Hopefully, employees never have to go through the workers’ compensation system, because doing so means that you suffered a significant injury. However, for those that do have to rely on workers’ compensation for their recovery, the process can be confusing.
Here, the workers’ compensation and personal injury lawyers at the Smith Law Office provide an overview of the process. Contact them online or call them at (816) 875-9373 for help in western Missouri.
File for Workers’ Compensation
After you get hurt on the job, the first step is to notify your employer. Many employers have a specific procedure for this, so review your employee handbook and follow it to the letter. Your employer will then send you to a doctor and cover the costs of the injury.
Meanwhile, the workers’ compensation insurance company will investigate your case. If it accepts the claim, it will make a determination of disability benefits and cover your medical expenses.
Because these insurance companies are for-profit, though, the coverage they provide is often inadequate. If it is not enough or if your claim gets denied, you can dispute it with the insurance company or with your employer. If this does not fix the situation, you can appeal the insurer’s decision.
Initial Appeal Options
In Missouri, you have several options at this step. All of them bring the Missouri Department of Labor and Industrial Relations into the case.
The least contentious is to go through a mediation process provided by the Workers’ Compensation Division’s Dispute Management Unit. Often done over the phone, the mediators guide you and your employer towards an outcome that satisfies everyone. They do not make binding decisions about your case.
You also have the option of requesting a conference with an administrative law judge. You and your lawyer would meet with the representatives for your employer and the insurance company to try to settle the case.
Finally, you can file a claim for compensation. This is often something that workers do when the other options have gotten nowhere.
File a Claim with the Division of Workers’ Compensation
If you file a claim for workers’ compensation, it starts the claims process. It has to be filed within the applicable statute of limitations, which is generally two years.
In many cases, the claim gets resolved in a pre-hearing or through mediation, which you or your employer can request in order to wrap up the case quickly. If it does not, it can go to a final hearing, which is usually only scheduled after you have reached maximum medical improvement.
If you are struggling to make ends meet while the case progresses because of the stingy benefits that you are receiving, you can request a hardship hearing. This can lead to a temporary or partial award of benefits.
At the final hearing, an administrative law judge will hear your case and issue a ruling.
The Appeals Process
If you are unhappy with the outcome of the case, you can appeal it. All of these appeals rely on the record created in the final hearing before the administrative law judge. Offering new evidence on appeal is extremely difficult to do.
If you are unhappy with the LIRC’s decision, you can appeal your case to the Missouri Court of Appeals. This court can only review the LIRC’s application of the law, though. It has to accept any factual findings that the LIRC makes.
If you are still unhappy, you can request a review by the Missouri Supreme Court. However, this last level of appeal is extremely rare. The court will generally deny a request for appeal unless your case has a new legal issue to resolve.