SECTION I WHAT TO DO WHEN INJURED ON THE JOB This booklet is designed to give you general information concerning your rights when injured on the job. The following sections of this booklet outline the provisions of Missouri s Workers Compensation Law and also discuss your potential rights against parties other than your employer for on-the-job injuries. You should always keep the following points in mind: 1. Report any injury (no matter how slight) immediately to your employer or his representative, such as a foreman or supervisor, and your shop steward. In no case should you wait more than 30 days after the accident, or more than 30 days after being diagnosed with an occupational disease. If you are unable to report the injury, then a member of your family should report the injury. 2. When reporting the injury, ask that a written record be made of your injury or provide your employer with written notice, including your name, the time, place and nature of the injury. 3. Ask for medical treatment through your employer as soon as possible after the injury. 4. Maintain your own records of the time and place of the injury, any possible witnesses to the accident, to whom and when you reported the injury, and instructions you were given by the employer or its representative upon report of the injury. 5. Keep a record of all medical treatment and examinations, including doctors, hospitals, and dates of treatment. Likewise, keep a record of all time lost from work because of the injury and compensation you received for the lost time. 6. Should your employer or its insurance carrier refuse medical care or compensation to you, or terminate any benefits to which you feel you are still entitled, you should immediately contact an attorney and/or the main office of the Division of Workers Compensation in Jefferson City, Missouri at (573) 751-4231 or any branch offices listed on page. 7. With respect to your Workers Compensation claim, you are not required to agree to any settlement offered by your employer or its insurance carrier. If a fair settlement cannot be reached, you have the right to have an administrative law judge decide your case. 8. You may be entitled to more benefits than just medical care and compensation for time off work. Do not forget the possibility that any injury may have permanent consequences. In addition, parties other than your employer may have to pay you damages beyond those provided under the Workers Compensation Law (see Section VII of this booklet). 9. Benefits are available under Missouri s Workers Compensation Law even though the accident was caused by employee fault. However, where the accident is caused by failure to abide by a safety rule, the benefits recoverable can be reduced (see Section III of this booklet). 10. It is illegal under Missouri law for your employer to discharge you or discriminate against you because you have filed a claim for Workers Compensation benefits.
SECTION II TEN COMMONLY ASKED QUESTIONS ABOUT WORKERS COMPENSATION 1. Do I have the right to choose my own doctor at my employer s expense? You do have the right to select your own doctor, hospital, medical facilities and services, but you do so at your own expense. Unless you are willing to pay for these yourself, your employer has the right to choose and direct which doctors treat you, where you are treated, etc. 2. Do I have the right to a second opinion at my employer s expense? No. The Workers Compensation law does not require an employer to pay for a second medical opinion, but it may be authorized if requested. 3. How much compensation am I entitled to receive when I am authorized off work for a workrelated injury? You are entitled to temporary total disability payments based on 66 2/3% of your average weekly wage as of the date of your injury, subject to certain minimum and maximum limitations. To determine your average weekly wage as of the date of your injury, the general rule is to add your gross earnings for the 13 weeks that you actually worked prior to your date of injury and divide by 13. 4. Am I entitled to the difference between the temporary total disability workers compensation benefits paid for the period I was authorized off work and the wages I would have normally earned? No. 5. Are workers compensation benefits such as temporary total disability and permanent disability payments taxable? No. 6. When do temporary total disability benefits begin? Temporary total disability benefits begin after you are authorized off work more than three regularly scheduled work days. However, if you are authorized off work for 14 days or more, whether regular work days or not, compensation is then due for the initial three day waiting period. 7. Am I entitled to compensation for pain and suffering during my recovery? No. However, to the extent that you continue to have pain and to suffer from your injury after your recovery period, your permanent disability benefits may be greater. 8. Does my employer have to pay me for work missed due to doctor appointments for treatment or physical therapy? No. In fact, your employer may require you to take paid leave, personal leave, or medical/sick leave when work time is missed for treatment, therapy or medical evaluations.
9. Does my employer have to pay me travel mileage for medical treatment or physical therapy? Your employer does not have to pay mileage unless you receive medical treatment outside the employee s principle place of employment. 10. Is my employer obligated to provide vocational training if I am unable to return to my job due to my work-related injury? No. It is not mandatory for an employer to provide vocational rehabilitation services although it is allowed if your employer is willing. SECTION III GENERAL INFORMATION The Missouri Workers Compensation Law is designed to provide various types of benefits to employees who suffer injury or death arising out of and in the course of their employment as a result of an accident or an occupational disease. Coverage Most working people in Missouri are protected by the Workers Compensation Law. Although employers with four or less employees (except for the construction industry) are not automatically subject to the law, they may elect to be covered by filing a notice with the Missouri Division of Workers Compensation in Jefferson City, Missouri, or by purchasing and accepting a valid workers compensation insurance policy. Your employer has the option of insuring its liability with an insurance company, or of becoming a self-insurer if it can show proper financial responsibility and obtain approval from the Division of Workers Compensation. If you are not sure whether your employer is covered, you may either ask your employer or contact the Division of Workers Compensation in Jefferson City, Missouri at (573) 751-4231. You are covered by the Workers Compensation Law as soon as you start on your job and any time you are working. You are not required to work for any amount of time or to earn any certain amount of money before being covered. Similarly, you are not required to be a full-time employee as opposed to a part-time employee. As a general rule, every employer subject to the provisions of the Workers Compensation Law shall be liable, irrespective of the employee s own negligence, to provide benefits to an employee who suffers an injury or death arising out of and in the course of their employment as a result of an accident or occupational disease. The rights and remedies granted to an employee under Workers Compensation Law are generally exclusive and shall preclude an employee from suing his employer, co-employees, or the employer s agents for damages attributable to the injury or death. You should be aware, however, that in certain situations, your benefits under the Workers Compensation Law may be reduced and even forfeited entirely. Your benefits shall be reduced by at least 25 percent but not more than 50 percent in the following situations: 1. If your injury is caused by your failure to use safety devices. There is no requirement that this failure be willful. 2. If your injury is sustained in conjunction with the use of alcohol or non-prescribed controlled drugs even if you have no knowledge of the employer s alcohol/drug-free workplace policy.
Your benefits shall be forfeited in the following situations: 1. If the use of alcohol or non-prescribed controlled drugs in violation of the employer s policy is the proximate cause of your injury even if the employer s policy is not posted or publicized and even if the employer had actual knowledge of your alcohol/drug use and it went undisciplined or authorized such use. 2. If it is shown that your blood alcohol content is more than the legal limit at the time of your injury. 3. If your employer has reason to suspect drug or alcohol use, and you refuse to take a drug or alcohol test when your employer has a policy which authorizes this testing. 4. If you are terminated for post-injury misconduct, your temporary total disability benefits can be forfeited. 5. If your injury occurs while engaging in recreational activities, whether voluntary or involuntary. Injury or Death Caused by Accident or Occupational Disease The Workers Compensation Law covers any injury or death of an employee arising out of or in the course of his or her employment as a result of an accident or an occupational disease. The construction of the law will be strictly construed for all injuries. In other words, the law does not give the benefit of the doubt to the employee. An accident is defined by the Missouri Workers Compensation Law as an unexpected, traumatic event or unusual strain identifiable by time and place of occurrence and producing at the time objective symptoms of an injury caused by a specific event during a single work shift. Any injury by accident or occupational disease must be the prevailing factor in causing the injury. The prevailing factor is defined to be the primary factor, in relation to any other factor causing both the resulting medical condition and the disability. In addition, an injury resulting directly or indirectly from idiopathic causes is not compensable. If you are unsure whether your injury is compensable, report it immediately to your employer and follow the appropriate steps as outlined on pages 1-2 of this booklet. Thereafter, if there is a dispute as to your employer s liability, immediately contact an attorney and/or the main office of the Division of Workers Compensation in Jefferson City, Missouri at (573) 751-4231, or any of the branch offices listed on page of this booklet. Mental Injuries Mental injuries resulting from work-related stress shall not be considered arising out of and in the course of employment and therefore compensable, unless it is demonstrated that the stress is workrelated and was extraordinary and unusual. A mental injury shall not be considered to arise out of and in the course of employment if it resulted from any disciplinary action, work evaluation, job transfer, layoff, demotion, termination or any similar action taken in good faith by the employer. Benefits Under the Law There are three basic types of benefits available to you if you are injured on the job: 1. Medical care to cure and relieve the effects of your injury; 2. Physical Rehabilitation services to help you return to work either at your usual job or another one; and
3. Compensation payments for: a) time lost from work and b) permanent disability. If your injury results in death, additional benefits are provided for your surviving dependents. SECTION IV FILING A CLAIM When any dispute arises between you and your employer or its insurance company regarding benefits, you or your attorney should file a Claim for Compensation with the Division of Workers Compensation. A claim MUST be filed: a) within two years after the date of injury, death, or last compensation payment made on account of the injury; or b) if the employer does not file a report of injury, within three years from the date of injury, death, or last compensation payment made, if not an occupational disease; or c) in the cause of an occupational disease, the claim should be filed within two years from the time that the occupational disease becomes reasonably discoverable and apparent that an injury has been sustained related to such exposure. If an injury results in death or if an employee dies during a period in which a claim could have been brought but his death was not attributable to a work-related accident, then the surviving dependents of the employee may file a claim. Claim Processing After the filing of a Claim for Compensation, the employer or his insurance carrier has 30 days from the date of the Division s acknowledgement of receipt of the formal claim to file a formal answer. A copy of the answer will be sent to the employee and, if applicable, to his attorney. Upon request by either party, your claim will be set for a pre-hearing conference at the nearest Division office. At the time of the conference, any disputes can be taken up to see if they can be resolved without a formal hearing. If there is no resolution reached at that point, then a mediation conference will be held at a later date before an Administrative Law Judge of the Division. If the claim remains unresolved, a formal hearing will be scheduled. At the formal hearing, a court reporter will take down the testimony and evidence presented to the Administrative Law Judge. The Judge will then issue a written decision and send each side a copy of the decision. If either party is dissatisfied with the decision of the Administrative Law Judge and wishes to appeal, then an application for review must be filed with the Labor and Industrial Relations Commission within 20 days of the decision. Further appeals are also possible through Missouri courts. Representation The law does not require you to have an attorney to either file a claim or appear before an Administrative Law Judge of the Division of Workers Compensation. If you do retain an attorney, the attorney s fee must be approved by an Administrative Law Judge of the Division. The normal practice is for attorneys to handle Workers Compensation claims on a contingency basis, which means the attorney receives a percentage of any compensation he obtains for the employee. Costs incurred, such as those for
medical evaluations or copies of medical records, are the responsibility of the employee and thus are deducted from the employee s recovery. One thing you should remember in deciding whether you want or need an attorney with respect to your claim is that your employer or its insurance company will have an attorney. This attorney is obligated to protect the interest of his client, rather than your interests. In addition, the law after August 28, 2005 requires that the Judges at the Division of Workers Compensation approve all settlements as long as they are not the result of undue influence or fraud. There is no longer a requirement that the settlement be fair.
Location of Division Offices The main office is: P.O. Box 58 722 Jefferson Street Jefferson City, Missouri 65102 (573) 751-4231 The branch offices are: 111 North Seventh Street 1805 Grand Avenue 250 Wainwright Building Suite 400 St. Louis, Missouri 63101 Kansas City, Missouri 64108 (314) 340-6865 (816) 889-2481 3737 Harry S. Truman Boulevard 3311 Texas Suite 300 Joplin, Missouri 64804 St. Charles, Missouri 63301 (417) 629-3032 (636) 940-3326 1736 East Sunshine 525 Jules Street Suite 610 Route 315 Springfield, Missouri 65804 St. Joseph, Missouri 64501 (417) 888-4100 (816) 387-2275 3102 Blattner Drive Suite 101 Cape Girardeau, Missouri 63701 (573) 290-5757
SECTION V BENEFITS A. Medical Care and Treatment If you have a job-related injury, disability or occupational disease, your employer has an obligation to provide such medical, surgical, chiropractic and hospital treatment, including nursing care, custodial care, ambulance transportation, medicines, crutches, x-rays, etc., as may be reasonably required after your injury or disability to cure and relieve the effects of the injury. If you desire, you do have the right to select your own doctor, hospital, medical facilities and services, but you do so at your own expense. Unless you are willing to pay for these yourself, your employer has the right to choose and direct which doctors treat you, where you are treated, etc. However, if it is demonstrated to the Division of Workers Compensation or the Labor and Industrial Relations Commission that there is reasonable ground for believing that medical services are being provided by your employer in such a manner to endanger your life, health, or recovery, then a change in the physician, surgeon, hospital, etc. may be ordered. You may have your own doctor treat you or select your own medical care facility at your employer s expense IF your employer or his insurance company authorizes it. In addition, if a situation arises where you are in need of immediate emergency treatment and are unable to seek medical treatment authorized by your employer or its insurance company, you should seek the appropriate emergency treatment and the employer or his insurance company may be required to pay for such treatment. Finally, your employer s obligation to provide medical care and treatment also includes a requirement to furnish you with artificial limbs, surgical orthopedic joints, and braces as needed for life. You do have the right to refuse medical care or treatment. However, your benefits may be affected by your unreasonable refusal to submit to medical or surgical treatment. B. Physical Rehabilitation Physical rehabilitation is intended to help restore the injured person, as soon as possible, to a condition of self-support and maintenance as an able bodied worker. In order for you to qualify for physical rehabilitation benefits, the injury must be a serious one where physical rehabilitation is deemed necessary by a qualified physician. A serious injury is defined by the Division of Workers Compensation as being grave or viewed with apprehension. Examples of serious injuries where the employee may be entitled to physical rehabilitation benefits are: quadriplegia, paraplegia, amputations of hand, arm, foot or leg, atrophy due to nerve injury or nonuse and back injuries not amenable to recognized medical and surgical procedures. When such a determination is made, the Director of the Division of Workers Compensation is notified and the Director s approval must be obtained. If this occurs, physical rehabilitation must be provided at a facility which is specifically qualified to provide physical rehabilitation for seriously injured workers and has received a Certificate of Qualification from the Division of Workers Compensation. To encourage your cooperation as an injured worker in accepting such rehabilitation, you are paid $40 per week during the period of rehabilitation. An injured worker must receive a minimum of two weeks of physical rehabilitation to qualify for this additional benefit. This amount is not paid by your employer or its insurance company, but by a State fund and the payment is in addition to any benefits you may be entitled to from your employer. You will receive the benefits during the entire period you are receiving physical rehabilitation. However, this period of payments shall not exceed 20 weeks except in unusual cases and then only by special order of the Division of Workers Compensation. These payments are not made after you have returned to work.
C. Vocational Rehabilitation In certain circumstances when an employee has sustained an injury of sufficient severity that results in a loss of employment, an employee may, if authorized by the employer and its insurance company, receive vocational rehabilitation services that are reasonably necessary to restore him to employment. It is important to note that this provision is not mandatory on the employer or its insurer. D. Disability Compensation Benefits Four types of disability benefits may be provided: 1) Temporary total disability 2) Temporary partial disability 3) Permanent total disability; and 4) Permanent partial disability If you receive payments under any of the four listed categories, they are tax-free. There are no deductions from these payments for state, federal or social security taxes. 1. Temporary Total Disability (T.T.D.) While you are temporarily unable to do any work as a result of your injury, you are entitled to receive cash compensation for a period not to exceed 400 weeks. The determination of the amount of each weekly payment is based on your weekly earnings at the time your injury occurred. The basic rule is that the weekly rate of compensation for temporary total disability payments shall be 66 2/3% of your average weekly earnings as of the date of your injury, subject to certain minimum and maximum limitations. The minimum rate for temporary total disability benefits is $40 per week. Effective T.T.D. Max. Date Rate 7-01-2009 to 6-30-2010 $807.48 7-01-2010 to 6-30-2011 $799.11 7-01-2011 to 6-30-2012 $811.73 7-01-12 to 6-30-13 $827.75 7-01-13 to 6-30-14 $853.08 The Missouri Workers Compensation Law provides that an employee s average weekly wage AWW for purposes of determining the applicable weekly compensation rates shall be computed as follows: (a) (b) (c) If the wages are fixed by the week, then the amount so fixed shall be the AWW; If the wages are fixed by the month, then the AWW shall be the monthly wage so fixed, multiplied by twelve and divided by fifty-two; If the wages are fixed by the year, then the AWW shall be the yearly wage so fixed divided by fifty-two;
(d) (e) If the wages are fixed by the day, hour or output of the employee, then the AWW shall be computed by dividing by thirteen the wages earned by the employee by the day, hour or output of the employee in the employ of the employer in the last thirteen consecutive calendar weeks immediately preceding the week in which the employee was injured. If employed by the employer for less than thirteen weeks, then the AWW shall be computed by the number of calendar weeks or any portion thereof during which the employee was actually employed by the employer; and If the employee has been employed less than two calendar weeks immediately preceding the injury, the employee s AWW shall be equivalent of the AWW prevailing in the same or similar employment at the time of injury. In computing the AWW, only weeks in which work is performed and wages paid shall be considered for determining the total wages earned or the number of weeks actually worked. Temporary total disability payments are not made for the first three regularly scheduled work days unless the injury lasts longer than fourteen days. If the disability lasts longer than fourteen days, the law requires payment for the first three regularly scheduled work days to be made retroactively to the employee. There is also a provision requiring that your employer notify you if your benefits are being terminated and the reasons for such a termination. This provision also allows for an expedited hearing to be held at the Division if you dispute this termination. 2. Temporary Partial Disability (T.P.D.) If you are partially disabled for a temporary period of time, you are entitled to compensation during your disability for a period of no more than 100 weeks. For example, if an employee s job involves heavy lifting and his doctor authorizes his return to light duty work which pays less than his regular job, the employee would be entitled to receive temporary partial disability while working at the lower paying job. This situation rarely occurs. 3. Permanent Total Disability (P.T.D.) If you are permanently and totally disabled as a result of a work-related injury or occupational disease, you are entitled to receive weekly compensation benefits for your lifetime. Your weekly benefit is determined in the same way as your weekly benefit for temporary total disability. 4. Permanent Partial Disability (P.P.D.) Permanent partial disability means a disability that is permanent in nature and partial in degree. Permanent partial disabilities involve either scheduled or unscheduled injuries. A scheduled injury is one that is listed below under Schedule of Losses. See pages 35-36 for a visual chart of these scheduled injuries. Schedule of Losses Weeks (1) Loss of arm at shoulder 232 (2) Loss of arm between shoulder and elbow 222 (3) Loss of arm at elbow joint 210 (4) Loss of arm between elbow and wrist 200 (5) Loss of hand at the wrist joint 175 (6) Loss of thumb at proximal joint 60 (7) Loss of thumb at distal joint 45 (8) Loss of index finger at proximal joint 45
(9) Loss of index finger at second joint 35 (10) Loss of index finger at distal joint 30 (11) Loss of either the middle or ring finger at proximal joint 35 (12) Loss of either the middle or ring finger at second joint 30 (13) Loss of either the middle or ring finger at the distal joint 26 (14) Loss of little finger at proximal joint 22 (15) Loss of little finger at second joint 20 (16) Loss of little finger at distal joint 16 (17) Loss of one leg at the hip joint or so near thereto as to preclude the use of artificial limb 207 (18) Loss of one leg at or above the knee, where the stump remains sufficient to permit the use of artificial limb 160 (19) Loss of one leg at or above ankle and below knee joint 155 (20) Loss of one foot, in tarsus 150 (21) Loss of one foot, in metatarsus 110 (22) Loss of great toe of one foot at proximal joint 40 (23) Loss of great toe of one foot at distal joint 22 (24) Loss of an other toe at proximal joint 14 (25) Loss of any toe at second joint 10 (26) Loss of any other toe at distal joint 8 (27) Complete deafness of both ears 180 (28) Complete deafness of one ear, the other being normal 49 (29) Complete loss of the sight of one eye 140 The above schedule assigns a value to specific parts of the body and the values (designated weeks ) represent the total loss by severance or complete loss of use in referring to a specific body part. A partial loss of one of the above-listed items is also a scheduled loss. For example, the loss of your arm at the shoulder is a scheduled injury entitling you to 232 weeks of compensation at your applicable compensation rate. Thus if it were determined that you suffered a 50% loss of the use of your arm at the shoulder, you would be entitled to 116 weeks of compensation (50% of 232 weeks). If your disability involves one of the 29 scheduled losses above and the disability of that part of your body is total by reason of severance or complete loss of use, the number of weeks of compensation awarded shall be increased by 10%. For example, if you lost one of your legs at or above your ankle and below your knee joint (number 19 of the Schedule of Losses), you would be entitled to 155 weeks plus 10% of 155 weeks (15.5 weeks) for a total of 170.5 weeks. If you suffer an injury not listed on the Schedule of Losses, you are entitled to recover compensation based on the percentage of disability to the body as a whole. For determination, the human body is assigned the maximum value of 400 weeks of compensation. For example, if you were to suffer a 20% back injury, you are entitled to receive 80 weeks of compensation (20% of 400 weeks). The same factors in determining the weekly rate of compensation for a temporary total disability are used in determining the rate for a permanent partial disability. Again, the rate depends on your average weekly earnings at the time of the accident and is subject to certain minimum and maximum limitations. The general rule is that partial disability payments shall be 66 2/3% of your average weekly
earnings as of the date of your injury. The minimum permanent partial disability rate is $40 per week, and the maximum permanent partial disability rate, which is determined by your date of injury, is as follows: Effective P.P.D. Max. Date Rate 7-01-2009 to 6-30-2010 $422.97 7-01-2010 to 6-30-2011 $418.58 7-01-2011 to 6-30-2012 $425.19 7-01-12 to 6-30-13 $433.58 7-01-13 to 6-30-14 $446.85 It should also be noted that if the injured employee is less than 21 years of age at the time of injury, the employee's permanent partial disability rate may be determined to be as high as the maximum rate allowed for any injury on the date that the employee s injury occurred. This may be true regardless of the minor employee s average weekly wage. Although permanent partial disability benefits are expressed in terms of weekly compensation upon settlement of a claim, such benefits are normally paid in a lump sum. To see how a lump sum figure is normally determined, please see the examples in Section VIII of this booklet. E. Disfigurement Included among the provisions of Missouri s Workers Compensation Law pertaining to permanent partial disability is compensation to an injured employee for serious and permanent disfigurement of the head, neck, hands or arms. An award for disfigurement may be obtained in addition to an award for permanent partial disability. The maximum benefit for disfigurement is 40 weeks of compensation. F. Death Benefits Where an accidental job-related injury causes your death, your employer shall pay your reasonable burial expenses in an amount not to exceed $5,000. Your employer shall also pay death benefit compensation to your total dependents. The maximum death benefit, which is determined by the date of the accident, not necessarily the same as the date of death, is as follows: Effective Max. Death Date Rate 7-01-2009 to 6-30-2010 $807.48 7-01-2010 to 6-30-2011 $799.11 7-01-2011 to 6-30-2012 $811.73 7-01-12 to 6-30-13 $827.75 7-01-13 to 6-30-14 $853.08
With respect to your dependents, a surviving spouse who either lived with you or was legally entitled to support from you is regarded as a total dependent. In the event your surviving spouse remarries, your surviving spouse is entitled to a lump sum payment equal to the amount of benefits due for a period of two years. Your surviving spouse will then be entitled to no further benefits. Your child under the age of 18, or over 18 who is physically or mentally incapacitated, is also regarded as a total dependent provided your child was either living with you at the time of your death or was legally entitled to receive support from you. If you have no total dependents, any person who received some support from you but is not entirely dependent upon you at the time of your injury may receive partial benefits as a partial dependent. G. The Second Injury Fund The Second Injury Fund is a fund maintained by the Treasurer of the State of Missouri to provide payments of compensation to employees with preexisting disabilities who have suffered an enhanced permanent disability as the result of having a subsequent compensable injury. Certain thresholds and strict definitions apply to Second Injury Fund claims in terms of the types of pre-existing disabilities which qualify in order to receive compensation from the Fund. The handling of and settlement of these claims can be complicated. In addition, there are provisions applying to those employees who have concurrent employment with more than one employer. These provisions apply to temporary total disability benefits and may allow an injured employee to receive additional compensation from the Second Injury Fund when the employee is authorized off work from more than one employer, but only receiving temporary total disability benefits from one employer. SECTION VI YOUR MEDICAL HISTORY AND RIGHT TO PRIVACY Your employer is generally entitled to and able to obtain any information and medical records pertaining to your workers compensation claim. This does not mean that your employer is entitled to information concerning previous treatment, medical conditions or disabilities which are totally unrelated to your workers compensation claim. If you are requested to sign a release that calls for disclosure of information beyond that which is related to your workers compensation claim, you should contact your union representative or your attorney. SECTION VII THIRD PARTY CLAIMS An employee who suffers an injury which is covered by the Workers Compensation Law cannot sue his employer in Civil Court for damages attributable to that injury. However, if the wrongful conduct of a person other than the employer caused the injury, the employee may sue the third party for damages beyond those provided by the Workers Compensation Law. For instance, assume that you are a truck driver for the ABC Trucking Company and that while making a delivery for your employer, you are involved in an auto accident with John Doe. Assume further, that this accident was the result of John Doe s negligence and you sustained injuries in the accident as a result of his negligence. You have a workers compensation claim against your employer and, additionally, can file a lawsuit against John Doe. To use another example, assume that you work for the ABC Factory and during the course of your employment you suffer an accident while working with a piece of machinery. Assume further that the accident was caused by a defective condition of the machinery and that the defective condition of the machinery existed at the time that it left the hands of
the manufacturer, making the machinery unreasonably safe for its intended use. Assuming that you suffered injuries as a result of the accident, you again can file a workers compensation claim against your employer and you can file a lawsuit against the manufacturer of the defective machinery. In both of the above examples, the additional lawsuits would be called third-party claims. When you have a third-party claim for injuries suffered sustatined while working, your employer is entitled to recover amounts it paid for workers compensation benefits out of the recovery you make against a third party in civil litigation. Frequently your attorney can negotiate a partial, rather than full, reimbursement of the workers compensation benefits. It should be emphasized that the amount recoverable in a third-party civil claim often greatly exceeds the amount recoverable under the Workers Compensation Law. Accordingly, the possibility of a third-party claim should be considered in every instance where you suffer an injury covered by the Workers Compensation Law. SECTION VIII EXAMPLES OF CLAIM SETTLEMENTS Example One Scheduled Injury Facts: John Employee makes $1500.00 per week working for the ABC Corporation. July 1, 2005, John slipped on an oil spot on the floor at work and severely strained his knee. As a result of this accident, John received medical treatment and was unable to work for 10 weeks. Despite the medical treatment provided by John s employer, the knee never fully recovered. As a result of the accident of July 1, 2005, it was determined that John had suffered a 20% permanent partial disability of the injured knee. Workers Compensation Benefits: A. Medical: John is entitled to have all of his surgical and medical bills paid by his employer or its workers compensation insurance carrier. B. Compensation I. Temporary Total Disability Because John made $1500.00 per week at the time of his injury and 66⅔% of this amount exceeds the maximum weekly benefit rate allowed by law for temporary total disability compensation, John will receive temporary total disability payments at the maximum allowable temporary total disability rate at the time of injury or $675.90 per week. John was unable to work for 10 weeks as a result of the accidental injury to his knee. He is entitled, therefore, to 10 weeks of compensation at the rate of $675.90 per week: 10 weeks of lost time x $675.90 = $6759.00 II. Permanent Partial Disability Because John made $1500.00 per week at the time of his injury and 66⅔% of this amount exceeds the maximum weekly benefit rate allowed by law for permanent partial disability compensation, John will receive the maximum allowable permanent partial disability rate at the time of his injury or $354.05 per week. John suffered a 20% permanent disability of his knee. Under the schedule of losses table, the total loss of a knee (No. 18 on the schedule) entitles a worker to 160 weeks of compensation. Since John suffered a 20% loss, he is entitled to 32 weeks of compensation (20% of 160 weeks) at the maximum allowable rate of $354.05 per week:
Summary of Compensation: 32 weeks x $354.05 = $11,329.60 $ 6,759.00 Temporary Total Disability Benefits $11,329.60 Permanent Partial Disability Benefits $18,088,60 Total compensation John receives for his knee injury Example Two Unscheduled Injury Facts: Assume the same facts as in Example One, except that instead of a knee injury, John Employee hurts his lower back as a result of a fall from slipping on the oil spot. It is determined that as a result of this injury, John has suffered a 20% permanent partial disability. Workers Compensation Benefits: A. Medical: John is entitled to have all of his medical bills paid by his employer or its workers compensation insurance carrier. B. Compensation: The only change in benefits in this example from the previous example is in the amount of compensation John will receive for the permanent partial disability of his back. Thus, he will again be entitled to temporary total disability payments as follows: 10 weeks of lost time x $675.90 = $6759.00 Permanent Partial Disability John has suffered an injury to a pert of his body that is not listed on the schedule of losses on page. In this case, his disability is referable to his whole body rather than a specific part. The entire human body is assigned the value of 400 weeks of compensation and since John has suffered a 20% permanent partial disability of the whole body, he is entitled to 80 weeks of compensation (20% of 400 weeks) at the maximum allowable rate of $354.05: 80 weeks x $354.05 = $28,324.00 Summary of Compensation $ 6,759.00 Temporary Total Disability Benefits $28,324.00 Permanent Partial Disability Benefits $35,083.00 Total compensation John receives for his back injury. Example Three Workers Compensation and Third Party Claim Facts: Assume the same facts as in Example One, except that John Employee was making a delivery for his employer when the truck he was driving was struck by a vehicle being driven by Joe Smith. The accident was caused by the negligence of Joe Smith and as a result of the accident, John hurt his knee to the same extent he did in Example One, and was unable to work for the same period of time.
Workers Compensation Benefits: John would be entitled to the exact same benefits from his employer or his employer s workers compensation insurance carrier as he received in Example One. Third Party Claim: In addition to John s workers compensation claim against his employer, John may file a claim or civil lawsuit against Joe Smith for his injury and damages caused by Joe Smith s negligence. Unlike a workers compensation claim, the potential amount of John s recovery in a claim against Joe Smith is unlimited. John may seek reimbursement for his entire lost wages, compensation for his pain and suffering and all other damages he sustained. If John is successful in his claim against Joe Smith, John s employer would be entitled to reimbursement for workers compensation benefits he paid to John. This reimbursement, however, is always negotiable by your attorney.