Legal Frequently Asked Questions (FAQs): Get Your Injury, Accident, And Insurance Questions Answered By Attorneys Who Know The Law
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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.
Can I file for Unemployment Compensation benefits when I am off work and getting treatment for my work injury?
Section 287.170.3 RSMo. states that applying for unemployment and receiving unemployment benefits disqualifies employee from receiving any workers' compensation benefits while they are receiving unemployment benefits. If you apply for unemployment benefits, you will not be able to receive any workers' compensation benefits for temporary total disability for the same weeks in which you receive unemployment benefits.
What is PTD (permanent total disability) and how does a worker obtain these benefits?
When a worker suffers a work-related accident, and he or she is unable to return to any reasonable work, then a claim should be evaluated to determine whether the worker is permanently and totally disabled. Section 287.020.6 states "'total disability'...shall mean inability to return to any employment and not merely mean inability to return to the employment in which the employee was engaged at the time of the accident." So, if an injured worker cannot go back to his old job, the question then becomes, can he go back to any job? To answer this question, you will need the testimony of a physician and, most likely, the help of a vocational rehabilitation expert who support the claim that the workers is permanently and totally disabled.
I have a terrible scar on my arm after the workers' compensation doctor performed surgery. Can I get any additional compensation for my scar?
Scarring and disfigurement is also compensable, but only if the scarring is sustained to the head, neck, hands or arms. Section 287.190 states that the Division or Commission may allow an additional sum of compensation for disfigurement as it may deem just, up to a maximum of 40 weeks of compensation.
What are TPD (temporary partial disability) benefits and when can I receive these types of benefits?
Temporary partial benefits can be paid if the employee is still rehabilitating, but is able to perform some work during the rehabilitation period. If the pay is less than his average weekly wage, then 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, in the exercise of reasonable diligence, will be able to earn during the disability, to be determined in view of the nature and extent of the injury and the ability of the employee to compete in an open labor market.” § 287.180 R.S.Mo.
What are TTD (temporary total disability) benefits and how much will I receive in these benefits?
Section 287.170 RSMo. requires employers to pay employees 2/3 of their average weekly wage, up to a maximum of 105% of the state’s average weekly wage. Temporary total disability (TTD) or temporary partial disability (TPD) benefits shall be paid while an employee is off work throughout the rehabilitative process.
Two interesting additions to the statute include the following:
An employee is disqualified from receiving temporary total disability during any period of time in which the claimant applies and receives unemployment compensation.
If the employee is terminated from post-injury employment based upon the employee's post-injury misconduct, neither temporary total disability nor temporary partial disability benefits are payable. "Post-injury misconduct" shall not include absence from the workplace due to an injury unless the employee is capable of working with restrictions, as certified by a physician.
If I have an accident that is not my fault and I have to go to the emergency room, what do I tell the billing representative when they ask about insurance information?
If you need emergency care, you don't have to time to worry about how your bills are going to be paid. Frankly, automobile liability insurance carriers that represent the other driver in an accident do not pay your medical bills as they are incurred. They only pay you to reimburse you for all your bills at the time of settling your case or, if you cannot settle your case, after you win your case at trial. Most medical providers don't want to wait months or even years to get paid and may pursue collection from you while your auto accident case is pending.
Therefore, you have two options when it comes to giving the hospital your insurance information. If you have "medical payments coverage" on your own auto insurance policy, you can give the hospital your own auto insurance information and they will bill your auto insurance under that coverage first. If you are not sure whether you have medical payments coverage on your auto insurance, or if you know you don't have such coverage, then give the hospital your own health insurance card. These two types of coverage---medical payments coverage and health insurance coverage---will pay your bills immediately so that you don't have to worry about dealing with bill collectors while you are getting treatment for your injuries. Hopefully, you will get enough in your settlement or jury verdict to reimburse you for all of your medical expenses. You may have an obligation to reimburse your health insurer if you do get a settlement from the other driver's auto liability insurer, so make sure you examine your health policy thoroughly to see if this is the case. If you do see an obligation in your health insurance policy to reimburse the health insurer when your accident case is resolved, it is a good idea to contact an attorney to help you understand the actual rights to reimbursement held by your health insurer.
I received a notice from Social Security that my case was scheduled for a video hearing. I don't like it. I want a hearing in person. Am I stuck with a video hearing?
No. You have an absolute right to object to a video hearing, so long as the request is made at the earliest possible opportunity. You hearing date will be changed so that an in-person hearing can be scheduled.