Almost all Missouri state and private employers are required to carry workers’ compensation insurance. These required insurance policies typically provide benefits to cover the costs of expenses stemming from injuries suffered in the workplace or medical treatment for occupational disease or illness. Employees do not have to pay a premium for this coverage – each employer pays it, and coverage begins on an employee’s first day of work. One of the most common questions injured workers ask is: “How is workers’ comp calculated?” This is a valid query, particularly as concerns the coverage for partial wage replacement if the employee has to miss work for more than three days. If you believe you are not getting the full schedule of benefits you are entitled to, or if your employer denies your valid claim, a Missouri workers’ compensation lawyer may be able to help. Contact Steelman Gaunt Crowley today at (573) 341-8336 to schedule a free consultation.
How Is Workers’ Comp Calculated for Medical Care?
Missouri workers’ compensation benefits are intended to cover all medical treatment related to an employee’s workplace injury or illness. Examples include medically necessary surgeries or rehabilitative therapies, prescription medications, and the costs of durable medical devices or assistive technologies. Workers do not have to pay a deductible or co-pay to access these benefits, as the employer’s insurance policy covers all costs. Workers may also be entitled to mileage to and from their medical appointments and any overnight accommodations they may need if they see a specialist or other provider far away from their homes.
Workers’ Compensation Authorized Health Care Providers
The employer has the right to choose the medical care provider an injured worker sees for a workplace injury. However, you may be permitted to see your own doctor or a specialist if your employer and their workers’ comp insurance carrier permit it. You should not receive a bill for services unless you choose a doctor different from the employer-designated one, per § 287.140 Mo. Rev. Stat. However, an injured worker may also opt to see a different treating physician at their own expense.
Calculating Your Missouri Wage Replacement Benefit
If an employee cannot return to work because of their injuries, or if they are recovering from surgery or other treatment for the work-related injury, then the worker may be entitled to receive Temporary Total Disability (TTD) wage replacement benefits. On the other hand, if the employer-selected doctor approves an employee for light duty or modified duty work, then the injured employee may not be eligible for these TTD benefits, but might still qualify for Temporary Partial Disability (TPD) benefits.
Usually, TTD continues until the employee returns to work or the doctor determines that they have reached their maximum medical improvement, according to § 287.149 Mo. Rev. Stat. (the point at which further treatment will not make a discernible difference). Injured employees wondering “How is workers’ comp calculated?” may want to know that compensation begins on the fourth consecutive working day on which an employee misses work due to their occupational illness or work-related injury, but if an employee cannot work for more than 14 consecutive days, they will receive back pay for those first three days. For both PTD and TTD wage replacement benefits, the average weekly wage is calculated based on your gross weekly wages, not the net (after taxes and other deductions). These payments are also tax-free. The benefits are calculated as follows:
Temporary Partial Disability
TPD benefits are paid weekly. They are calculated as 66 2⁄3% of the difference between the employee’s average weekly earnings at the time of the injury and what the employee earns during the period of disability, subject to a maximum TPD rate, which changes annually. Each employee’s maximum benefit amount is based on the year in which they become injured.
Temporary Total Disability
If a Missouri employee cannot work at all, they will receive 66⅔% of their average weekly rate at the time of their injury. Like TPD, temporary total disability benefits have a maximum weekly payment amount, and the maximum also changes annually. TTD benefits are not taxable.
Permanent Disability Benefits Under Missouri Workers’ Compensation
After suffering a workplace injury, some people may be disabled to the point of being unable to return to work. Or, they may have contracted a workplace illness or disease, such as those sometimes proceeding from long-term exposure to toxic fumes or mold, that leaves them unable to work. In these cases, the employee may be eligible for permanent disability benefits. These are calculated as follows:
Permanent Partial Disability
An eligible employee’s Permanent Partial Disability (PPD) benefits are 66 2⁄3% of the employee’s average weekly wage at the time they were injured (subject to a maximum cap). However, in some cases the employee may be able to opt for a lump sum payment of their partial disability benefits instead. Qualification for the lump sum payment is based on the nature of the disability and its extent.
Permanent Total Disability
Permanent Total Disability (PTD) payments may be paid to the worker for the rest of their life. This, like the rest of the disability schedule of benefits, is also 66 2⁄3% of their gross weekly wages at the time of the accident. Also like the other wage replacement benefits in the Missouri workers’ compensation payment schedule, PTD has a maximum payment set by law. Injured workers may in some cases be able to negotiate a lump-sum payment for PTD benefits, as well.
If you have questions about whether a lump-sum payment may be an option in your case, or about the lump-sum negotiation process, you may wish to consider retaining the services of a Missouri workers’ compensation lawyer from Steelman Gaunt Crowley. A skilled workers’ compensation attorney will be a trained negotiator and can be a valuable asset in helping you achieve the best outcome for your case.
What Happens if I Am Not Getting My Full Benefits?
Sometimes, an employer will deny a workers’ compensation claim, alleging that the employee somehow caused the accident or that there is no employer-employee relationship. Other times, the insurance company may deny treatments, claiming they are not medically necessary.
Injured workers may have the right to appeal when they are not getting the benefits to which they are rightfully entitled. Workers can file the first appeal with the Missouri Labor and Industrial Relations Commission. An attorney is not legally required for this process, but you may wish to consider working with an experienced workers’ compensation lawyer who can help draft your claim and present it before the Commission.
Getting the Help You Need From a Missouri Workers’ Compensation Lawyer
Do you need help filing for workers’ compensation benefits in Missouri, or are you wondering “How is workers’ comp calculated?” A workers’ compensation attorney familiar with the Missouri system may be able to assist you. The experienced workers’ compensation lawyers at Steelman Gaunt Crowley represent injured employees, helping Missouri workers secure the benefits to which they are entitled so they can heal, pay their bills, and return to work safely. We offer a complimentary initial consultation, and you can book yours by calling (573) 341-8336.
