Six Questions to Ask if Your Missouri Workers' Comp Claim Has Been Denied

In the State of Missouri, most workers are covered under the workers’ compensation system for injuries and illnesses that are work related. The workers’ compensation system is a no-fault system that provides covered workers with medical treatment and wage replacement benefits for injuries and illnesses that qualify.

The first step in determining if you are eligible for workers’ compensation benefits is to file a Claim for Compensation with the Division of Workers’ Compensation. If your claim is approved you will begin receiving benefits. Unfortunately, many valid injury claims are initially denied. Too often, injured workers accept this denial as the final word and fail to pursue the claim any further. Don’t make this mistake if you have received a notice indicating that your workers’ compensation claim has been denied! You have a right to appeal that denial and you should exercise that right if you believe that you deserve workers comp benefits.

Before moving forward, it is best to talk with an experienced Missouri workers’ compensation attorney for guidance.

Consider the following six questions if you’ve received a denial. The answers will likely be relevant to your appeal.

1. What were the grounds for the denial? The notice of denial you received should provide a reason for the denial. Some of the most common reasons why an initial workers’ compensation claim is denied include:

1. Incomplete or inadequate application
2. Employer is not required to provide coverage
3. You are not a covered worker
4. Your injury or illness is not work related
5. Intoxication caused the accident

2. Is your employer required to carry workers’ compensation coverage? Most employers are required to provide workers’ compensation covered in Missouri. As a general rule, an employer who has five or more employees must provide coverage. Employers that are not required to carry workers’ compensation may nevertheless purchase coverage if they choose to do so.

3. Are you considered a “covered” worker? Most, but not all, workers are covered by the workers’ compensation laws in Missouri. Some exceptions include:

1. Farm laborers
2. Domestic servants
3. Real estate agents
4. Commercial carrier owner-operators
5. Workers covered under another workers’ comp system such as a federal system.
6. Independent contractors

4. Does your injury or illness qualify? Injuries or illnesses arising out of and in the course of employment potentially qualify for compensation in Missouri. Pre-existing conditions are usually not covered. However, if a pre-existing condition was exacerbated by an on-the-job accident it could be covered. Accidents that occur while driving to and from work are typically not covered but there are exceptions to this as well. Occupational illnesses and diseases may qualify for benefits if they are job related.

5. Was your claim timely filed? Missouri has a statute of limitations for workers’ compensation claims of two years. Failing to file a claim within that time frame can forever prevent you from collecting benefits for that particular work-related injury.

6. What happens next? The first step in the Missouri workers’ compensation appeals process is to inform the Missouri Workers’ Compensation Division’s Dispute Management Unit that you disagree with the denial of your claim.

If you believe that you have a legitimate claim for workers’ compensation benefits but your claim has been denied, consult an experienced Missouri workers’ compensation attorney before moving forward.

As the Missouri Department of Labor’s website advises claimants when discussing the right to hire an attorney, “the law has been changed many times over the years, and each change makes cases more complicated.” Typically, your employer and/or your employer’s workers’ compensation insurance carrier will be represented by an attorney at any hearings or proceedings in your case. To ensure that your rights are protected and to level the playing field it is best to contact an experienced Missouri workers’ compensation attorney the moment you are notified that your claim has been denied.