When you are injured in the workplace, Workers’ Compensation covers your medical bills, lost wages, and disability benefits if you are partially or fully disabled as a result of the injury. However, this employer-provided insurance may not cover every injury or every employee. There are exceptions and it is important for workers to understand those exceptions. What does Workers’ Compensation not cover? If you or your injury is an exception, what are your alternatives to ensure you are compensated for a workplace injury? Steelman Gaunt Crowley may be able to assist you if you need assistance with a Workers’ Compensation claim or have questions about what is covered. Our experienced Workers’ Compensation attorneys understand the system and may be able to assist you in resolving your claim. Call (573) 341-8336 to schedule a consultation and review your options.
How Does Workers’ Compensation Work in Missouri?
In Missouri, as in most other states, Workers’ Compensation is a state-mandated system providing no-fault insurance that pays workers specific benefits when they are injured while working. The Missouri Department of Insurance states that employers can purchase this insurance or become a state-certified self-insurer if they meet the requirements. Workers’ Compensation covers the injured employee’s medical care, partial lost wages, and permanent disability benefits. In exchange, the employer is provided immunity from a civil lawsuit from the employee because of the injury.
In order to receive the appropriate benefits for a workplace injury, the injured worker must follow a specific process outlined by the Missouri Department of Labor. This process begins with reporting the injury to their employer and getting medical care. If the injury is severe enough, the worker should seek medical care first and report the injury to their employer afterward. The employer will report the injury to the insurer, who will then pay out the appropriate benefits, and once the worker has recovered or reached maximum medical improvement, the claim will be resolved. In some cases, workers may need to appeal a decision from the insurer.
Employer Exceptions to Missouri Workers’ Compensation
While most workers can assume they will be covered by Workers’ Compensation if they are injured in the workplace, this is not always the case. What does Workers’ Compensation not cover? There are a few types of employers who do not have to meet the requirement for Workers’ Compensation. However, these employers can voluntarily provide Workers’ Compensation to avoid being sued by an employee who has been injured on the job.
Sole proprietors and partners in a business are not covered by Workers’ Compensation and are not required to have it if they are the only employees of the business. However, in a limited liability corporation (LLC), close family member-employees and members are covered by Workers’ Compensation unless they opt out. Any employer with less than five employees is exempt, except for contractors who must have Workers’ Compensation if they have a single employee, per the Missouri Department of Insurance. Whether the employees are full-time, part-time, seasonal, or temporary is irrelevant for purposes of this insurance.
Employee Exceptions to Missouri Workers’ Compensation
In addition to certain employers being exempt from Workers’ Compensation, certain employees are also exempt. What does Workers’ Compensation not cover when referring to employees? First, Workers’ Compensation will not cover an injury with a disputed cause. If there is evidence that the injury did not occur at work but at home or somewhere else, Workers’ Compensation will deny the claim. They will also deny claims for injuries like spider bites (unless the individual’s job requires working with insects or wildlife) and existing injuries that are aggravated by work (such as a softball injury that hurts more after working). Personal health crises are also unlikely to be covered unless they can be directly linked to the work. For example, an individual who had a heart attack at work is unlikely to receive Workers’ Compensation unless the heart attack can be shown to be the result of work and not a pre-existing cardiovascular issue. A Workers’ Compensation attorney with Steelman Gaunt Crowley may be able to assist you if your claim for a workplace injury has been denied.
Other exceptions to Missouri Workers’ Compensation include:
- Farm laborers and domestic servants
- Certain real estate agents and direct sellers
- Commercial motor-carrier owner-operators
- An employee who requests a religious exception if both the employee and employer meet the requirements of Title 26 USC § 1402 (g)
- Inmates confined to state prisons, penitentiaries, county or municipal jails or patients and residents of state mental health facilities if the labor or services provided are exclusively for the state, county, or municipality that has custody of the inmate, patient, or resident
- Unpaid volunteers of tax-exempt organizations except as provided in Missouri Section 287.243
- Contest workers, adjudicators, or sports officials for interscholastic activities, programs, or amateur youth programs who are not otherwise employed by the association of schools, sponsoring school, or nonprofit tax-exempt organization that is sponsoring the activity or program
What Are a Missouri Employer’s Responsibilities When an Accident Occurs?
Employees are generally familiar with their responsibilities when they are injured, but they may wonder what their employer is responsible for. The employer must report the injury to the insurance carrier or Third Party Administrator within five days of the injury or five days of the date the injury was reported, whichever is later. The employer, or the insurance carrier, is required to report the injury to the Division of Workers’ Compensation within 30 days of learning about the injury, unless the injury was minor, required only immediate first aid, and did not result in further medical treatment or lost work time. The Missouri Department of Labor states that an employer’s failure to report workplace injuries to the Division of Workers’ Compensation within the required time frame may result in a fine, imprisonment, or both.
Additionally, prior to an accident occurring, the employer has a responsibility to create a safe workspace free of dangerous conditions. They must provide appropriate safety equipment which may include items such as hardhats, safety glasses, or eyewash stations. Employers must maintain workplace safety by doing things such as cleaning up spills when they are reported, repairing broken machinery, and clearly marking or closing off hazards such as unsafe staircases. If they do not do these things, and an accident occurs, the employer may be vulnerable to legal action.
How Can a Missouri Workers Compensation Attorney Assist You?
Sustaining an injury at work can be not only painful but confusing. You may be worried about medical expenses, paying your bills while out of work to recover, and what will happen if you do not fully recover. By understanding what does Workers’ Compensation not cover, you can alleviate some of these worries. If you have had a Workers’ Compensation claim denied or have other concerns regarding a workplace injury, Steelman Gaunt Crowley may be able to assist you. Call (573) 341-8336 to speak with one of our seasoned Workers’ Compensation attorneys and learn more about your legal options.
