medical care or not fulfill its obligation to provide appropriate medical care.

If an employer or their insurer does not provide you the care you need, we demand that care in writing and call them. If they continue to refuse, we file “hardship” claims/motions with the Division to get the Administrative Law Judge to order the employer/insurer to provide the medical care. R.S.Mo § 287.203. Note that if the employer or insurer refuses or denies the claim, you can go to the doctor of your choice. Unless you are willing to pay for the treatment by yourself or through your own private insurance, you must go to the treatment provider that has been authorized by your employer.

In addition, your employer does not have to pay you for work that you missed in order to attend doctor’s appointments or other treatment, including physical therapy. R.S.Mo § 287.140. In fact, your employer may require you to take paid leave, personal leave, or medical/sick leave when work time is missed for treatment, therapy, or medical evaluations. An employer only has to pay for transportation if the treatment was authorized to be received at a facility that is outside of the principal place of your employment.

3. File Your Claim with the Division

Filing the claim is really the beginning of the case and a required act. R.S.Mo § 287.420. Filing your claim allows you a number of benefits under the Missouri workers’ compensations statute. A sample injury report is attached as Appendix 2. By filing a claim, you place your employer and insurance company on notice of your claim for benefits under the statute. Although both should already be aware of the injury via your filing of a written injury report directly after it occurs, the claim itself provides additional notice that you are seeking compensation. There are many instances where the employer does not file an injury report – so this may be the first the work comp system is aware of the claim. You have two years from an injury to file a claim but three years if the employer never filed and injury report. R.S.Mo § 287.420.

A “work accident” in work comp means: “an unexpected traumatic event or unusual strain unidentifiable by time and place of occurrence and producing the objective symptoms of an injury caused by a specific event during a single work shift.” R.S.Mo § 287.120.2. You want to identify a single incident causing your injury and what happened, like “In the course and scope of claimant’s employment with defendant, claimant was lifting a box and felt a pop in her back (shoulder, knee).”

This means that not every injury is compensable under the workers’ compensation statute. Rather, an injury will not be deemed compensable under workers’ compensation if it merely happened to occur at work, but work was not a prevailing factor in the injury—if the injury is one to which the worker would have been exposed to in the normal scope of everyday life, then it is no longer compensable. In Duever v. All Outdoors, Inc., the Missouri Court of Appeals affirmed a worker’s compensation award for an employee who was injured after he slipped on black ice walking to the office from the parking lot. 371 S.W.3d 863, 865 (Mo. Ct. App. 2012). The employer’s insurance challenged the award, arguing that the employee’s injury did not “arise out of the course and scope of employment” and was therefore not compensable. Id. at 867. The Court emphasized that the employer is liable irrespective of negligence and that the employee was owed compensation when injured at work from event such as the one described. Id. at 868. The employer attempted to argue that the employee’s injury did not qualify due to the fact that his injury was of a type that he could have been equally exposed to outside of work, but the Court rejected this argument, indicating that when an injury is directly connected to an accident which occurred while an employee was working, said employee is entitled to compensation. Id.

So, when you are filling out your claim form, you need to be sure to allege that your injury occurred: “in the course and scope of claimant’s employment with the employer, the prevailing cause of the above described injury was….” Although using that phrase in no way guarantees that you will have a valid claim, it will be a long way towards demonstrating to the claims adjuster that you understand the pleading requirements associated with the Missouri workers’ compensation statute.

However, this is not a negligence standard. The injured worker only needs to show the injury happened at work and because of work. You do not have to show or prove that the employer was negligent, broke a safety rule or caused the risk to be there in the first place. Workplace accidents can happen in a really wide variety of ways and injuries can be similarly varied.

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