Once an injured worker makes a demand for treatment, Section 287.140 leaves the employer with two choices. It can authorize the care and keep control of which doctor provides it. Or it can refuse or ignore the demand, in which case it may be held responsible for the reasonable and necessary treatment the worker goes and gets on their own.

There is no third option where the employer sits on the request while it “evaluates the claim.” The Missouri Court of Appeals said so plainly in a September 2026 decision in one of our cases. The hearing judge had excused the employer because the surgery happened three weeks after the written demand. The Court of Appeals reversed. Nothing in the statute, and nothing in the cases interpreting it, gives an employer a waiting period.

The case involved a St. Louis carpenter with two herniated discs from years of lifting and bending. His surgeon recommended a microdiscectomy. His attorney sent the employer’s attorney a written demand for surgery on February 14, 2018, and two more demands over the next two weeks. The employer never responded. The surgery went ahead on March 7, followed by a fusion that August. At the hearing, the employer argued it should not have to pay because it was still evaluating the claim, and because the worker had signed a lien agreement with his surgeon. The hearing judge and the Labor and Industrial Relations Commission agreed. The Court of Appeals did not. The full hearing summary and appeal result are on our site.

1. No time to evaluate. The court held that the Commission applied a standard of its own making. The statute gives the employer two options and no grace period. Three weeks of silence was a refusal.
2. Not answering is the same as saying no. The employer never contacted the worker, never offered a doctor, and never explained itself. The court pointed out it could have reasserted control at any point simply by scheduling an appointment with its own doctor.
3. Signing a lien with your surgeon does not mean you refused authorized care. The Commission had inferred that a doctor’s lien proved the worker never intended to accept the employer’s treatment. The court called that speculation. You cannot reject an offer that was never made.

The result: the denial of the medical bills, about $248,000 across the two surgeries, was reversed and sent back to the Commission to be calculated and awarded. The disability award, which the employer had not challenged, stands. The court did not award sanctions, because the employer’s medical examiner had given it some basis to contest whether the injury was work-related. That is a separate question from who pays for treatment.

The rule protects you only if the demand is made the right way and the record shows what the employer did with it. A few practical points:

• Put it in writing. An oral request to a foreman is hard to prove later. In the carpenter’s case, the hearing judge did not credit the worker’s testimony that he had asked for treatment before the written demands, and that part of the award was not disturbed on appeal. The written demands are what won.
• Address it to the right person. The claim adjuster or the employer’s attorney, with a copy of the doctor’s recommendation attached, so there is no argument later about what was requested.
• Keep every piece of correspondence, including the silence. The dates on which the employer did not answer became the case.
• Talk to an attorney before surgery is scheduled, not after. The demand is the hinge. Done properly, it shifts the cost of your treatment to the employer. Done loosely, or not at all, it leaves you paying. A second opinion before you settle covers the same ground.
• Expect the insurer to raise causation anyway. The employer in this case still fought over whether years of lifting caused the disc injuries. That required medical experts and a hearing. It is why we prepare every case as if it will be tried.

This is one of the clearest statements of the demand rule we have seen from a Missouri appellate court, and it came from a case that went through a hearing, a Commission review, and an appeal to get there. If your employer or its insurer has stopped responding to a request for treatment, that silence may be worth more than you think. Protecting future medical care after the surgery is the next question, and it belongs on the same timeline.

In 2025 alone, our firm spent over $700,000 on expert witnesses. Cases like this one are why. When an Insurer pays nothing and explains nothing, the record has to prove everything.

Our firm handled roughly 1 in 4 of recent workers’ compensation trials at the St. Louis Division of Workers’ Compensation, out of hundreds of attorneys representing Missouri workers. Insurers know which firms will actually try a case, and it changes how they negotiate.

A total denial is not the end of a claim. It is the beginning of the record a trial firm builds.

Can I get my own surgery if workers’ comp won’t approve it in Missouri?

You can always choose your own doctor at your own expense. The question is whether the employer ends up paying. If you made a demand for treatment and the employer refused or did not respond, and the surgery is later found reasonable and necessary for your work injury, the employer may be ordered to pay for it. If you skipped the demand and simply went to your own surgeon, the employer often has a defense.

How long does my employer have to respond to a request for treatment?

Missouri’s statute does not give the employer a set number of days to think it over. A 2026 Court of Appeals decision held that the Commission could not invent a reasonable evaluation period. The employer’s options are to authorize the care or to risk paying for the care you obtain on your own.

Does a doctor’s lien hurt my workers’ comp case?

A lien agreement lets your surgeon treat you now and get paid from any recovery later. The Court of Appeals rejected the argument that signing one proves you would have refused the employer’s doctor. On its own it is not evidence against you. What matters is whether the employer ever offered authorized treatment after your demand.

Should I send the demand myself or have a lawyer do it?

Either can work, but the demand has to be in writing, specific about the treatment recommended, and sent to the adjuster or the employer’s attorney so there is a record. We send these demands for our clients with the doctor’s recommendation attached and track the response dates, because those dates may decide who pays. Every case is different; results depend on the facts.