TN 5 (09-12)
DI 52120.140 Missouri Workers' Compensation (WC)
The Missouri (MO) Department of Labor and Industrial Relations, Division of Workers' Compensation (DWC) handles WC cases. Private carriers provide WC in the majority of cases, but some employers can self-insure.
A. Types of WC payments and payment provisions
The Missouri Revised Statutes, Chapter 287 covers WC payments. All periodic payments are subject to the state maximum amounts. In addition, there is a state minimum amount of $40 per week for temporary total (TT), permanent partial (PP), and permanent total (PT) when the injury occurred on or after 09/28/1981. Once started, they cannot stop temporary partial (TP), TT, or PT WC without notifying the beneficiary and affording him or her of their right to protest.
1. Temporary Partial (TP) (287.180)
MO pays TP:
when the doctor releases an individual to return to work with light duty or modified duty restrictions;
at two-thirds of the difference between the individual's average earnings before and after the injury; and
for a maximum of 100 weeks.
TT payments are based on:
PT payments are based on:
4. Permanent Partial (PP) (287.190)
PP paid as Scheduled Awards:
in addition to TT or TP benefits,
upon the termination of TT or TP benefits, and
not reduced for any TT or TP paid.
PP has a lower state maximum amount than TP, TT, and PT. Award amounts are based on two-thirds of an individual’s gross average weekly wage for a certain number of weeks, and paid as lump sum payments.
PP for specific loss: A formula (referred to as a ‘schedule’) converts disabilities into a number of weeks of WC based on the body part injured. Loss of an arm at the shoulder, for instance, yields 232 weeks of WC. In addition, the percentage of disability assigned to the injured body part determines the amount of PP paid, 116 weeks of WC, PP for a 50 percent loss of the use of an arm.
Disfigurement: Missouri pays additional PP for serious and permanent disfigurement to the head, neck, hands, or arms. The maximum period awarded is 40 weeks.
Non-scheduled injuries: For permanent partial injuries other than those specified in the statutory schedule of losses, or for the body as a whole, the maximum period awarded is 400 weeks.
5. Second Injury Fund (SIF) payments (287.220 and 287.141)
Missouri makes SIF payments after or in addition to other WC payments. In addition to WC for uninsured employers, DWC can make three types of payments to injured individuals from the SIF. All payments are offsettable except the physical rehabilitation payments.
These payments compensate an individual when a current work-related injury combined with a prior disability creates an increased combined disability. The basic concept is the whole is greater than the sum of the parts. For example, if an individual has a 15 percent disability from the prior injury, and his combined disability is now 40 percent, the SIF pays for the increased disability. The SIF benefit amount varies from case to case. An individual must have a permanent pre-existing disability to be eligible for these benefits.
Physical rehabilitation payments: For serious injuries, the DWC can authorize weekly payments of $40 from the SIF while the individual receives physical (not vocational) rehabilitation services. These payments are in addition to any other WC paid and generally issued for up to 20 weeks. In certain circumstances, a special order from the DWC can extend that period of rehabilitation. These payments are not offsettable.
Second job wage loss benefits: This WC benefit only applies to injuries that occur after 08/28/1998 and may be available to an employee who works at two or more jobs. When an employee has a work-related injury from his or her “first job” and is physically unable to work at his or her other job(s) due to that injury, the employee may claim additional benefits from the SIF for the loss of wages from the “second job.”
The DWC or the Commission whose primary duty is the administration of the Department of Labor and Industrial Relations can commute periodic PP or PT and redeem them by the employer’s payment of a lump sum that DWC sometimes uses to purchase an annuity. Commutation is a departure from the normal method of payment and it is only allowable when unusual circumstances warrant it and is in the best interest of the injured individual.
Any agreement to settle or compromise a claim for WC is valid only if approved by a state administrative law judge (ALJ) or the Commission. MO generally pays settlements as a lump sum payment. The following are standard compromise settlement facts:
Missouri law passed in 07/1998 allows proration of PP and PT lump sum settlements over the expected life of the injured individual. SSA determined we can apply the proration effective on or after 07/1998 but not retroactively, unless a settlement made before then specifies a proration based on life expectancy. The prorated rate specified in the approved settlement document controls calculations and becomes the rate we use.
SSA must consider and use the most advantageous method of lump sum proration in calculating offset by applying rules in DI 52150.060.
The state ALJs prepare settlement decisions on a Form WC-G-11 (Stipulation for Compromise Settlement) that does not include language regarding a proration amount. Generally, MO specifies the proration amount on a separate page usually titled “Addendum to Settlement” or “Additional Comments.”
Sometimes, the second page does not include the ALJ’s signature or a date. However, the state ALJs advises us to (if the documents are prepared the same day) treat the “Social Security language” on the second page attached to the settlement document as part of the original settlement. Therefore, accept these additional documents as part of the original settlement unless it is obvious that the court prepared the document later.
SSA should rely only on the terms specified in the original documents in prorating lump sum awards. Disregard any SUBSEQUENT language appending the award documents or incorporated by the claimant's attorney even when a state ALJ signed it.
When a lump sum settlement requires both the carrier and SIF to pay their part of the settlement as lump sums payments, COMBINE the amounts and treat as a single lump sum for offset computation purposes.
For instructions on stipulation of compromise settlements see DI 52120.140F.4.
B. Cost-of-living adjustments (COLA)
Missouri does not give COLAs on WC payments, so there is no need for a yearly diary.
C. Attorney fees
Attorneys are entitled to reasonable fees and expenses, as determined by the state ALJ. Fees for claimants are limited to 25 percent by policy.
D. Retirement Insurance Benefit (RIB) considerations
Missouri does not offset WC for receipt of RIB.
E. Time limitations for filing claims
The DWC must receive claims within:
Two years after the date of the injury or within two years after the individual receives his or her last WC payment;
Two years after an occupational disease was reasonably discoverable; or
Three years after the date of the injury or the last WC payment made, if the employer did not timely report the injury or illness to the Division.
F. Requests to verify WC payment amounts
1. Initial request for WC information
The DWC requires the injured individual to sign our request or provide another written signed statement giving permission to release WC information. The preferred request form is an SSA-1709 (Request for Workers' Compensation/Public Disability Benefit Information).
a. Requests for information requirements
The SSA-1709 must contain the following information to avoid return of the form without the information requested:
signature of injured worker authorizing consent to release information,
WC claim number,
date of injury, and
employer’s name, for which we are seeking WC information (if the employer’s name is unknown, indicate “employer unknown” on the SSA-1709).
NOTE: There can be rare instances where we cannot obtain the number holder’s (NH’s) signature, (e.g. the NH is deceased, retro Disability Insurance Benefits (DIB) is payable, and WC verification from SIF is necessary. The surviving spouse signs the SSA-1709). DWC will consider each SSA-1709 signed by someone, other than the injured worker, on a case-by-case basis. Contact the Kansas City Regional Office WC analyst or the Mid America Program Service Center WC analyst and explain the case specifics so they can directly contact the DWC. The WC analyst will then question what documentation the DWC needs in order to accept a signature other than the injured worker.
b. Required consent obtained
Take the following actions when you obtain required consent:
Show “Missouri Division of Workers' Compensation, ATTN: Customer Service Unit” in the “TO” block of the SSA-1709.
Complete the rest of the front of the form and include your return fax number in the “RETURN TO” block;
Fax the SSA-1709 to the state at fax number 573-526-4718.
If consent is on a separate document:
Write your signature in the “Signature of SSA Official” block of the SSA-1709.
Write “see attached consent statement” in the claimant signature block.
Fax the SSA-1709 and any accompanying release to the state at fax number 573-526-4718.
Expect a reply within one or two business days. Direct any questions to the Customer Service Unit at 1-800-775-2667. Note that the DWC may not have complete information from the WC carrier, so attempt to obtain verification from the carrier before contacting the Division.
NOTE: Missouri DWC considers settlement documents open public records; therefore, they will release copies of settlement documents without consent. Other records Missouri considers as open public records include:
awards issued after contested hearings before an ALJ,
a claim for compensation, or
2. DWC returns request
Occasionally the DWC returns an SSA-1709 accompanied by a signed consent with a cover letter explaining the consent requirement and does not provide any further information. The cover letter provides contact information and a phone number for a DWC technician. Since we did obtain consent for release of the information, call the person indicated on the cover letter to resolve these issues individually on a case-by-case basis.
3. Settlement document request
Because the WC settlement documents are open public records, the DWC will release copies of settlement documents without consent. You can get a copy of a settlement without consent but cannot get information about any WC payments made prior to the settlement (unless that information is in the settlement document itself).
NOTE: The document copies provided will not have the individual’s Social Security number (SSN) due to the Missouri Sunshine Law, so make sure you keep a record of your requests by name as well as SSN.
4. Requests for SIF information
Use Form SSA-1709 to request verification of SIF payments from the Missouri DWC.
a. Obtaining SIF information
The request may authorize the DWC to disclose “any and all” settlements, awards, and Form WC-2-2 (Notice of Commencement/Termination of Compensation) in its possession. The DWC suggested using the phrase (“any and all”). The signed SSA-1709 gives the DWC the authorization to release all information on benefit payments relating to any employer(s), SIF, settlements, and awards.
b. Requests for information on SIF claim must include:
c. Address for SIF requests to the DWC
Mail or fax requests to:
Missouri Division of WC
Attn: Second Injury Fund Payment Information Request
PO Box 58
Jefferson City MO 65102
The fax number is (573) 526-4718
5. Stipulation of Compromise Settlements
If the DWC file contains a Stipulation of Compromise Settlement, it will reflect:
information relating to medical costs paid,
TT disability benefits paid,
PP disability amounts the employer or insurer would pay to the injured worker.
Also refer to compromise settlements in DI 52120.140A.7. in this section.
If a settlement is available in their files, the DWC provides SSA with a copy of the Stipulation of Compromise Settlement agreement or award.
NOTE: The DWC staff cannot offer clarification or advice on any of the information within these agreements or awards. For any additional verification of WC or Public Disability Benefit (PDB) or needed clarification, contact the injured worker first, then outside sources such as:
the worker’s attorney,
the courts, or
any Federal, State, or local governments.
Also refer to instructions on other sources of verification in DI 52145.001F.
The Missouri courts generally get involved at the appellate level. A worker can appeal the DWC’s award to the Commission, the Missouri Court of Appeals, and finally to the Missouri Supreme Court. The DWC provides SSA with court decisions where applicable.
G. MO WC forms
One of the following sources can complete the form:
The injured employee receives a copy of this form.
The injured worker completes this form for approval of a settlement agreement.
The following information explains this two-page form:
The first page is a visual chart showing the number of weeks of PP that is payable for certain injuries.
The second page contains a table with Missouri maximum WC rates.
H. Reference links