Injuries That Qualify for Workers’ Compensation

Being injured on the job can be challenging and lead to confusion for workers trying to understand their rights and eligibility for receiving compensation. Under Missouri law, not all workplace incidents are covered by workers' compensation, so it's important to understand the requirements of workers' compensation and what types of injuries qualify for coverage. 

At The Law Office of Steve Slough, our personal injury attorney is experienced in handling workers' compensation claims and fighting for fair and comprehensive coverage. Here, we break down the specifics of workers' compensation, the types of injuries that do and don't qualify, and the rights and responsibilities that employees and employers should be aware of.  

Understanding Workers' Compensation 

Workers' compensation is a state-mandated insurance program designed to provide benefits to employees who suffer occupational diseases or accidental injuries while on the job. This system is designed to eliminate the need for litigation between the injured worker and their employer. Essentially, it creates a simpler process for employees to receive the compensation they need for workplace-related injuries, while also protecting employers from potentially costly lawsuits. 

In Missouri, employers are required to offer workers' compensation to support their employees in the event of an on-the-job injury. The Missouri workers' compensation system operates on a no-fault basis, meaning employees do not need to prove their employer was at fault to receive compensation. However, it also means employees forfeit the right to sue their employer for negligence related to the injury. Generally, workers' compensation includes coverage for: 

• Medical expenses, such as all reasonable and necessary medical treatments related to the sustained injury, including doctor visits, surgeries, and prescriptions. 

• Rehabilitation costs, such as physical therapy, occupational therapy, and other services to help the employee recover. 

• Wage replacement, such as a percentage of your average weekly wages if the injury prevents the employee from working. 

For a work-related injury to be covered by workers' compensation, it must meet certain criteria. In general, an injury qualifies for workers' compensation if it occurred while the employee was performing job-related duties on behalf of their employer (either on-site or while traveling for work), was caused by a specific work-related activity during work-related events, or resulted in physical or mental impairment that required medical treatment or caused disability. 

Types of Injuries Covered by Workers' Compensation 

Certain types of work-related injuries are almost universally accepted for workers' compensation. These include but are not limited to: 

• Slips and Falls: One of the most common workplace accidents, often leading to severe injuries like fractures or head trauma. 

• Repetitive Stress Injuries: Resulting from overexertion of muscles and vibration, leading to conditions like carpal tunnel syndrome and tendonitis. 

• Cuts and Lacerations: Accidents involving sharp tools or equipment can lead to painful and sometimes debilitating injuries. 

• Work-Related Vehicle Accidents: Whether you drive for a living or were in an accident as a passenger, most work-related vehicle injuries are covered. 

• Occupational Illnesses: Conditions that develop over time due to exposure to harmful substances at work, such as asbestos, industrial noise, or radiation. 

Injuries That Do Not Qualify for Workers' Compensation

While many injuries are covered by workers' compensation, not every injury sustained at the workplace will qualify. This can vary by state and includes instances where the injury does not have a direct and proximate correlation to the job duties of the employee. In Missouri, these include but are not limited to: 

• Off-Duty Injuries: Unless it can be proven that the injury was sustained while directly performing work-related activities, injuries sustained while off-duty are generally not eligible. 

• Self-Inflicted Injuries and Misconduct: Injuries resulting from willful intent or negligent behavior may not be covered, as well as any injuries incurred while not following safety protocols. 

• Intoxication: Being under the influence of alcohol or drugs at the time of the incident can often lead to an employee's claim being denied. 

• Injuries From Personal Travel: Commuting to and from work is typically not covered. However, work-related travel (such as truck driving or courier services) is covered. 

Employer and Employee Rights and Responsibilities 

Each state has its own set of rules and regulations governing workers' comp. In Missouri, employers must provide a safe working environment and support injured workers with the necessary benefits. Missouri employer rights and responsibilities include: 

• Maintaining Safety Standards: Ensuring the workplace is free from hazards, including providing protective gear, consistent up-to-date training, and conducting regular facility maintenance. 

• Complying with Reporting Rules: In the event an employee is injured on the job, employers must report any injuries to the workers' compensation board and maintain records of the incident. 

Employees, on the other hand, are required to familiarize themselves with their coverage and follow the correct workplace safety procedures to help mitigate potential injuries. Missouri employee rights and responsibilities include: 

• Access to Medical Attention: All employees have the right to seek medical treatment and should not be liable for any out-of-pocket costs. 

• Compensation for Time Off: If an injury keeps an employee from working, the employee is eligible for wage replacement benefits. 

• Protection from Employer Retaliation: Employees cannot be legally terminated or demoted for filing a workers' compensation claim. 

Filing a Workers' Compensation Claim in Missouri 

If you've suffered an injury while at work, understanding your rights and what to do is the first step towards obtaining the benefits you deserve. Here's a comprehensive breakdown of the critical actions and the subsequent steps involved: 

1. Report the Injury: Immediately notify your employer after the incident. Your report should include the date, time, and nature of the injury to create a clear record of the event. 

2. Seek Medical Help: Visit an approved healthcare provider, as outlined by your employer’s workers' compensation insurance, to prevent any issues with coverage for treatment. 

3. File a Claim: Your employer should provide you with the necessary documents to file a workers' compensation claim. Make sure that all the details about the injury are accurate and complete. 

4. Claim Investigation: Your claim will undergo an investigation process, which typically takes up to 14 days. An evaluator will consider the extent of your injury and its effect on your ability to work to determine its validity and the benefits you might qualify for. 

What to Do If Your Workers' Compensation Claim Is Denied  

If your workers' compensation claim was denied, you have the right to appeal the decision. While appealing a denied worker's compensation claim can seem daunting, knowing the right steps to take can significantly increase the chances of reversing the decision. Here's how you can appeal a denied workers' compensation claim in Missouri: 

1. Review the Denial Letter: Understand why your claim was denied. The denial letter must state the reason, whether it’s due to filing deadlines, insufficient evidence, or other factors. 

2. File a Notice of Appeal: In Missouri, workers must file an appeal for a denied compensation claim within 20 days from the date the denial notice was received. 

3. Gather Additional Evidence: Collect medical records, witness statements, and further documentation that shows your injury is work-related and qualifies for compensation. 

4. Request a Hearing: You can request a hearing before a judge. At this hearing, you'll have the opportunity to present your case, including any new evidence. 

5. Consult Legal Representation: An experienced workers' compensation attorney can represent you at the hearing, help gather compelling evidence, and advocate on your behalf. 

6. Prepare for Possible Mediation or Trial: Some cases may be settled during mediation. However, if the parties cannot agree, the case will proceed to trial, where the judge will make a final decision based on the presented evidence. 

Depending on the evidence and arguments presented, the judge can either overturn the denial and approve your workers' compensation benefits or affirm the denial. If the decision is not in your favor, you may have further appeal options within the Missouri court system. 

Seek Experienced Legal Counsel 

Suffering an injury at work can be confusing if you don't know what to do. At the Law Office of Steve Slough, we are committed to helping you understand what injuries are covered, the process for filing a compensation claim, and your rights as an employee. If you've been injured at work or had your workers' compensation claim denied, contact us for a free consultation. Located in Clayton, Missouri, we proudly serve clients throughout St. Louis County, St. Charles County, and Madison County, Missouri, and St. Clair County, Illinois.