Medical Benefits

In Missouri, there are four (4) major benefits available in a workers’ compensation case. The first is medical expenses paid by the employer as long as the employee receives treatment from the authorized healthcare provider. If the employee lives outside the metropolitan area of the principal place of employment, the employee would also be entitled to round-trip mileage to and from authorized healthcare providers. An employee can always see their own doctor, but it would be at the employee’s expense.

Temporary Disability Benefits

The second benefit available is temporary disability benefits. These benefits can be either temporary total disability ("TTD") or temporary partial disability ("TPD") benefits. Temporary total disability benefits are paid to an employee while the employee is off of work due to injury or has been released to restricted duty, but the employer cannot accommodate the restrictions. TTD benefits are determined by multiplying the gross average weekly wages ("AWW") earned for the 13 weeks preceding the week in which the injury occurred by 66 ⅔% (subject to the State maximum rate). In many instances, it is necessary to get a wage statement from the employer to determine this amount, as an employee may have earned overtime. There could even be instances where the AWW is determined using less than 13 weeks. For instance, if an employee has missed more than five (5) regularl or scheduled work days during the 13 week period of time or did not work for the employer for 13 weeks, you would use less than 13 weeks to determine the AWW. I suspect most employees who handle a case on their own are not aware of the rules for calculating AWW pursuant to R.S.Mo.'287.250 and may be leaving "money on the table".

Temporary partial disability ("TPD") benefits are paid to an employee who has returned to work, but is not able to earn the AWW wage he/she was earning before the injury. In these instances, the employee is due 66 ⅔% of the difference between what he/she would have earned had he/she been back to full time duty and the amount actually being earned performing restricted work. This benefit is rarely paid because once the employee returns to work (even in a restricted job), he/she usually receives the AWW being earned before the injury.

Permanent Disability Benefits

Depending upon the severity of the injury, an employee is entitled to either permanent partial disability ("PPD") or permanent total disability ("PTD") benefits. This is the third benefit available. PPD benefits are typically determined using a different compensation rate than PTD benefits because of the maximum compensation rate allowed under State law. These maximums are determined based on the date of the injury. In a PPD case, the maximum compensation rate is substantially less (about 50% of the PTD rate) than the PTD maximum compensation rate. The other variables for determining PPD benefits is (a) the percentage of disability suffered (doctors provide these percentages) and (b) the weeks attributable to the body part injured (this is set out in a statute). The authorized treating doctor will usually provide a disability rating that is advantageous to the employer. The employee should always consider getting a second rating at his/her own expense in order to increase the value of the case. There is no pain or suffering in the work comp system.

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