Terms You Need to Know

Missouri Work Comp Terms You Need To Know

Free Resources to help you understand the words and phrases used in your work comp claim. The Missouri Workers Compensation system is governed by the Missouri Workers Compensation Act. The Act is strictly construed, which means that the courts are not supposed to read any additional meaning into the provisions of the Act and have to apply the words literally as they are written. This creates a lot of problems, particularly when there are disputes about what those words mean. On top that, work comp lawyers, insurance companies and judges often use acronyms, as certain words and phrases as used all of time and are abbreviated.

Below you will find an explanation of commonly used words, phrases and acronyms so you can better understand your Missouri Workers Compensation Case.

TTD refers to an employee’s physical status while he is in recovering from an injury and unable to continue his normal work activities. Generally, the employee is off of work and at home or in the hospital, because he is physically unable to work and the employer does not have any other work that the employee can perform within his physical restrictions.

TTD also refers to the weekly checks that an employee receives while he is temporarily totally disabled and unable to work. These TTD Checks are paid weekly and constitute 66% of an employee’s Average Weekly Wage (AWW). Notably, this amount is capped by the law. These weekly checks are part of the 2nd Benefit for Injured Workers in Missouri.

Please see our Benefits Calculator to learn more about your TTD benefits are calculated.

It is very common for the BiState Injury Center to fight with insurance companies over TTD, both in the amount of the AWW and in simply getting the payments to the injured worker. Insurance companies often ignore the rules of how AWW is calculated and try to use the TTD Checks as evidence when the employee cashes them.

TTD is terminated (i.e. cut off) when an employee is declared to have reached Maximum Medical Improvement (MMI) by a physician.

TPD refers to an employee’s physical status while he is recovering from an injury and able to work a little but not in his full, normal capacity. Generally, the employee is at work can only put in reduced hours due to the injury or he is performing a different, lower paying task for the employer while healing. As a cost saving measure, the employer can force an injured employee to work a different position, so long as the new job duties do not violate the injured worker’s medical restrictions.

TPD also refers to the weekly checks that an employee receives while is temporarily working a lower paying position or his hours are reduced. TPD checks are meant to bring the employee’s weekly payments up to 66% of his normal Average Weekly Wage (AWW). Notably, this amount is capped by the law. These weekly checks are part of the 2nd Benefit for Injured Workers in Missouri.

It is very common for the BiState Injury Center to fight with insurance companies over TPD, both in the amount of the AWW and in simply getting the payments to the injured worker. Insurance companies often ignore the rules of how AWW is calculated and point to the fact that the employee is still working as proof that TPD is not required – false. The true calculation is based on the AWW.

TPD is terminated (i.e. cut off) when an employee is declared to have reached Maximum Medical Improvement (MMI) by a physician.

PPD refers to an employee’s physical status after he has received all medical care necessary to treat and relieve the symptoms of the work injury and reached maximum medical improvement. An injured worker who has a permanent partial disability has fully recovered from the work related injury and is able to resume working. However, the injury left a lasting physical problem or effect called a disability. This disability can include loss of strength, loss of movement, loss of function, ongoing pain and a number of other symptoms that may persist for the rest of the employee’s life.

PPD is also the basis for the 3rd Benefit for Injured Workers in Missouri – the final lump sum settlement. The Missouri Work Comp system is designed to compensate employees for being injured at work, and every employee who has ongoing problems from a work place injury is owed money based upon the ongoing permanent partial disability that the employee must work through.

This benefit is awarded after all medical treatment in done and the case is over.

Please see our Benefits Calculator to learn more about how PPD benefits are calculated and learn how much your Missouri workers compensation claim may be worth.

PPD is almost always contested by the insurance companies, and an experienced Missouri workers compensation lawyer can make a tremendous difference in increasing the value of your claim. The work comp lawyers at BiState Injury Center fight the insurance adjusters and their lawyers to establish the Nature & Extent of the work place injury and demonstrate the lasting effects that a hurt worker will have to deal with the rest of his life.

PTD refers to an employee’s physical status after he has received all medical care necessary to treat and relieve the symptoms of the injury but the employee is physically unable to return to work and is not employable in the open labor market. Basically, the injured worker is so hurt that he is never going to work again. Traumatic brain injuries, amputations and a combination of serious injuries often lead to the employee being found Permanently and Totally Disabled. The key to PTD is that the employee cannot work for anyone ever again, not just in the position he had. If someone can work in a reduce capacity or in a different job, then he does not qualify for PTD.

PTD is also the basis for the 3rd Benefit for Injured Workers in Missouri – the final lump sum settlement. Often with injuries that completely disable a worker, future medical care is also a concern. Please see our Benefits Calculator to learn more about how PTD benefits are calculated and learn how much your Missouri workers compensation claim may be worth.

PTD is almost always contested by the insurance companies, and an experienced Missouri workers compensation lawyer can make a tremendous difference in increasing the value of your claim, as well as establishing the correct value of your ongoing medical care. The work comp lawyers at BiState Injury Center fight the insurance adjusters and their lawyers to establish the Nature & Extent of the work place injury and demonstrate the lasting effects that a hurt worker will have to deal with the rest of his life. Additionally, the BiState lawyers help injured workers navigate the complex relationship between work comp claims and the Medicare system. Importantly, all PTD injuries are going to involve Medicare.

When a physician feels that an injured worker has reached the maximum level of improvement possible by modern medicine, then the doctor will release the work from care and declare him at Maximum Medical Improvement. Essentially, the worker has received all care necessary and no matter what other treatment is done, the worker will never get any better. MMI is the triggering event for a number of issues in the Missouri Workers Compensation system, such as terminating TTD and moving toward mediation of the case.

A declaration of MMI also stops the employer and insurance companies duty to pay for a hurt worker’s medical care – the 1st Benefit under the Missouri Work Comp System.

The Missouri Work Comp Lawyers at BiState Injury Center constantly fight insurance companies and their doctors over how MMI applies to an injured worker. The insurance doctors want to move the injured worker through the system as fast as possible and often declare MMI far before the worker is healed. For instance, a doctor may declare an injured worker at MMI and schedule 2-3 more sessions of physical therapy. That is NOT MMI, because the doctor clearly thinks the injured worker needs more medical care. We zealously fight these early releases and demand additional treatment when our clients need it.

“Injured Employee” is often abbreviated as EE by lawyers and judges in the court documents. Employees are also referred to as “Claimants

The State of Missouri maintains an average weekly wage for employees across the entire state. The Division of Workers Compensation uses this statewide average to determine maximum workers’ compensation benefits for each year. This SAWW value is also used directly in some calculations, such as determining benefits for Type 2 Occupational Diseases.

An injured worker’s Average Weekly Age is the basis of determining his Compensation Rate (Comp Rate). AWW is calculated by taking the average of the injured employee’s gross income prior 13 weeks with that employer.

A number of exceptions exist to this calculation that can dramatically affect how the AWW is calculated, such as the 30 Hour Rule. The workers compensation lawyers at BiState know these exceptions and fight to ensure the AWW is accurately calculated because this value can drastically affect every other benefit due to the injured worker.

The judges who preside over Missouri Work Comp cases are called Administrative Law Judges (ALJs). Importantly there are no juries in work comp – the ALJ assigned to your cases controls all decisions.

It is important that your work comp lawyer is familiar with the ALJs and understands how they react to a variety of arguments and positions. The experienced Work Comp Lawyers at the BiState Injury Center have argued cases in front of the vast majority of the ALJs in Missouri and know how to present facts and evidence to bring favorable rulings.

Nature & Extent refers to what part of the body was injured and how bad was the injury.  PPD and PTD are calculated based upon values assigned by the Missouri Workers Compensation Disability Table, as well as the level of ongoing disability that a hurt worker deals with after he has reached MMI.

Nature is the body part at issue, where the value comes from the Disability Table.

Extent is the ongoing disability, discussed as a percentage value, that the workers in suffering in that body part.

The Comp. Rate is the value used to determine an injured worker’s TTD, PTD, PPD and PTD benefits.  Basically, this value controls every other payment that an injured worker receives and is absolutely crucial to get right.

The Comp. Rate is 66% of the injured worker’s Average Weekly Wage (AWW), capped according to the Missouri Work Comp Disability Table.  The Comp. Rate is subject to certain minimums and maximums that dramatically affect a hurt worker’s compensation.

 When calculating PPD and PTD and arguing the nature and extent of a workplace injury, the Missouri Workers Compensation System recognizes that some injuries affect a person’s entire body.  Rather than break out different values for these serious injuries like other body parts on the Disability Table, we use the BAW value, which is 400.  Any injury to the brain, head, back, spine, chest, or an internal organ is considered an injury to the Body as a Whole, and we use 400 for the Nature value in the PTD and PPD calculations.
The employer involved in a work comp claim is abbreviated as ER. In the work comp system, the term “Employer” covers your actual employing company, as well as the company’s workers compensation insurance company. In reality, the insurance company is who runs your medical treatment and makes all of the decisions – not your boss.
The Second Injury Fund. Please see our Frequently Asked Questions below for information on how the SIF operates in Missouri Workers Compensation claims.

Frequently Asked Questions

Missouri Work Comp Frequently Asked Questions

This is often the first question we hear, and it is a difficult one to answer because every person and every situation is different.  For instance a cut or scratch that required no stitches and a quick trip to the company nurse or Concentra probably does not need a lawyer becasuse there is no ongoing disability or disagreement over TTD checks. However, injuries involving broken bones, torn tendons, traumatic brain injuries or anything that requires the employee to miss weeks of work have many complicated pieces where a lawyer can make a major impact for the hurt worker.  If nothing else, having a Missouri Workers Compensation Lawyer navigate your claim through the work comp system takes a tremendous strain off of you and your family, allowing you to focus on healing.

Many lawyers are afraid to admit that not every case needs a lawyer.  The truth is that if you were not badly injured or you do not require medical attention, there is very little that a lawyer can do to help and add value to your claim. However, if you have questions about your treatment, the workers compensation laws in Missouri, or your benefits under the Missouri Workers Compensation Act, call a Missouri Workers Compensation Lawyer.  Consultations are free and there is no harm in speaking with a lawyer that has handled work comp cases in Missouri.  Lawyers will deal with the insurance companies and their unfair adjusters, taking the headache and worry off of you.  This allows you to focus on your recovery and regain your health.

Lawyers in Missouri cannot advertise themselves as being “the best” at any one particular area of the law, including workers compensation claims.  However, not all lawyers handle all types of cases.  Just like doctors, lawyers tend to focus their energies and attention on specific types of cases.  For instance, the BiState Injury Law Center focuses on cases where someone has been hurt at work.  When trying to select a lawyer to help with your Missouri Workers Compensation Claim, there are a few questions you should ask.
Questions You Should Ask Your Missouri Work Comp Lawyer

How much does it cost to hire a work comp lawyer to handle a case like mine?

Different types of lawyers charge their clients in a number of ways, but almost every Missouri work comp lawyer works on a contingent fee.  This means that you pay nothing unless you win the case.  Our fee is 25% of the final lump sum award we recover for you.  If you do not win, we do not get paid.

How often will you contact me? What is your communication policy?

One of the most common complaints we hear from clients that are upset with their current work comp lawyer is that their lawyer never calls them or they do not know what is going on with their case.  At the BiState Injury Law Center, we believe that the more the client knows, the more empowered the client becomes in their recovery and the stronger the case we can present to the insurance companies and to ALJs.  To create this empowerment, we employ an energetic team environment, where our entire office actively works on your case.  A number of our team members will contact ever month, in writing and over the phone, and happily arrange face-to-face meetings. More importantly, our lawyers give our personal cell phone numbers to our clients.  If you have a question, you need an answer – fast!  We do asking that clients schedule specific times to speak with the lawyers so that they are prepared to answer your questions and are focused only on your case.  There is never an excuse for not being informed about your case. We want you on on team, and we want to fight for you.

Have you ever handled a work comp claim in Missouri?

It is important to hire a lawyer that has experience in handling workers compensation claims. Once they receive their license, every lawyer can legally handle any type of case in Missouri.  However, that does not mean they know the right questions to ask, the proper investigation methods, or how to present a work comp claim to an administrative law judge. The rules and procedures governing the Missouri Workers Compensation system are different from the civil and criminal courts.  You need a work comp lawyer that knows the law and the techniques necessary to win your case.  The lawyers at the BiState Injury Law Center have handled workers compensation claims across Missouri and have represented injured workers in situations similar to yours.

The simple answer is: As soon as possible.”

Missouri Statute 287.420 requires that an injured worker notify his employer in writing within 30 days of the injury. However, “Actual Notice” to the Employer can nullify the need to put the notice in writing. We have written an article explaining how actual notice works – read more >>

People asking if they have a good work comp claim are essentially wondering if their injury is “compensable.” If a claim is compensable then the Employee is entitled to benefits through work comp, as a result of the injury. If the injury is not compensable, then the Employee does not receive benefits.

In order to have a “compensable claim” under the Missouri Workers Compensation Act you must prove:

  1. That you were an Employee;
  2. Your Employer was required to follow the Missouri Work Comp Act;
  3. You sustained an injury or death;
  4. That arose in the course and scope of your job.

The injury must have a reasonable connection between the injury and the duties of your job and not simply something you would be exposed to outside of work.

Occupational diseases and repetitive motion injuries are also compensable if they are linked to your job.

The Second Injury Fund (SIF) is a governmental group that was created by the Missouri Legislature to help employees with disabilities get jobs. This is done by encouraging employers to hire people that have been previously injured (not necessarily at work). The idea is that the SIF limits the workers compensation liability for an employer because the SIF takes responsibility for any pre-existing disability the worker may have.

The SIF has undergone significant changes over the years, but since January 1, 2014, the SIF will make payments to workers that have become permanently and totally disabled. This can be a tricky calculation, but essentially, if someone is now totally disabled as the result of combining the most recent injury and the pre-existing injuries, then the SIF will pay some benefits to the injured worker, rather than the Employer bearing the entire cost.

The SIF also pays injured workers’ medical benefits (Benefit #1), when their Employer did not carry workers compensation insurance but was subject to the Act.

An acute injury is a one-time accident, where there is little question as to the mechanism of injury – i.e. you know exactly HOW you were hurt, though you may not know the extent of the damage.

For example, falling off a ladder and hurting your back is an acute injury. You know exactly what day you fell off the ladder and there is no question what caused your back to start hurting. You may not know the specific back injury you sustained, but no one questions the WHEN and the HOW

Conversely, a occupational disease or repetitive injury happens either over time, or you cannot pinpoint a precise moment when you were exposed to the substance that caused you harm.

Important Links

Important Links for your Missouri Work Comp Claim