WHY CAN’T I CHOOSE MY OWN DOCTOR?

Under Missouri Worker’s Compensation Law, the employer is required to provide “medical, surgical, chiropractic, and hospital treatment, including nursing, custodial, ambulance and medicines” as may be reasonably required by the employee who suffered personal injury while on the job. Further, the employer’s Missouri work comp insurance must pay for this treatment, deductibles, reasonable traveling expenses (up to 250 miles each way), and ongoing medical examinations. Under this system, your employer has the right to decide which physicians you see for your injuries (not the workers’ compensation insurance company).

If you are not satisfied with your treatment and have a need or desire to go to another provider, you are obligated to pay all costs. Your Work Comp lawyer should do their best to get your employer to refer you to another physician. If they refuse to agree to this referral, your must file a work comp claim with the Missouri Board of Labor and Industrial Relations, then schedule a hearing before an administrative judge to discuss your options.

As a last resort, you and your attorney may find a physician’s office that will allow you to receive the medical treatment that you need on a lien basis, (basically, a promise to pay later out of settlement proceeds or when the employer finally agrees to pay or is ordered to pay these bills).

CAN’T I JUST SUE MY EMPLOYER FOR NEGLIGENCE?

If you sustain an injury on the job, your recourse is through the state Workers’ Compensation Law, which provides a way for injured employees to receive benefits without having to prove anyone else’s negligence. According to the law, any employer with five or more employees must provide workers’ compensation insurance. All employers in the construction industry must comply. This system provides for your medical treatment, temporary benefits if a doctor says you are unable to work, and compensation for any permanent disability you are left with. These are available regardless of fault, but the system is your only remedy, and you cannot sue for negligence or recover for pain and suffering.

However, as with most things in life, there are exceptions. For instance, If the employer does not carry the proper workers’ compensation insurance, you have the right to sue your employer if you prove he or she was negligent and caused your injury.

WHAT INJURIES DOES WORKERS’ COMPENSATION COVER?

Workers’ compensation will cover the following types of injuries:

• Any injuries sustained during job-related tasks, in or out of the workplace
• Occupational diseases and illnesses your employment directly caused
• Scarring or disfigurement to the head, neck, arms, or hands
• Permanent and total disability

There are no rules as to which injuries do and do not qualify for workers’ compensation. If the employee sustained the injury during work-related tasks, workers’ comp will cover the damages. Once you report your injury, seek medical care, but check with your employer to see if he or she has a preference before you seek medical attention. Remember, your employer has the right to decide which physician you see for your injuries, and may refuse to pay a provider that you select without prior authorization. The sooner you go to the doctor for your injuries, the better.

WHAT BENEFITS DOES WORKERS’ COMPENSATION PROVIDE?

Once the program accepts the claim, the employee will receive compensation for:

• Medical expenses. Workers’ comp will pay for all accident-related medical expenses, including tests, surgeries, and treatments.
• Lost wages. If the injury results in temporary disability and the inability to work, the employee may receive temporary total or partial disability benefits.
• Mileage for driving to medical treatment, if treatment is necessary outside of the local area. There is a 500-mile round-trip limit.
• Permanent disability benefits. You may be entitled to a weekly or lump-sum settlement for life if the workplace accident results in permanent disability. The amount will depend on the extent of the disability and your average wage.
• Weekly benefits to surviving family members after work-related death. The employer must also pay up to $5,000 in funeral and burial expenses.

ARE ALL EMPLOYERS REQUIRED TO HAVE WORKERS COMP INSURANCE?

Any company with five or more employees in the State of Missouri is required to carry Workers’ Compensation insurance. Workers who are injured on the job or contract a work-related disease or illness receive the benefits of this employer-provided insurance to help pay for medical and other expenses incurred as a result of the injury, illness or disease. The insurance might also pay benefits to survivors of workers killed on the job.

DO I HAVE TO HAVE A LAWYER REPRESENT ME?

While you are not required by law to have a lawyer, you may need a lawyer for the following reasons:

1. Most employers and insurance companies are required by law to have a lawyer present at all docket settings before the Division of Workers’ Compensation, so in most cases you will have to speak with the workers’ compensation insurance lawyer at one or more times before your case is concluded.
2. The Administrative Law Judge assigned to your case, nor any employee of the Missouri Division of Workers’ Compensation, can give you legal advice or act as your lawyer or advisor.
3. A workers’ compensation case is a legal proceeding. The decisions you make regarding your workers’ compensation case may impact you for the rest of your life.
4. While many workers’ compensation cases are still handled routinely without problems, the law has been changed many times over the years, and each change makes cases more complicated. Issues involving Medicare, Medicaid, Social Security, unemployment benefits, and Second Injury Fund claims also complicate many cases.