When you have been injured on the job, you may wonder, “What will happen next? or “When will I be eligible for a settlement?” If you are asking these questions, you are not alone. After you are injured, the following is the standard process you can expect to occur:
1. Obtain initial medical treatment
After you have sustained a work related injury, the most important and first thing you must do is seek initial treatment for your injuries. It is your employer’s responsibility to pay for your treatment, but you must visit the physician or hospital of your employer’s choosing.
2. Notify your employer of your injury
Under Missouri law, you must provide your employer written notice (preferably via certified mail) of the time, place and nature of your injury (along with your name and address) no later than thirty days after your accident. If you are claiming an occupational disease or repetitive trauma, you must provide the same information no later than thirty days after your disease is diagnosed. Although there are certain circumstances where the thirty day period may be waived (if, for example, the employer was not prejudiced by the delay), you should not rely on such exceptions. It is your duty to provide proper notice to your employer. If you have retained the services of an attorney, your attorney can provide notice to your employer for you.
3. If you haven’t already, contact a workers’ compensation attorney
Only a workers’ compensation attorney can carefully evaluate your entire claim. Although you may believe your employer and your employer’s insurance company have your best interests at heart, it is likely they are equally concerned about avoiding paying a large workers’ compensation claim or hospital bills. You are entitled, however, to compensation and proper treatment for your injuries.
4. Your attorney will file a claim with the Missouri Division of Labor and Industrial Relations
The filing of this claim satisfies the two year statute of limitation requirement.
Therefore, after the claim is officially filed, your case does not have to be resolved within two years of your injury. In fact, in many cases, your continued treatment will prevent settling your case for quite some time. Your attorney will file your claim for compensation, but you will need to provide your attorney detailed information regarding your injury and wages.
5. Your employer will answer your claim
Within 30 days, your employer will answer your claim for compensation by either admitting or denying that you were injured within the scope of employment with this particular employer. The answer is, for the most part, a formality. Even if the employer denies that you were injured on the job, your attorney can proceed with your case and have the matter ultimately decided by the administrative law judge.
6. Periodically, your case will be heard in front of an administrative law judge
Every month or two (depending on which workers’ compensation office is handling your claim), your case will be called up to a pre-hearing conference. Although “pre-hearing conference” sounds complicated and important, it is usually just an opportunity for the administrative law judge to ask the attorneys where the case stands. For instance, if you are still in treatment, you cannot settle your claim. Therefore, the judge would simply continue your case onto another pre-hearing conference in the future. Let’s say that at the next pre-hearing conference, you have completed treatment but have not yet received a medical rating, the judge would again push the case onto the next pre-hearing docket. This would continue to happen until negotiations break down between the parties, and the judge must decide your case. Because pre-hearing conferences are mostly for the attorneys and administrative law judge, your appearance is generally not necessary. The pre-hearing conference rooms are often crowded with attorneys, and your attorney may have to wait quite some time for your case to be called. You are, of course, welcome to attend if you think it would help you better understand the workers’ compensation process or your claim.
7. As long as you continue to experience symptoms related to your work related injury, you are entitled to ongoing medical treatment.
Even after your claim has been filed, you are still entitled to treatment for your work related injury. You are required to visit a physician of your employer’s choosing (usually your employer’s insurance company chooses). However, if you are dissatisfied with your employer’s chosen doctor, your attorney can ask your employer to provide you with another doctor. If your employer refuses, your attorney can ask the administrative law judge to appoint a new doctor for treatment. As long as you visit an approved physician, any treatment related to your work injury must be paid for by your employer. If you prefer, you can choose your own treating physician at your own cost. It is VERY important that you continue treatment. Otherwise, your employer may claim that part of your permanent injury was caused by your own failure to seek ongoing medical treatment. It is also important, because you case can generally only be settled once a physician finds that additional treatment will not improve your injury.
8. Eventually, your treating physician will notify you that your injury cannot improve any further.
At some point in time, your treating physician will inform you that your injury
will not get any better with additional treatment. In medical terms, your doctor will
inform you that you have reached “maximum medical improvement” (“MMI”). Once your doctor determines that you have reached MMI, it is time to obtain a final rating which is used to calculate your permanent partial disability settlement.
9. You will be rated for your injury.
After you have reached MMI, you will need to be rated for your injury. Although it sounds complicated, all a rating does is determine how much permanent function you have lost due to your work related injury. For example, if you injured your right hand and a doctor rated you at 10% permanent partial disability to your right hand, your doctor is really just saying that for the rest of your life, your hand will be 10% less functional than an uninjured hand. Initially, your employer will be required to pay for a rating. Like your treatment, however, you will be required to receive the rating from a doctor of your employer’s choosing. If your rating seems unfair or incorrect, your attorney may advise you to pay for a rating at a doctor of your choosing. Although you will be required to pay for this cost (typically between $200-$500), it could significantly increase your compensation.
10. Your attorney will begin negotiations with your employer/employer’s insurance company.
After you have received a rating, your attorney will begin negotiations on your behalf. If you received more than one rating (i.e. your employer’s doctor and your own), your attorney will attempt to negotiate your claim towards your most favorable rating. As with any negotiation, there is usually some room to work, and both parties typically wish to avoid a trial. If negotiations are successful, you will be paid a lump sum settlement. If they are not, the case will need to be set for trial.
11. If your attorney is able to successfully negotiate your claim, you will receive a lump sum settlement.
After an agreement is reached with your employer, your attorney will prepare a document called a “stipulation.” A stipulation is a contract between you and your employer where you agree to dismiss your claim (and never re-file it) in exchange for an agreed upon amount of money. Your attorney will handle completing the stipulation, and it will need to be signed by you, your attorney, the opposing party (i.e. insurance company, employer, etc.) and the judge. Once the stipulation is signed by all parties, a check will be sent to your attorney. The check will be made out to you and your attorney. You will need to sign the check, your attorney will deposit the check into his trust account, and your attorney will write you a check for the net amount owed to you. Attorney’s fees are set by statute in Missouri at 25% of your lump sum award.
12. If your attorney is unsuccessful in negotiating your claim, your case will proceed to trial.
At trial, your attorney will be able to present evidence on your behalf including your independent medical rating, wage statements and any evidence that your injury occurred on the job. It will ultimately be up to the administrative law judge to decide if you are entitled to compensation and, if so, how much. If the administrative law judge rules against you, you can appeal the decision to a higher court.
13. Your file is closed
Upon trial or settlement, you case will be considered closed. Your attorney will return any original documentation to you and retain a copy for a period of several years. You are entitled to a copy of your complete file if you wish. At this time, your arrangement with your attorney is complete.
Workers Compensation Overview | FAQ | Injured on the Job Now What?