Missouri Benefits

MISSOURI WORKERS' COMPENSATION LAW SUMMARY 2012 - 2013
Maximum Compensation Rates

   TTD,TPD,PTD     PPD        Qualifying AWW 
    & DEATH
07/01/03 – 06/30/04        $662.55        $347.05     $ 993.83/520.58
07/01/04 – 06/30/05        $675.90        $347.05     $1013.85/981.08
07/01/05 – 06/30/06        $696.97        $365.08     $1045.46/547.62
07/01/06 – 06/30/07        $718.87        $376.55     $1078.42/564.88
07/01/07 – 06/30/08        $742.72        $389.04     $1114.08/583.56
07/01/08 – 06/30/09        $772.53        $404.66     $1158.80/606.99
07/01/09 – 06/30/10        $807.48        $422.97     $1211.22/634.46
07/01/10 – 06/30/11        $799.11        $418.58     $1198.67/627.87
07/01/11 – 06/30/12        $811.73        $425.19     $1201.10/637.79
07/01/12 – 06/30/13        $827.75        $433.58     $1241.63/650.37

Maximum Benefits

Disfigurement (287.190.4 – 40 weeks at PPD rate)

Applies to head, neck, face, hands, arms

Death benefits– no limit
Medical benefits – no limit
TTD – 400 week maximum
PPD – 400 week maximum
TPD – 10 week maximum
Burial – (287.240.1) - $5000.00


WAITING PERIOD: 287.160 – No TTD or TPD shall be payable for the first three days or less of disability during which the employer is open for the purpose of operating its business unless the disability shall last longer than fourteen days in which event payment for the first three days shall be made retroactively to the claimant.

MILEAGE: 287.140.1 - Must pay mileage up to two hundred fifty miles each way but only when traveling outside employee’s principal place of employment. As of 07/01/12 reimbursed at 0.525 cents per mile. (Confirm current rate at (573) 751-4231)

SCHEDULE OF LOSSES: 287.190                                            WEEKS

  1. Loss of arm at shoulder........................................................ 232
  2. Loss of arm between shoulder and elbow................................ 222
  3. Loss of arm at elbow joint..................................................... 210
  4. Loss of arm between elbow and wrist...................................... 200
  5. Loss of hand at the wrist joint................................................ 175
  6. Loss of thumb at proximal joint............................................... 60
  7. Loss of thumb at distal joint.....................................................45
  8. Loss of index finger at proximal joint.........................................45
  9. Loss of index finger at second joint............................................35
  10. Loss of index finger at distal joint..............................................30
  11. Loss of either the middle or ring finger at proximal joint...............35
  12. Loss of either the middle or ring finger at second joint..................30
  13. Loss of either the middle or ring finger at distal joint....................26
  14. Loss of little finger at proximal joint............................................22
  15. Loss of little finger at second joint..............................................20
  16. Loss of little finger at distal joint.................................................16
  17. Loss of one leg at the hip joint..................................................207
  18. Loss of one leg at or above the knee.........................................160
  19. Loss of one leg at or above the ankle and below knee joint..........155
  20. Loss of one foot in tarsus.........................................................150
  21. Loss of one foot in metatarsus..................................................110
  22. Loss of great toe of one foot at proximal joint............................. 40
  23. Loss of great toe of one foot at distal joint.................................. 22
  24. Loss of any other toe at proximal joint........................................ 14
  25. Loss of any other toe at second joint.......................................... 10
  26. Loss of any other toe at distal joint...............................................8
  27. Complete deafness of both ears................................................180
  28. Complete deafness of one ear, the other being normal................. 49
  29. Complete loss of the sight of one eye........................................140



AMPUTATION: 287.190.2 The number of weeks of compensation allowed in the schedule shall be increased by ten percent (10%).

PERMANENT PARTIAL DISABILITY: 287.190 – POST 08/28/05 - "Disability shall be demonstrated & certified by a physician.” All opinions expressed to a "reasonable degree of medical certainty.” Objective findings ["those findings demonstrable on physical examination or by appropriate tests or diagnostic procedures”] shall prevail over subjective complaints. Compensation reduced to extent pre-existent disability contributed to overall rating.

ACCIDENT AND INJURY: 287.020.2 & .3 - Pre 08/25/05
The word "accident" means an unexpected or unforeseen identifiable event or series of events happening suddenly and violently, with or without human fault, and producing at the time objective symptoms of an injury. An injury is compensable if it is clearly work related. An injury is clearly work related if work was a substantial factor in the cause of the resulting medical condition or disability. An injury is not compensable merely because work was a triggering or precipitating factor.
The word "injury" means an injury which has arisen out of and in the course of employment. The injury must be incidental to and not independent of the relation of employer and employee. Ordinary, gradual deterioration or progressive degeneration of the body caused by aging shall not be compensable, except where the deterioration or degeneration follows an incident of employment.
An injury arises out of and in the course of employment only if:
(a) it is reasonably apparent, upon consideration of all the circumstances, that the employment is a substantial factor in causing the injury;
(b) it can be seen to have followed as a natural incident of work;
(c) it can be fairly traced to the employment as a proximate cause; and
(d) it does not come from a hazard or risk unrelated to the employment to which workers would have been equally exposed outside of and unrelated to the employment in normal non-employment life.

ACCIDENT AND INJURY: 287.020.2&3 – POST 08/28/05

Accident : "An unexpected traumatic event or unusual strain identifiable by time and place of occurrence and producing at the time objective symptoms of an injury caused by a specific event during a single work shift. For an injury to be compensable, the accident must be the prevailing factor, which is defined as the primary factor, in relation to any other factor, causing both the resulting medical condition and disability.
Idiopathic injuries: 287.020.3(3) "An injury resulting directly or indirectly from idiopathic causes is not compensable.”

Heart Attack: 287.020.3(4) An injury only if the accident "is the prevailing factor in causing the resulting medical condition.”

Going to & From Work: 287.020.5 Injuries in company owned vehicles while commuting are not compensable.
Parking Lot: 287.020.5 No liability for accidents that occur on customary, approved, etc routes used to get to work.

OFFERS BEFORE REPRESENTATION: 287.390.5 – Written settlement offer to pro se claimant filed with division precludes attorney fee on that offer.

RECREATIONAL ACTIVITIES: 287.120.7 - Pre 08/28/05 Excludes from compensability only those injuries resulting from voluntary activities even if employer "promoted sponsored or supported” the event. POST 08/28/05 – Removes "voluntary” from statute but continues to provide that injury is compensable if employer orders participation, pays wages during participation or injury is due to unsafe employer premises.

ALCOHOL & DRUG USE: 287.120.6 - Pre 08/25/05 If injury sustained in conjunction with alcohol etc, compensation shall be reduced by 15%. Employee has to have "actual knowledge” of anti-intoxication policy and employer must make "diligent effort” to apprise of policy. If intoxication is the "proximate cause” of the injury, all benefits are forfeited.

ALCOHOL & DRUG USE: 287.120.6 - POST 08/25/05 If injury sustained in conjunction with alcohol etc, compensation shall be reduced by 50%. Employee no longer has to have "actual knowledge” of anti-intoxication policy and employer no longer has to make "diligent effort” to apprise of policy. If intoxication is the "proximate cause” of the injury, all benefits are forfeited. If intoxication above legal limit, rebuttable presumption that intoxication was proximate cause. Refusal to take alcohol/drug test results in benefit forfeiture if: (1) employer had cause to suspect usage OR (2) policy requires testing.

TEMPORARY TOTAL DISABILITY: 287.140.1 – POST 08/28/05 - No longer entitled to TTD while receiving P.T. or attending employer’s rating exam.
Sick leave: 287.140.14 Employer may require employee to use personal or sick leave in lieu of TTD for medical treatment, evaluations or P.T.

BURDENS OF PROOF: 287.808
Affirmative defense – proven by employer
Entitlement to compensation – proven by employee
Facts – must be established as "more likely true than not true”.

OCCUPATIONAL DISEASE: 287.063 & .067 – Pre 08/28/05
An occupational disease is compensable if it is clearly work related. An occupational disease is not compensable merely because work was a triggering or precipitating factor.
With regard to occupational disease due to repetitive motion, if the exposure to the repetitive motion which is found to be the cause of the injury is for a period of less than three months and the evidence demonstrates that the exposure to the repetitive motion with a prior employer was the substantial contributing factor to the injury, the prior employer shall be liable for such occupational disease.

OCCUPATIONAL DISEASE: 287.063 & .067 – POST 08/28/05
287.063.2 Employer who last exposed employee to the hazard prior to evidence of disability is liable.
287.063.3 Statute of limitations shall not begin to run until it is reasonably discoverable injury sustained "related to such exposure.”
287.067.2 Injury from repetitive motion is compensable only if "occupational exposure was the prevailing factor” in causing the condition.
287.067.2 Aging – "Ordinary gradual deterioration … of the body caused by aging … shall not be compensable.”
287.067.8 Three Month Rule – liability only allowed to relate back to the "immediate prior employer.”

JURISDICTION: 287.110.2 – Pre 08/28/05 The Missouri Workers' Compensation Act applies to all injuries received and occupational diseases contracted in this state, regardless of where the contract of employment was made, and also to all injuries received and occupational diseases contracted outside of this state under contract of employment made in this state, unless the contract of employment in any case shall otherwise provide, and also to all injuries received and occupational diseases contracted outside of this state where the employee's employment was principally localized in this state.

JURISDICTION: 287.110.2 – POST 08/28/05 If injury occurs outside of the state, Missouri still has jurisdiction if employment was principally localized in Missouri "within 13 calendar weeks of the injury or diagnosis of the occupational disease.”

SAFETY DEVICES: 287.120.5 Failure to use safety devices ”shall” reduce benefits by "at least 25% but not more than 50%.” Employer must only demonstrate "reasonable effort” to ensure employee use of devices and employee’s failure to use no longer need be "wifull.”

COMPUTING AVERAGE WEEKLY WAGE / COMPENSATION RATE:

The method of computing an injured employee's average weekly earnings shall be as follows:

If the wages are fixed by the week, the amount so fixed shall be the average weekly wage;

If the wages are fixed by the month, the average weekly wage shall be the monthly wage so fixed multiplied by twelve and divided by fifty two;

If the wages are fixed by the year, the average weekly wage shall be the yearly wage fixed divided by fifty two;

If the wages were fixed by the day, hour, or by the output of the employee, the average weekly wage shall be computed by taking the wages earned in the last thirteen consecutive calendar weeks immediately preceding the week in which the employee was injured and dividing by thirteen. If the employee was employed by the employer for less than thirteen weeks, then take the wages earned in the period of time actually worked and divide by the actual number of weeks worked. For purposes of computing the average weekly wage in this paragraph, the absence of five regular or scheduled work days, even if not in the same calendar week, shall be considered as absence for a calendar week. If the employee began employment on a day other than the beginning of a calendar week, that calendar week and the wages earned during that week shall be excluded in computing the average weekly wage;

If the employee has been employed less than two calendar weeks immediately preceding the injury, the employee's weekly wage shall be considered to be equivalent to the average weekly wage prevailing in the same or similar employment at the time of the injury, except if the employer has agreed to a certain hourly wage, then the hourly wage agreed upon multiplied by the number of weekly hours scheduled shall be the employee's average weekly wage; and

If the hourly wage has not been fixed or cannot be ascertained, or the employee earned no wage, the wage for the purpose of calculating compensation shall be taken to be the usual wage for similar services where such services are rendered by paid employees of the employer or any other employer.

STATUTE OF LIMITATIONS: 287.430 - No proceedings can be maintained unless a claim is filed with the Division within two years after the date of injury or death, or the last payment made under the Act on account of the injury or death; provided, however, that if the report of injury is not filed by the employer within one month from the date of injury or death, the claim for compensation may be filed within three years after the date of injury, death, or last payment made. This Statute of Limitation shall not begin to run in cases of occupational disease until it becomes reasonably discoverable and apparent that a compensable injury has been sustained (287.063.3).

NOTICE: 287.420 – PRE 08/28/05: Written notice of the time, place and nature of the injury to be given to the employer as soon as practicable but in no event later than 30 days after the accident. POST 08/28/05: Claim barred unless employee can prove that employer was not prejudiced by failure to receive notice.
Notice in Occupational Disease and Repetitive Trauma cases: written notice within 30 days of diagnosis of condition. The Good Cause exception for failure to provide timely notice has been repealed.

Copyright Stretz/Quinn P.C. 2016