Legal Frequently Asked Questions (FAQs): Get Your Injury, Accident, And Insurance Questions Answered By Attorneys Who Know The Law
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So, the workers’ compensation adjuster told me that I am no longer going to get my weekly benefits because she says I am “at MMI.” What does that mean? And is she right?
“MMI” is shorthand for the term “maximum medical improvement.” In 2017, that term was specifically defined in Setion 287.020 RSMO as follows: “For the purposes of this chapter, “maximum medical improvement” shall mean the point at which the injured employee’s medical condition has stabilized and can no longer reasonably improve with additional medical care, as determined within a reasonable degree of medical certainty.” In other words, when the doctor says no further care will improve your condition, you are at “MMI.” In 2017, the workers’ compensation law was amended to state clearly that TTD or TPD benefits shall be paid throughout the rehabilitative process 287.149.1 RSMo.
The adjuster is right. If you have reached MMI and no further care will help you, they can terminate those weekly benefits, even if you don’t go back to work right away. Of course, you are still entitled to receive compensation at the conclusion of your case for permanent partial or permanent total disability, but that could be many months after your temporary total (weekly) disability benefits end.
If you disagree with the doctor that you are at “MMI,” you will need to get an opinion from a different doctor contradicting that opinion and seek a hardship hearing if you want to contest that determination.
I am working light duty while recovering from my work injury, and my employer is paying me $10.00 per hour instead of my regular $20.00 per hour. Can they do that?
Yes, they can, but you are owed temporary partial disability benefits, or TPD benefits. TPD benefits are paid if the employee is able to perform some work during the rehabilitation period. These benefits are typically paid if the employee is released to light duty while still receiving medical treatment, and the employer provides light duty work, but at a lower rate of pay. The worker can be paid benefits equal to 2/3 of the difference between the average earnings prior to the accident and the amount which the employee is able to earn during the disability.
For instance, if the employee's pre-injury pay was $800 per week, but the employer is only paying the employee $400 per week while the employee does light duty work, the employer/work comp insurer owes the employee the following: $800 - $400 = $400 week difference. 2/3 of $400 = $266.67. Therefore, temporary partial disability benefits should be paid in the amount of $266.67.
Do All Missouri Employers Have to Carry Workers' Compensation Insurance?
Not all employers have to carry workers' compensation insurance in Missouri. If a company has less than five employees total, that employer does not have to carry workers' compensation insurance. There is an exception to this rule for certain construction contractors, who must buy workers' compensation insurance even if they have only one employee. However, an employer with less than five employees can still elect to be covered under the Missouri Workers' Compensation law by purchasing insurance. Many small employers want to do this, even though it is not required, because purchasing workers' compensation insurance prevents the employer from being subject to getting sued in state court if their employees become injured on the job. Employees who work for covered employers can only bring an action against their employer for their injuries in the workers' compensation tribunal.
I received weekly workers' comp benefits last year, but did not get a W-2 or 1099. Do I have to pay taxes on those benefits?
No. Workers' compensation benefits are generally not taxable. You should always seek the services of an accountant or tax advisor if you ever have a question about the taxability of any income you received in a given year. Here is further information from the IRS: http://www.irs.gov/publications/p525/ar02.html#en_US_2014_publink1000229331
My employer is making me take vacation time to go to a medical evaluation with their chosen work comp doctor. That doesn't seem right. Can they do that?
Unfortunately, that is true. Under Section 287.140.14 RSMo., the employer may require an employee to use accrued vacation or sick time to attend medical appointments, physical rehabilitation or medical evaluations during regular work time--even if they are scheduled by the employer or its workers' compensation carrier. This does not apply to medical treatment you receive when you are out of work and receiving temporary total disability benefits. It only applies to appointments that are scheduled when you are back to work after an injury.
I was hurt at work and the doctor says I cannot work right now. My employer is fighting the workers compensation case and so I am not being paid for my time off work right now. I need money! Can I file for unemployment?
Filing for unemployment can be a bad idea if you are off work due to a work-related injury. First of all, in order to apply for unemployment, you have to certify to the unemployment folks that you are ready, willing and able to work, which is not true if a doctor has ordered you off work. This can truly affect your credibility at the hearing of your workers' compensation case.
Second, Missouri Workers Compensation law states that an injured worker is disqualified from receiving temporary total disability benefits during any period of time "in which the claimant applies and receives unemployment compensation." Section 287.170.3 RSMo. This means that if the employer eventually accepts your claim, or if you win your claim at hearing, you will not be able to collect temporary total disability benefits during the weeks you also received unemployment benefits. At the time of this writing (9/20/14), Missouri's maximum unemployment benefit is $320.00 per week. On the other hand, the maximum weekly temporary total disability benefit is 2/3 of your average weekly wage,up to a state maximum $861.04. You should find out what your weekly unemployment benefit would be versus what your weekly workers' compensation benefit would be before you decide to disqualify yourself from receiving temporary total disability benefits by applying for unemployment.
I have been off work for four months for a back injury and now my employer tells me that they don't have to hold my job for me any longer because I used up all of my FMLA time. Is that right?
Unfortunately, that is not an untrue statement. The FMLA guarantees qualifying employees twelve weeks of unpaid medical leave each year. If an employee returns to work before the end of the 12-week period, the employee has the right to be restored to the same or equivalent position with equivalent pay and benefits. An employee may receive compensation while on FMLA leave either through using his or her sick time or vacation, or through workers' compensation payments. However, an absence due to a work injury that is covered by workers' compensation benefits may run conncurrently with FMLA leave. Therefore, if you are off work longer than 12 weeks for a work injury, your job may no longer be protected under the FMLA, even if you are out on workers' compensation leave. However, there may be other employment laws that may afford you protection, so consult a lawyer if you find yourself in this position.
I was injured on the job in Missouri and I don't want to go to the doctor chosen by my employer. Can I go to a doctor of my choice?
Under Missouri law, your employer has the right to choose your physician. If you go to a doctor of your own choice, the employer will not have to pay for that doctor. But beware if you decide to go to a doctor of your own choice! You may think that your health insurance company will pay for that doctor, but many times the health insurance carrier will refuse to pay for your chosen doctor because they will claim that the workers' compensation carrier should be paying the bill. And the workers compensation carrier will refuse to pay the bill because you did not go to their chosen doctor. You could get stuck having to pay your chosen doctor out of your own pocket, with no help from either the workers compensation insurer or your health insurer.
I settled my workers' compensation claim, but I am in pain again and want to get more treatment. Can I re-open my workers' compensation case?
Most likely, the answer is "No." Section 287.140 .8 sets forth the extremely limited circumstances under which a settled claim can be reactivated. A claim can be reactivated only "after the claimant can show good cause for the reactivation of the claim" AND "the claim shall be made only for the payment of medical procedures involving life-threatening surgical procedures or if the claimant requires the use of a new, or the modification, alteration or exchange of an existing, prosthetic device." Under this law, "life threatening" means "a situation or condition which, if not treated immediately, will likely result in the death of the injured worker."
How much money will I receive for temporary total disability benefits (TTD) while I am off work and getting treatment?
Before you can compute your weekly TTD benefits, you have to know your average weekly wage. Section 287.250 RSMo. sets forth the manner of determining average weekly wage. In a nutshell:
(1) If wages are fixed by the week, that is the average weekly wage;
(2) If wages are fixed by the month, the wage is computed by taking the monthly amount, multiplying it by 12 months and then dividing that by 52;
(3) If wages are fixed annually, take annual wage and divide by 52;
(4) If wages are earned by the hour, day or by output, then take the amount actually earned in the immediately preceding 13 weeks and divide by 13. (There are a few exceptions to this rule in the case of workers who have worked less than 13 weeks for the employer and for workers who miss more than five regularly scheduled workdays during the 13-week period)
You would receive 2/3 of this average weekly wage while you are off work, up to a maximum amount that changes every year. As of this writing (December, 2012), the maximum weekly amount a worker can receive for TTD benefits is $827.75.