What types of benefits are available for a work comp claim?

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When a covered worker suffers a covered work-related injury, the Missouri Workers’ Compensation Law offers benefits. These benefits may be offered by an employer simply at the request of the injured employee. However, more commonly, the injured worker must file a Claim for Compensation seeking to enforce these rights. But what types of benefits are available for an injured worker? 

The primary purpose of work comp is ensuring that an injured employee receives medical treatment. Section 287.140 makes this clear. In fact, this benefit is so well established it is generally offered immediately after a workplace injury, even without having to file a work comp claim. The treatments include medical examinations, prescriptions, physical therapy, surgery, and even prosthetic devices such as hearing aids or prosthetic limbs. 

They type of medical treatment that is to be provided includes all treatment which is reasonably calculated to relief or cure the effects of the work-related injury. As the Court of Appeals discussed in Tillotson v. St. Joseph Medical Center, this includes a large amount of treatments, even if such treatments benefit other conditions the injured employee suffers from. The goal of these treatments is to reach maximum medical improvement, or MMI. This may mean returning the employee to full and complete health, without any lasting effects. A common example of this would be a simple broke bone that heals without complication. However, MMI may not be a full recovery, but instead a plateau of improvement. An example of this would be a traumatic brain injury. The injured employee may never be able to reach pre-accident health, but will eventually reach a point where her condition won’t improve any further. 

In instances of MMI that is not full recovery, the employee may be entitled to future medical benefits. For instance, a severe back strain may cause lasting back pain for the injured employee. The employee is entitled to pain medications, chiropractic care, or other pain mitigating treatments for the rest of his or her life. However, MMI is almost always necessary to determine what medical benefits are necessary, in both the present care and any future benefits.    

It is important to keep in mind that work comp is a compromise between employers and employees. In terms of medical benefits, this means that there is a trade-off for injured employees: the employer controls the medical treatment. This means that the employer seeks the treating physicians and, to a large extent, which treatment is offered at what time. This almost always means that an injured employee is sent to a doctor he or she is unfamiliar with and may not be the employee’s ideal choice. It also means that an employee must often undergo conservative treatments, even if the employee would prefer surgery immediately. A common example comes with elbow injuries. When a ligament tears, that ligament will not heal on its own, period. However, it is come for an authorized treating physician—a work comp doctor—to require an employee to undergo injections before surgery is authorized. These injections treat the pain caused by the ligament, not the injury itself. However, an employee must follow the work comp doctor’s treatment plan to continue to have medical benefits provided by the employer. An employee can always decide to pursue his or her own treatment, but an employer does not have to pay for this treatment absent limited circumstances. 

The law also provides monetary benefits to an injured employee that cannot work. These benefits come in the form of temporary disability benefits, which can be either total temporary disability (TTD) or partial temporary disability (PTD). An employee is entitled to TTD benefits when he or she is unable to work in any capacity because of the work-related injury. In contrast, PTD is appropriate when the employee is able to work, but not in his or her normal position. 

The amount of TTD benefits is determined using what the employee earned. Typically, the amount is the employee’s average weekly wage based upon the 13 weeks preceding the injury. In contrast, calculating PTD depends on a comparison of the pre-injury earnings and post-injury earnings.     

When a work-related injury is sufficiently severe, the employee may be entitled to benefits for permanent impairment. At one end of the spectrum is an employee that loses the ability to compete in the open labor market and thus becomes permanently and totally disabled. Such an employee is entitled to PTD benefits. These benefits last for the employee’s life and are generally paid at a rate of 2/3 of the employee’s average weekly wages. 

When an injury does not remove the employee’s ability to work completely, the employee may still be entitled to an award for permanency. These benefits compensate the employee for permanent damage to the employee’s body. The amount of these benefits is determined using a percentage and a number of units assigned to that part of the body. For example, an injury to the elbow is assigned 210 units. If any employee is found to have some moderate pain in the elbow forever, a doctor may find that they have suffered a 25% permanency rating of the elbow. This means that the employee is entitled to 52.5 units, of 25% of 210. The units are assigned a dollar value based on average weekly wage of the employee.

While other benefits are may be available based upon the exact circumstances of each case, these are the most common benefits available to an injured employee. Getting the benefits you are entitled to usually requires a fight and attempting to get these benefits on your own can be difficult, if not impossible. Make sure you have experienced attorneys that know what you are entitled to receive and how to get there.

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