Missouri Workers' Compensation Insurance

Overview of Missouri Workers' Compensation

Missouri's workers' compensation system is governed by Chapter 287 of the Missouri Revised Statutes. The system provides a no-fault mechanism for compensating employees injured on the job while protecting employers from most workplace injury lawsuits.

Employer Coverage Requirements

General Requirement: 5 or More Employees

Missouri requires workers' compensation coverage for:

• Private employers with 5 or more employees
• Employee count includes all full-time, part-time, and seasonal workers
• Out-of-state employers with employees working in Missouri

Construction Industry Exception

All construction industry employers must provide workers' compensation coverage:

• Regardless of the number of employees
• Even sole proprietors with one employee
• Includes general contractors and subcontractors
• Broader definition of construction activities

Exempt Employers and Employees

Certain categories may be exempt from mandatory coverage:

• Employers with fewer than 5 employees (non-construction)
• Domestic servants in private homes
• Some agricultural workers
• Certain real estate agents (independent contractors)
• Corporate officers (may elect out with proper documentation)

Exam Tip: The construction industry exception is critical for the exam. Remember that ALL construction employers must have workers' comp coverage regardless of how many employees they have.

The No-Fault System

How No-Fault Works

Missouri workers' compensation operates as a no-fault system:

• Benefits paid regardless of who caused the accident
• Employer negligence not required for coverage
• Employee negligence does not bar recovery (with limited exceptions)
• Faster claims resolution than litigation

Exceptions to No-Fault Recovery

Benefits may be reduced or denied if injury results from:

• Intoxication - Employee under influence of alcohol or drugs
• Willful misconduct - Intentional violation of safety rules
• Horseplay - Reckless behavior unrelated to work
• Self-inflicted injury - Intentional self-harm
• Failure to use safety devices - When properly provided and trained

Benefits Not Reduced For:

• Simple negligence by employee
• Lack of experience
• Ordinary workplace accidents
• Honest mistakes in performing job duties

Workers' Compensation Benefits Structure

Medical Benefits

Missouri provides full medical coverage for work-related injuries:

• No deductible for the employee
• No copayments required
• Full cost of reasonable and necessary treatment
• Choice of physician - Employer may designate initial treating physician
• Duration - Until maximum medical improvement (MMI)

Temporary Disability Benefits

Temporary Total Disability (TTD):

• Paid when employee cannot work at all during recovery
• Rate: 66 2/3% of average weekly wage
• Maximum: Subject to state maximum weekly benefit
• Waiting period: 3 days (waived if disability exceeds 14 days)
• Duration: Until MMI or return to work

Temporary Partial Disability (TPD):

• Paid when employee can do limited work during recovery
• 66 2/3% of wage difference (pre-injury vs. current earnings)
• Encourages return to work in modified capacity

Permanent Disability Benefits

Permanent Partial Disability (PPD):

• Paid for permanent impairment after MMI
• Based on body part schedule or rating percentage
• Lump sum or weekly payments
• Does not require total inability to work

Permanent Total Disability (PTD):

• Paid when employee cannot perform any work
• Lifetime benefits in most cases
• 66 2/3% of average weekly wage
• Subject to annual cost-of-living adjustments

Death Benefits

Benefits to dependents when work injury causes death:

• Surviving spouse: Weekly benefits for life or until remarriage
• Dependent children: Benefits until age 18 (or 22 if in school)
• Funeral expenses: Up to $5,000 (subject to adjustment)
• Total maximum: Based on state benefit limits

Vocational Rehabilitation

• Provided when employee cannot return to former job
• Includes retraining and job placement assistance
• May include education benefits
• Designed to restore earning capacity

The Exclusive Remedy Doctrine

What is Exclusive Remedy?

The exclusive remedy doctrine means that workers' compensation is the only remedy an injured employee has against their employer for workplace injuries:

• Employees cannot sue employers in civil court
• Protects employers from personal injury lawsuits
• Trade-off for no-fault benefits
• Applies to co-employees acting within scope of employment

Exceptions to Exclusive Remedy

Employees may sue outside workers' comp when:

• Intentional tort by employer - Deliberate injury
• Third-party liability - Non-employer caused injury
• Dual capacity - Employer in different legal role
• Lack of coverage - Employer failed to maintain insurance

Third-Party Liability

When a third party (not the employer) causes workplace injury:

• Employee receives workers' comp benefits
• Employee may also sue the third party
• Insurer may have subrogation rights
• Common examples: Defective products, negligent drivers, property owners

Exam Tip: Exclusive remedy is a fundamental concept. Employees give up the right to sue their employer in exchange for guaranteed no-fault benefits. This is the "grand bargain" of workers' compensation.

Missouri Division of Workers' Compensation

Administrative Authority

The Missouri Division of Workers' Compensation (DWC) is the state agency that:

• Administers the workers' compensation system
• Resolves disputed claims
• Monitors employer compliance
• Certifies self-insured employers
• Collects and maintains injury data

Claim Process

Dispute Resolution

For disputed claims, Missouri offers:

• Informal mediation through DWC
• Formal hearing before Administrative Law Judge (ALJ)
• Appeal to Labor and Industrial Relations Commission
• Judicial review in state courts

Penalties for Non-Compliance

Employer Penalties

Employers who fail to maintain required coverage face:

• Civil penalties: Up to $50,000
• Criminal penalties: Class A misdemeanor for first offense
• Class D felony for subsequent offenses
• Personal liability: Loss of exclusive remedy protection
• Injunction: Court order to cease operations

Consequences of Non-Compliance

Insurance Options for Employers

Commercial Workers' Compensation Insurance

• Purchase from licensed insurance carriers
• Standard coverage following NCCI forms
• Experience modification rating affects premiums
• Claims handling by insurer

Self-Insurance

Qualified employers may self-insure by:

• Demonstrating financial capability
• Obtaining approval from DWC
• Posting security deposit or bond
• Providing claims administration
• Meeting ongoing reporting requirements

Group Self-Insurance

• Multiple employers form association
• Pool resources for coverage
• Share administrative costs
• Subject to regulatory approval

Recent Missouri Workers' Compensation Reforms

Missouri has made several reforms to its workers' compensation system:

• Clarified definition of compensable injury
• Established objective medical evidence requirements
• Updated benefit calculation methods
• Strengthened fraud prevention measures
• Streamlined dispute resolution process