Workers' Comp Claim - How It Works

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Chapter 9 how a workers' comp claim works

"Workers' Compensation in Missouri: Succeeding in Your Injury Claim"

Workers' Comp Claim | How it Works

There are a number of different steps to any worker’s compensation claim. First, after an injury the employer should file a report with the Missouri Division of Worker’s Compensation. Next, the employee typically files a claim for compensation with the Division. Typically, the employee then continues to receive medical treatment and may receive temporary partial disability payments depending on the nature of the work and injury. While working toward a settlement or resolution of a claim, there are a number of hearings both parties attend.

If disputes arise during the claim, the lawyers try to resolve them short of judge intervention. Letters and emails are sent. Employee’s lawyers make demand on the employer/insurer via their lawyer for benefits, medical care, TTD payments, etc. If these cannot be resolved Hardship requests are filed and then mediated or tried.

A “conference” is also held before a judge in cases where no claim for compensation is filed. At a conference, the parties meet and attempt to settle and resolve the case. A conference is held after the employer or employee request one from the division.

Prehearing

A prehearing is a similar proceeding which occurs when a party has filed a claim for compensation. A prehearing is similar to a conference. Parties can work to attempt to settle a claim or a judge can approve a mutually agreed-upon settlement plan. The parties can also work to settle any other disputes so that the case can proceed. It is necessary to have a prehearing before a party can request mediation. A prehearing can be requested by a party or the Division. An employee should not attend a prehearing unless instructed to do so by their lawyer.

Mediation

A mediation is a settlement conference, where the opposing parties attempt to settle and resolve the case. This conducted before an administrative law judge as well. Either party can request mediation. Typically, a party requests a mediation when issues with medical treatment or temporary benefits arise, second injury fund issues arise, or one party has a final rating and is ready to settle and resolve the claim. The mediation is an important opportunity to settle and can also help to move any case forward. If the case cannot be resolved through these hearings, it must proceed to a trial like proceeding such as a hardship or final hearing.

Trial

If a claim is resolved by a trial, it is conducted at the final hearing or at a hardship hearing. These proceedings are before an administrative law judge and operate similarly to a civil trial. All the evidence by both sides are presented to an ALJ who makes a final determination or order on the claim. These final Orders can be appealed to the Labor and Industrial Relations Commission.

Applying MO Law to Out of State Employers and Injuries

The greatest consideration when attempting to hold an out of state employer responsible to an employee who was also injured out of state under Missouri law is establishing personal jurisdiction. If the Missouri long-arm statute applies to the area of law (which it would in said cases), then employees must establish specific or general personal jurisdiction. General jurisdiction exists only if the defendant or employer has its principal place of business in the state, or if the corporation is incorporated in the state, or if the corporation carries on a continuous and systematic part of its business in the state. However, specific jurisdiction exists when a state is alleged to have jurisdiction over a defendant because the defendant’s activities in that state gave rise to the claim.

Specific jurisdiction exists over a defendant if: (1) it has contacts with the forum state which are related to the cause of action; (2) those contacts are indicative of the defendant having purposefully availed himself of the privilege of conducting activities within the forum state; and (3) the exercise of jurisdiction does not offend traditional notions of fair play and substantial justice. In addition, personal service of the defendant while they are in the forum state is sufficient.

Sufficient minimum contacts exist for specific jurisdiction when there is a causal nexus, that is, the claim underlying the litigation relates to defendant's forum-state activities. Island Insteels Inc. v. Waters, 35 F. Supp 2d 167 (1998). The unilateral activity by a third party claiming some affiliation with the defendant is insufficient. Hanson v. Denckla, 357 US 235, 255 (1958).

Purposeful availment of the privilege of conducting activities within the forum state is the most important of the three factors. A strong showing of purposeful availment can overcome a weak showing of contacts. As with the question of what is proper contact, purposeful availment turns on the extent to
which the defendant's involvement with the forum was intentional. Where business actives reach out beyond one state and create continuing relationships and obligations with citizens of another state, courts need not resort to fictional consent in order to sustain the jurisdiction of regulatory agencies in a latter state.
Burger King Corp. v. Rudzewicz, 471 U.S. 462, 473 (1985).

In assessing traditional notions of fair play and substantial justice, the court considers five factors: the burden on the defendant; the interest of the forum state; the plaintiff's interest in obtaining relief; the interstate judicial systems interest in the resolution of controversies; and the shared interest of the several states in further fundamental social policies. Asahi Metal Indus. Co. v. Superior Court of California, 480 U.S. 182 (1987). The burden on the defendant is no greater than defending the workers' compensation suit that they have already agreed to defend. Missouri has an interest in ensuring that its worker’s compensation statute is followed.

To apply Missouri worker’s compensation law to an out of town employer/defendant an employee is going to have to establish personal jurisdiction over the defendant. Unless the employee can establish general personal jurisdiction because the employer has its principal place of business (most likely its headquarters) in the state or is incorporated in the state, then the employee will need to establish specific jurisdiction. Courts look at a number of factors in this analysis, and a working knowledge of Missouri civil procedure will be necessary to bring such a claim.

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