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An Employee's Guide to the Missouri Workers' Compensation System

Missouri Department of Labor and Industrial Relations Division of Workers' Compensation

Important Information
You may want to put names and telephone numbers here and keep this booklet in a handy place. The Employee Information Line phone number is printed at the bottom of each page. Your social security number _________-______-____________ Date of injury ______________________________________________ Division of Workers' Compensation injury number _________________

Your supervisor at work ______________________________________ Employer's telephone number ( ______ ) _________________________

Insurance company name _____________________________________ Claim adjuster's name ________________________________________ Claim adjuster's phone number _________________________________ Your insurance claim number __________________________________

Doctor's name ______________________________________________ Doctor's phone number _______________________________________ Other names and phone numbers __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________

This booklet briefly outlines Missouri Workers' Compensation Law and how it applies to work-related injuries or illnesses. This is not a complete description of the workers' compensation system or law. This pamphlet is not a complete statement of the workers' compensation law. It should not be relied on to answer your legal questions. The workers' compensation statutes will apply to determine the outcome of your work-related injury.

Helpful Hints for Injured Workers
Read and save this booklet. Save copies of all letters, forms, compensation checks and medical bills. Save notes of phone conversations. Put your injury number and date of injury on all papers and forms sent to the Division of Workers' Compensation. Stay in touch with your employer about your progress and plans to return to work.



In This Book
What is the Purpose of Workers' Compensation? ....................... page 2 Who Pays Workers' Compensation Benefits? ............................. page 3 Who Is Covered? ......................................................................... page 3 What Is Covered? ........................................................................ page 4 What Do I Do If I Am Injured? ................................................... page 5 Who Chooses My Doctor? .......................................................... page 5 What Does the Employer Do? ..................................................... page 6 What Does the Insurance Company Do? .................................... page 6 What If There Is A Problem? ....................................................... page 6 When Must A Claim Be Filed? ................................................... page 8 What Are The Benefits? .............................................................. page 9 Is Physical Rehabilitation Available? .......................................... page 11 What Part Does Safety Play? ....................................................... page 11 What Part Does An Attorney Play? ............................................. page 12 Fraud Warning. ............................................................................ page 12 Who Can Answer My Questions? ............................................... page 13
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What Is The Purpose Of Workers' Compensation?

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orkers' compensation provides benefits if you are injured or become ill because of your job. Workers' compensation covers injuries or illnesses caused or made worse by work or the workplace. Workers' compensation insurance coverage provided by your employer is intended to:

> Provide medical treatment and pay all reasonable medical costs related
to the injury.

> Help you return to work as soon as reasonably possible. > Pay part of your wages when you are off work because of the injury. > Provide compensation for permanent disability. > Pay benefits to dependents for a work-related death.
Workers' compensation does not cover self-inflicted injuries or if you are injured while participating in a recreational activity unless ordered to do so by your employer. When nonprescribed drugs or alcohol have a connection to the injury, benefits may be either reduced or forfeited depending upon the role the drugs or alcohol played in contributing to the injury. Also, benefits may be reduced if you fail to use safety devices or follow safety rules required by your employer. You do not have to prove that a work related accident or illness was your employer's fault or that it was not your fault.

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Employee Information Line 1-800-775-2667

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Who Pays The Workers' Compensation Benefits?

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any employers in Missouri purchase workers' compensation insurance policies from commercial insurance companies. Other employers are self-insured and pay the benefits themselves. The insurance company or the self-insured employer pays wage-loss and permanent disability benefits to injured workers and pays the medical costs to the health care providers who treat the injured worker. State law sets the benefit levels. The insurance company or self-insured employer is required to provide to the Division of Workers' Compensation the cost of medical care paid and the temporary total disability benefits paid in an underlying workers' compensation case. The Division's Case Review Unit follows up with the insurance company or self-ensured employer to ensure that the information is properly provided.

Who Is Covered?

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f you are employed in the construction industry, your employer must have workers' compensation insurance even if that employer has only one employee. Other employers must carry insurance if they have five or more employees. Railroad and maritime workers are not covered by Missouri law, but rather similar federal laws. The Missouri Workers' Compensation Law may not apply to employment of farm labor, domestic servants in a private home, or occasional labor performed for and related to a private household. In addition, the law may not apply to some family members of the employer, qualified real estate agents, direct sellers and certain unpaid volunteers, inmates and certain individuals working for amateur youth programs.

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What Is Covered?

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ll injuries and occupational diseases must meet the standard of work being "the prevailing factor" in causing the injury or disease and the injury and must be caused by a specific event during a single work shift. Idiopathic injuries that result from an unknown cause are not covered. Certain injuries that occur when the employee is going to and from the employer's premises are excluded. Only injuries that occur on property owned or controlled by the employer are compensable. Injuries that occur away from the employer's premises are covered only if the employee is acting within the course and scope of employment. You are protected from the first minute you are on the job and that protection continues anytime you are working. State law requires that a worker receive workers' compensation benefits for a work-related injury or illness. Also, state law requires most employers to have workers' compensation insurance and to pay all workers' compensation premiums. Your employer cannot:

> Take the cost of workers' compensation insurance from your wages. > Prevent you from filing for workers' compensation benefits. > Threaten you or take action against you for filing for benefits.
Employers must display an informational poster provided by the Division of Workers' Compensation which briefly explains employer and employee responsibilities in case of an injury. The poster includes the name of the workers' compensation insurance company or the designated individual if the employer is self-insured. If you cannot locate a poster or if the insurance company name is not listed, ask your employer.

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Employee Information Line 1-800-775-2667

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What Do I Do If I Am Injured?
> Do not wait. To protect your rights, report your injury to your
supervisor as soon as possible and in writing if possible.

> Make sure you tell your supervisor you were injured: what, where,
when and how.

> Get prompt medical attention from a health care provider authorized
by the employer.

> Inform your employer about your medical condition and when you can
return to work.

> Check

with your employer or call the Division of Workers' Compensation if you have any questions or concerns.

Prompt reporting is the key. Nothing can happen until your employer is informed about the injury. Ensure your right to benefits by a written notice of every injury, no matter how slight. Failure to report your injury or occupational disease to your employer may result in a forfeiture of workers' compensation benefits. To assure your rights to benefits, notify your employer of the injury or occupational disease in writing within 30 days.

Who Chooses My Doctor?

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he employer has the right to choose the doctor, hospital, medical facilities and services to treat your injury. The employer or insurer is not required to pay for treatment you seek or select on your own without authorization. However, the employer may authorize you to see your own doctor. Check with your employer or your employer's insurance company with respect to any medical treatment which you believe may be connected to your injury. If your employer refuses to provide medical care to treat your injury, you can seek medical treatment on your own. If the injury is later found to be work-related, the employer may be liable for reasonable medical expenses incurred that are associated with the injury.
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What Does The Employer Do?
> Your employer should make sure you receive necessary medical care
to treat your injury.

> Your employer reports the injury to the insurance company, or the
administrator if self-insured, within five days of the date of the injury or within five days of the date on which the injury was reported by you.

What Does The Insurance Company Do?

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nsurance companies or self-insured employers report the injuries to the Division of Workers' Compensation on a Report of Injury (Form WC-1) and file all other required reports with the Division of Workers' Compensation. Also, the insurance company or self-insured employer pays for medical costs incurred from the injury and makes benefit payments if work is missed due to an injury. If you are off work because of the injury more than three days during which the employer's business or operation is open, you are entitled to lost wage benefits. The insurance company must report the injury to the Division within 30 days of the employer's knowledge of the injury.

What If There Is A Problem?

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ost injuries are handled routinely. If you think you have not received all the benefits due you, or you have not received any benefits, follow these steps:

> Call the claims adjuster at the insurance company or the administrator
of the self-insured employer. Write down the date, time and adjuster's name for your records. Explain the problem and try to work it out. Many problems are resolved with a telephone call.
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Employee Information Line 1-800-775-2667 WC-118 (08-07) AI

> Make

sure the insurance company or self-insured employer is responsible for paying for medical services related to the injury. For example, although the insurance company must pay for your medical care, it does not have to pay for household services that are not medically prescribed. Call the Division of Workers' Compensation to inquire into available benefits. specialist at the Division of Workers' Compensation.

> Call 1-800-775-2667 to discuss your problem with an information > If a problem cannot be resolved, you may wish to take advantage of the
dispute management service provided by the Division of Workers' Compensation. This service is an informal process to assist the parties (employee and employer/insurer) reach a resolution to the problem. Dispute management is designed to quickly resolve the problems involving medical treatment or temporary disability. This process takes place before the injured worker has found it necessary to file a formal Claim for Compensation.

> You may also request a conference at the appropriate local office with
an administrative law judge if your problem involves an issue concerning the degree of permanent disability or any other issue with your workers' compensation benefits. To schedule a conference, call the nearest local office shown on the inside back cover.

> If you find it necessary to file a "Claim" with the Division of Workers'
Compensation, a Claim for Compensation (Form WC-21) must be used. This form may be obtained at any office of the Division of Workers' Compensation or on the Division's web site at www.dolir.mo.gov/wc.

> For additional information about the Dispute Management Unit, filing
a claim or any other concerns or questions regarding workers' compensation, please call 1-800-775-2667.

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When Must The Claim Be Filed?

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f you are unsuccessful in resolving the issues concerning your injury and decide to file a claim, the Claim for Compensation form must be received by the Division:

> Within two years after the date of the injury or, if you have already
received or are still receiving workers' compensation benefits for an injury, within two years after the last payment was received;

> If the employer did not file a Report of Injury, the Claim must be filed
within three years from the date of injury, death or last payment; or

> If your case involves an occupational disease, the Claim must be filed
within two years after the disease was reasonably discoverable if your employer filed a First Report of Injury. If the employer did not report the occupational disease, the Claim must be filed within three years. Once a Claim is received by the Division of Workers' Compensation, it is entered into the Division's computer system. The Division acknowledges receipt of the claim and sends a copy to the employer and insurer to file an answer. Actions that can be taken include:

> Prehearing - An informal meeting with an administrative law judge.
The purpose of the prehearing conference is to monitor the progress of the case, identify areas of agreement and dispute and move the case to resolution.

> Mediation - A proceeding in which a judge meets with all the parties to
the claim for the purpose of working out a compromise settlement.

> Hearing - A proceeding where an administrative law judge hears the
evidence and makes a decision resulting in either a denial or award of benefits. The laws of evidence do apply. The employee must prove he or she has suffered a work-related injury or illness and is entitled to workers' compensation benefits.

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What Are The Benefits?

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issouri law provides several kinds of workers' compensation benefits:

> Medical

>

care to treat the injury. Your employer or insurance company selects the health care provider. All bills for authorized medical testing and treatment, prescriptions and medical devices are covered. There is no deductible or co-payment. All costs are paid directly by your employer or the employer's insurance company. If you receive a bill, contact your employer or insurer immediately. Under Missouri law, medical providers or hospitals cannot bill you for services they provide to treat your injury if the injury is work-related and you have notified them by certified mail that the injury is workrelated. However, if your injury is found to be noncompensable under the Workers' Compensation Law, the doctor or hospital is entitled to collect the medical costs of your treatment from you. If you are required to submit to treatment outside of the local or metropolitan area of your principal place of employment, you are entitled to payment of reasonable travel expenses. In no event is the employer or insurer required to pay transportation costs of more than 250 miles each way from the place of treatment. Temporary Total Disability. Work-related injuries that cause you to miss work usually keep you from working only temporarily. If this is the case, you will receive Temporary Total Disability (TTD). This benefit is calculated at 66 2/3 percent of your average weekly wage, not to exceed a maximum amount set by the legislature. TTD is not paid for the first three days you are unable to work unless you are unable to work for more than 14 days. In these instances, the three day waiting period is reimbursed. The insurer or self-insured employer must send your benefit checks at the same time you were normally paid when you were working or at least every two weeks. TTD is paid for up to 400 weeks or until one of the following occurs: You return to work; You have been released by the doctor without any physical restrictions or there can be no improvement in your physical condition; Other events occur that can be legal reasons for stopping your benefits.



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> Temporary Partial Disability. If you return to work with temporary
restrictions due to your injury, and you earn less than before your injury, you may be eligible for Temporary Partial Disability (TPD) benefits. TPD is paid while you are still receiving medical treatment and equals two-thirds of the difference between your wage at the time of the injury and your new wage. This benefit can be paid for a maximum of 100 weeks. The amount cannot exceed the maximum TTD rate set by law.

> Permanent Partial Disability. Some injuries are permanent. For
example, you may have lost a part of a finger or your back will never function as it did before the injury. If you have an injury that is permanent and partial and the doctor has rated the injury, you are eligible for a Permanent Partial Disability (PPD) benefit. The percentage of disability assigned to the body part injured determines the amount of the PPD benefit paid to you. It is paid after your temporary total disability benefit ends.

> Permanent Total Disability. Sometimes a work injury or illness
prevents you from returning to any type of work. Then you may be eligible for Permanent Total Disability (PTD) benefits. PTD benefits are paid for life at the same rate as your Temporary Total Disability benefit.

> Death benefits. Dependents of a worker who dies because of a work
related accident or disease may be eligible for dependents' benefits. The weekly benefit is based on the number of dependents and the worker's wage. In addition, funeral expenses are paid up to a statutory maximum. The Workers' Compensation Law provides that an employer cannot discharge or discriminate against an employee for exercising his or her rights under the law or being off work because of an injury. There is no requirement in the Workers' Compensation law that an employer keep a job open while the employee is off or to rehire the employee. If you hire an attorney to represent you in your case, the attorney will be entitled to reasonable fees and expenses, as determined by the administrative law judge. Your attorney's fees will be paid out of the compensation you receive.

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Is Physical Rehabilitation Available?

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f you are unable to return to work after you have received the medical care necessary to cure your injury, physical rehabilitation may be available. For serious injuries, the Division of Workers' Compensation can authorize a weekly payment of $40 from the Second Injury Fund to be paid to you while you are receiving the physical rehabilitation services. The payment of this benefit is in addition to any other compensation to which you may be entitled. You will receive the additional benefit payments during the period you are actually being rehabilitated but for no longer than 20 weeks. In certain circumstances a special order from the Division of Workers' Compensation can extend that period of rehabilitation. The injury must be serious and the physical rehabilitation must be deemed necessary by a qualified physician. This includes, but is not limited to, paraplegia, quadriplegia, severe burns and head injuries. The rehabilitation must be provided at a facility which is qualified to provide physical rehabilitation for seriously injured workers and has received a certificate of qualification from the Division of Workers' Compensation.

What Part Does Safety Play?
ach insurance company is required by law to provide, upon request of the employer, safety engineering services to that employer. Most employers who take advantage of this program's services see a reduction in workplace injuries and, for many of them, the reduction is significant. Providing a safe workplace for employees requires sincere commitment from management. Also, it requires a strong commitment from employees. Understand the safety controls, requirements and policies of the company for which you work. It is not only the employer's responsibility to maintain a safe workplace but also yours.
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What Part Does An Attorney Play?

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he law does not require that employees be represented by an attorney in their workers' compensation claim. However, there may be times legal counsel may be beneficial. The decision to hire an attorney is solely the decision of the employee.

Fraud Warning
t is a crime for any person, including employers, employees, medical providers, insurance companies, insurance agents, lawyers or any other person, to lie or give false or fraudulent information in order to receive any benefit, payment or financial advantage that the person is not entitled to under the Missouri Workers' Compensation Law. Also, there is a noncompliance provision in the Workers' Compensation Law that states that any employer failing to insure for its workers' compensation liability is guilty of a misdemeanor. Anyone may file an allegation of fraud or noncompliance with the Division of Workers' Compensation by calling 1-800-592-6003. Complaints are received by the Division of Workers' Compensation's Fraud and Noncompliance Unit staff who investigate the complaint.

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Who Can Answer My Questions?
Your employer or its insurance company can answer most questions about your injury. For additional information, contact the Division of Workers' Compensation at any of the following numbers: Information Specialists - 1-800 -775-2667 - For employees only.

Central Office
Missouri Division of Workers' Compensation P.O. Box 58 Jefferson City, Missouri 65102-0058 573-751-4231 Website: www.dolir.mo.gov/wc

Division Offices
111 N. Seventh St., Room 250 St. Louis, MO 63101-2170 314-340-6865 3102 Blattner Dr. Suite 101 Cape Girardeau, MO 63703-6365 573-290-5757 3311 Texas Joplin, MO 64804-4343 417-629-3032 1410 Genessee Street, Suite 210 Kansas City, MO 64102-1047 816-889-2481 525 Jules St., Room 315 St. Joseph, MO 64501-1900 816-387-2275 3737 Harry S. Truman Blvd. St. Charles, MO 63301-4052 636-940-3326 1736 East Sunshine, Suite 610 Springfield, MO 65804 417-888-4100 3315 West Truman Boulevard P.O. Box 58 Jefferson City, MO 65102-0058 573-751-4231

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WC-118 (08-07) AI
Missouri Department of Labor and Industrial Relations

DIVISION OF WORKERS' COMPENSATION
P.O. Box 58 Jefferson City, MO 65102-0058

OFFICIAL BUSINESS RETURN SERVICE REQUESTED