|SB 0032||Revises workers' compensation law|
|Last Action:||05/15/95 - S Inf Calendar S Bills for Perfection w/pt. of order (pending)|
|Effective Date:||August 28, 1995|
SCS/SB 32 - This act makes the following changes in Missouri Workers' Compensation Law:
1. It narrows the definition of injury by requiring work to be the "major" factor as the cause of the injury for the injury to be compensable. To be the major factor would mean that the work comprised at least 51% of all the factors combined that caused the injury. Ordinary and gradual deterioration of the body caused by aging or normal day-to-day activities are not directly caused by the employment. Compensability is not allowable for aggravation of a preexisting condition except to the extent the work-related injury increases disability.
2. Currently, under the Workers' Compensation Law, any reference to the employer also includes his insurer. Under this act it would also include a group self-insurer.
3. Under current law, contractors are secondarily liable for the employees of subcontractors if the subcontractor had not insured the employee. The contractor, or secondary employer, is not liable if he maintains on file copies of current certificates of insurance from his subcontractors. A certificate of insurance shall provide that the holder be notified ten days prior to its cancellation or revocation.
4. The injured worker, the last employer and any prior employers of the injured worker may join any other prior employer to determine if there was repetitive motion exposure and to determine where the liability lies. If the injured worker does not cooperate in testifying to the facts surrounding a repetitive motion injury, the administrative law judge shall suspend all rights to workers' compensation benefits for that injured worker.
5. Workers' compensation benefits of an injured worker will be reduced by the weekly equivalent amount of the total amount that worker receives in Social Security benefits or other retirement or pension system benefits.
6. The exclusive remedy doctrine of the Workers' Compensation System is expanded to exempt co-employees, as well as the employer, from tort liability.
7. The act clarifies that safety measures adopted by an employer pursuant to a safety plan adopted by the insurer, if not obeyed or followed by an employee, shall result in a 15% reduction in benefits if such failure to obey the safety requirements results in an injury.
8. The act bars compensation if the injury was a result of horseplay.
9. The penalty for filing a fraudulent Workers' Compensation claim by a provider is a Class A misdemeanor and subject to a fine of $10,000 or two times the value of the fraud, whichever is greater.
10. If the insurer refuses to honor chiropractic care authorized by the employer, the employee may continue such treatment and the insurer will be responsible for no more than $750 of such care.
11. Managed care organizations certified by the Department of Insurance before August 28, 1993 must obtain recertification under criteria set by the Department.
12. Permanent disability assessments must be based upon objective medical evidence.
13. An employer may initiate benefit payments before a claim is filed but a voluntary payment is not an admission of the validity of the claim.
14. Temporary total, temporary partial or permanent total disability benefits cannot be paid if the injured worker is receiving unemployment compensation benefits or is incarcerated in a penal institution.
15. A provision enacted in 1993 required an employer who terminated benefits to notify the injured worker of such termination and the reasons for such termination and allowed the injured worker to request a hearing on the termination. This provision is repealed in this act.
16. An injured person shall be examined by a vocational expert to determine whether he can be rehabilitated. The vocational expert need not be a physician and his testimony shall be admissible. The testimony of a physician or a vocational expert shall be admissible as in civil cases. Costs of depositions shall be borne proportionally by the parties based on the total number of pages. The cost of expert witnesses should be paid by the party incurring costs and shall act as a lien against the party.
17. When an injured worker with multiple employment is entitled to temporary total disability benefits, the employer for whom the employee was injured is liable for compensation only to the extent that the employer would have to pay if he was the sole employer of the injured worker. The difference between that employer's liability and the full amount of compensation due shall be paid by the Second Injury Fund.
18. The act allows employers wishing to self-insure their liability to invest in U.S. or Missouri general obligation bonds to secure their liability.
19. A provision was enacted in 1993 that changed the injury reporting requirements for injuries costing less than $500 in medical costs. This act repeals that provision and puts the reporting requirement for those injuries back to what they were prior to 1993.
20. Employers may appeal a code classification to the Board of Mediation and if the Board changes the classification, the advisory organization shall be liable to the employer for an amount equal to two times the difference between the two rates for the period in which the higher rate was in effect.
21. Administrative law judges are prohibited from referring either party to a claim to any attorney or physician except in cases where the judge appoints an impartial physician to examine the injured worker to determine the extent of liability. If a judge should make a prohibited referral, the Division shall recommend to the Governor termination of the judge. This prohibition also applies to all employees of the Division of Workers' Compensation. The Division shall not refuse to approve a compromise settlement.
22. Administrative law judges are required to hear all evidence in a disputed claim within 30 days of the commencement of the hearing and issue a written award within 60 days after hearing the last of the evidence.
23. After the effective date of the act any claim for compensation for which no hearing has been conducted for four years after the claim for compensation was acknowledged by the Division shall be dismissed.
24. Any injured worker who fails to keep a regularly scheduled medical appointment for treatment related to a claim of injury shall reimburse the physician for an appropriate amount for the physician's time. If the employer or insurer pays for the unkept appointment then the injured worker must reimburse the employer or insurer out of any settlement proceeds.
25. Current Workers' Compensation Law requires that the provisions of that law be construed liberally. This act changes that to require that the provisions of the law be strictly construed.
26. Any injured worker entitled to weekly compensation shall report to the insurer all earnings at least once every three months. Any misinformation given by or information withheld by the injured worker subjects him to the fraud provisions of the Workers' Compensation Law.
27. The act limits attorney's fees for representing an injured worker to percentages applied to various levels of compensation awarded. Fees shall be established by contract and the contract is subject to review for reasonableness by the Director of the Division of Workers' Compensation. To determine reasonableness, the Director shall consider the time, labor and skill involved, the fee customarily charged for similar work, and the time constraints involved. Attorney fees cannot be paid for medical expenses or for vocational rehabilitation, and fees cannot be paid for temporary total disability unless the employer terminates compensation and the attorney obtains additional compensation. A fee cannot exceed $250 or a reasonable amount established by the Director if there is no dispute on the material facts, or if the final settlement does not exceed an initial offer made prior to representation by an attorney. The act limits the percentage of the attorney fee when the settlement exceeds the initial offer. Disputes over attorney fees shall be resolved by the Director.
28. By January 1, 1996, the Division of Workers'
Compensation must develop protocols for reasonable and
appropriate treatment of an injured worker by a medical provider.
In addition, the Division shall also develop a utilization review
procedure for medical treatment of an injured worker.