Can your employer refuse your Missouri workers’ compensation claim?
If you have a difficult employer or boss fighting your claim, document your conversations by writing a short note to confirm what everyone said. Date it, sign it, and give it to your bosses. Keep copies for your attorney.
It’s great to hear a client say that his/her supervisor filled out an incident report and provided the name of a physician for medical care. But that is not always the case. Clients have informed us about situations where supervisors have refused to fill out an incident report because the injury was not severe or because you didn’t know the exact date/time your pain started, despite your explaining that the repetitive nature of your job causes your pain every day.
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I don't like insurance companies and only represent the injured. I am not a large advertising law firm that settles cheap to meet monthly quotas. We fight hard for every client. The compensation we obtain for the injured is both federal and state tax free. We never ask our clients for a penny as all cases are handled on a contingency fee.
James Hoffmann
314 361 4300
[email protected]
FYI. There are a lot of TV ads and billboards claiming "bigger is better." That is not true. Some of those firms are from out of state and simply hired a few attorneys here in Missouri. And, always remember, quality over quantity. One good trial attorney is way better that 100 average attorneys who only settle cases to meet monthly quotas to pay the millions in advertising fees.
Law Office of James M Hoffmann LLC
Jim Hoffmann
2001 S. Hanley, suite 325
St. Louis, MO 63144
314 361 4300
[email protected]
God bless, love and hugs
Jim
Fighting for the injured.
James Hoffmann
Your Missouri car accident and workers comp lawyer
314 361 4300
[email protected]
Proud to fight for the injured.
Law Office of James M Hoffmann
2001 S. Hanley suite 325
St. Louis, MO 63144
314 361 4300
[email protected]
James Hoffmann
St. Louis, Mo work comp and car accident lawyer
314 361 4300
Law Office of James M Hoffmann
314 361 4300
[email protected]
Law Office of James M Hoffmann
2001 S. Hanley, suite 325
St. Louis, MO 63144
314 361 4300
[email protected]
Your Missouri car accident and workers compensation attorney
Glad to help. All cases on a contingency fee which means we will never ask a client for a penny.
Law Office of James M Hoffmann
James Hoffmann
Remy Hoffmann
Missouri personal injury attorneys
314 361 4300
[email protected]
The LIRC in Nouraie v. MO. Baptist Medical Center et al, Injury No.: 10-111746, March 13, 2013, sanctioned the employer for refusing medical care in connection with a repetitive use claim. The Employer obtained an expert long after the wrongful denial of benefits. This did not justify the prior wrongful denial. The LIRC explained:
“In any event, whether an employer has sent a worker for a medical examination prior to denying a claim is a factor for our consideration in determining whether an employer had reasonable grounds for denying a claim.”
The LIRC in Nouraie also explained:
“The courts have instructed us we are only to award such costs “where the issue is clear and the offense egregious.” Landman v. Ice Cream Specialties, Inc., 107 S.W.3d 240, 250-251 (Mo. 2003). We think it is clear that employers have an obligation to investigate the circumstances giving rise to alleged work injuries before denying benefits. And where the worker is available to discuss the injury, we think any reasonable employer conducting an investigation designed to determine whether an injury is work-related would discuss the alleged injury with the worker. In the instant case, Ms. Bequette, as employer's agent, denied evaluation, treatment and benefits to employee without even discussing employee's alleged back condition with employee. We think employer's act of denying workers' compensation benefits to employee before even discussing the alleged injury with employee constituted an egregious offense. Based upon the forgoing, we find employer defended this claim at the outset without reasonable ground.”
Merry Christmas.
James Hoffmann, Missouri work comp and auto accident attorney
314 361 4300
[email protected]
Claimant, a full-time carpenter for Employer, developed low back pain in September of 2017 making cabinets and displays for the Employer. Claimant’s job is physically demanding. Cabinets and displays can range from 60 to 500 lbs. Claimant job duties include lifting displays weighing up to 500 hundred pounds during the assembly process. Carts, each with 100 lbs of materials, are brought to Claimant who must lift the materials from each cart and assemble same. In October 2017, Claimant’s job duties caused his low back soreness to become severe pain with numbness down his right leg. At the final hearing, the Employer/Insurer produced no evidence of non-work activities that could have caused, or did cause, Claimant’s low back pain.
When Claimant’s low back pain became severe in Oct. 2017, he sought treatment with a chiropractor, Dr. Lynch, on 10/17/20217. Claimant then, on 10/23/2017, reported to Employer a repetitive use work injury to his low back. He went sent to Concentra by the Employer but left due to delays in providing immediate treatment as he had severe pain and radiculopathy. He went immediately to an urgent care and returned to work with a light duty slip for 6 weeks for which the Employer complied.
Despite asking the Employer for additional treatment during the next few months, none was offered. He kept the Employer informed of the treatment he was receiving on his own. IN December 2017, Claimant contacted attorney James Hoffmann who instructed Claimant to hand deliver a letter to the Employer making a written demand for treatment. Claimant delivered the letter in December 2017. At the hearing, Employer presented no evidence that it disputed the contents of the letter.
Immediately after receiving the letter, the Employer contacted the Insurer which then sent medical authorizations to Claimant who signed and immediately returned same to the Insurer. The Insurer then obtained a statement from Claimant in Dec. 2017 where Claimant informed the adjuster of a repetitive use low back injury at work and need for treatment.
After 6 weeks of light duty, Employer requested another light duty slip which Claimant provided.
Claimant continued to work light duty until Feb. 15, 2018, when Employer informed Claimant there was no more light duty and sent Claimant home. In the meantime, neither the Employer nor the Insurer offered treatment. The Employer’s attorney was aware of Claimant’s treatment as he was sending copies of Claimant’s medical records to Claimant’s attorney received via the authorizations signed by Claimant.
In Feb. 2018, Claimant’s attorney obtained a medical report from Dr. Armond Levy who related lumbar disc herniations and the necessity of surgery to Claimant’s work for Employer. Several demands were sent IN Feb. 2018 to the Employer for the surgery recommended by Dr. Levy and for TTD. At the hearing, Employer presented no evidence of any response to the demands for treatment and TTD made by Claimant’s attorney in February 2018.
Claimant then underwent 2 surgeries on his own for his low back, the first being in March 2018 and the second in August 2018. During that time, no TTD or treatment was offered. When Claimant returned to work in November 2018, after recovering from the second surgery, he was informed by the Employer that he was fired.
The Employer eventually sent Claimant to a physician, Dr. Bernardi, in November 2018, who is of the opinion that a person cannot suffer a repetitive use herniated disc. It is his opinion that herniated discs can only acute, and that any degenerative changes in the low back are genetic and cannot be caused by repetitive use occupations. In other words, Employer sent Claimant to a doctor who disagrees with Missouri law which specifically recognizes and accepts repetitive use injuries. Claimant had zero chance of a favorable opinion from Dr. Bernardi
This is the lawyer you want to hire! Just read the reviews. It is all true. Incredible! He will get you every dollar of lost wages, get you every ounce of medical treatment, and get you the highest possible award from the Division of Workers Compensation.
Law Office of James M. Hoffmann
2001 S. Hanley, suite 325
St. Louis, MO 63144
314 361 4300
[email protected]
Your Missouri workers comp and car accident attorney.
So, why did the doctor shave areas in the knee that were not symptomatic? Look at the bill: a meniscus surgery is onl $3000; but for every other area he "cleaned up", he gets $3000 for each area.
Law Office of James Hoffmann
314 361 4300
[email protected]
Your Missouri workers comp and car accident lawyer
James Hoffmann
314 361 4300
[email protected]
Law Office of James Hoffmann
314 361 4300
[email protected]
James Hoffmann
attorney
St. Louis workers comp and car accident lawyer
314 361 4300
[email protected]
I have represented numerous first responders in Missouri workers comp and car accidents. Heavy ambulance doors have caused severe post concussion syndrome and TBI's. Lifting victims has caused herniated discs requiring cervical and lumbar fusion surgeries. Glad to help our hero's.
Law Office of James Hoffmann
2001 S. Hanley, Suite 325
St. Louis, MO 63144
314 361 4300
[email protected]
Law Office of James Hoffmann
St. Louis personal injury and work comp lawyer.
314 361 4300
[email protected]
Per Tillotson v. St. Joseph Med. Ctr., 347 S.W. 3d 511 (Mo. App. W.D. 2011) to determine need for treatment, surgery, and treatment after surgery. Treatment need only be reasonably required to cure and relieve the effects of the injury. Id. Section 287.140.1 RSMo states in pertinent part that the Employer shall provide such medical as may “reasonably be required.
To be entitled to future medical care the employee must establish that there is a reasonable probability that he will need future medical care. Forshee v. Landmark Exc. & Equip., 165 S.W. 3d 533 (Mo.App. E.D. 2005) An [Employee] does not have to provide evidence of specific medical treatments or procedures which will be necessary in the future in order to receive an award of future medical care. See Chatmon v. St. Charles County Ambulance, 55 S.W.3d 451, 459 (Mo.App. E.D. 2001).
Employee has already satisfied the burden of proving a compensable injury. Here, defense's authorized Dr. Spears on 4/26/2010 opined "if she doesn't get improvement in her radicular pain, then the next step is going to be a microscopic transforaminal lumbar interbody fusion to remove the foraminal stenosis." He went on to state the January 2010 incident was a "fall (that) aggravated significantly a pre-existing condition". This is enough under Tillotson, Forshee, and, Chatmon (supra) to award further treatment.
Please also see Maness v. City of De Soto, 421 S.W.3d 532 (Mo. App. 2014). The court rejects Employer's contention that the mere existence of degenerative disc disease in the cervical spine and neck symptoms prior to the work accident requires a determination that Claimant's injury is not compensable.
See also the following in support:
If the evidence establishes that an accident caused a
disability or aggravated a preexisting condition or infirmity of an employee,
which produces a condition that would not have resulted in a normal, healthy
individual, an award is authorized. Fogelsong v. Banquet Foods Corp. 526
S.W.2d 886 (Mo. App., K.C.D. 1975)
An aggravation of an existing infirmity caused by an accident or occupational
exposure arising out of and in the course of employment is compensable under
Chapter 287, RSMo, even if the particular accident (occupational injury) would
not have produced such result in a normal and healthy individual. Mashburn v.
Chevrolet-Kansas City Division, General Motors Corp., 397 S.W.2d 23 (Mo.
App., K.C.D. 1965)
Law Office of James M. Hoffmann
2001 S. Hanley
St. Louis, MO 63144
314 361 4300
[email protected]
James M Hoffmann, attorney
2001 S. Hanley, suite 325
St. Louis, MO 63144
314 361 4300
[email protected]
I see this all the time with neck injuries, low back injuries, disc herniations, rotator cuff tears, meniscus tears: doctors do surgery under workmans comp and then blame ongoing pain on a made up pre-existing condition.
James Hoffmann
Your Missouri workers comp and car accident attorney
314 361 4300
[email protected]
Law Office of James M. Hoffmann
St. Louis, MO car accident and workers compensation lawyer
314 361 4300
Glad to fight for the injured worker in Missouri.
Law Office of James M. Hoffmann
St. Louis, Missouri workers comp, car accident, injury attorney.
314 361 4300
[email protected]
These reviews are correct. This attorney is incredible. He knows workmans compensation, fights for denied treatment and wages, and gets your on the job injury rated by the best doctors. I will be using him from here on our great experience.
It does not take a large law firm to fight an insurance company. It takes a good lawyer. There's a reason why injured insurance adjusters and injured insurance doctors call me to represent them. They know I fight and will not back down.
Law Office of James M. Hoffmann
St. Louis, MO workers comp and auto accident attorney
314 361 4300
[email protected]
If the doctor says that you suffered a compensable injury by accident, then the legal standard for determining employer’s obligation to afford medical care under the Missouri workmans comp law requires the employer to provide treatment reasonably required to cure and relieve the effects of the injury. The prevailing factor standard no longer applies.
Further, it is immaterial that treatment may have been required because of the complication of a pre-existing condition or that treatment will benefit both the compensable injury and a pre-existing condition.
The fact that medical treatment may also benefit a non-compensable earlier injury or condition is irrelevant.
Whether or not claimant may have needed future treatment even if the injury did not occur is irrelevant to the analysis of whether future medical care flows from the injury actually occurred. With respect to permanent partial disability it is immaterial that the employee had a prior condition as an employee is entitled to compensation for disability rising out of the medical treatment reasonably required to treat the injury.
With respect to future medical benefits, the claimant need only show reasonable probability because of the work-related injury, future medical treatment will be required. A claimant need not show evidence of the specific nature of the treatment required.
In other words, prior conditions, such as arthritis, is irrelevant if the doctor says you suffered a work injury. The employer/insurer must treat both.
James Hoffmann
St. Louis, Missouri workers comp and car accident lawyer.
314 361 4300
[email protected]
The Law Office of James M Hoffmann was referred to me from a previous client, that was extremely impressed, with his service and outcome.
I met with Jim Hoffmann to discuss a car accident. Three cars were involved, my car was totaled, and I was seriously injured. After meeting with Jim the very first time, I immediately felt comfortable, and knew that he would have my back, and would fight for me.
Throughout my journey, I dealt with a lot of pain and several issues that lasted for years. During this time I had to contact Jim and Jamie (Jim’s wonderful assistant) many times. Every time I sent an email with questions, I received feedback extremely quickly!
I feel Jim negotiated a great settlement for me!
The Law Office of James Hoffman will be the first place I contact if I ever need his help again!
Suzanne Charles
James Hoffmann
St. Louis, MO auto accident and workers compensation lawyer
314 361 4300
Glad to fight for the injured Missouri worker and those injured on car accidents.
James Hoffmann
Missouri personal injury attorney
314 361 4300
[email protected],
Jim Hoffmann
Missouri workers compensation and car accident attorney
314 361 4300
St. Louis, MO
Compensation? Get this lawyer. Simply better than all the rest.
James Hoffmann
314 361 4300
[email protected]
James Hoffmann
Missouri workers compensation and auto accident lawyer
314 361 4300
[email protected]
Writing a proposed award for an upcoming work comp trial for an injured Missouri worker. L4-S1 lumbar fusion with plates and screws. Pursuing permanent and total disability plus denied medical. Here is the case law on denied medical in MO workers compensation:
The employer is held liable for medical treatment procured by the employee only when the employer has notice that the employee needs treatment, or a demand is made on the employer to furnish medical treatment, and the employer refuses or fails to provide the needed treatment. Hawkins v. Emerson Electric Co., 676 S.W.2d 872, 880 (Mo.App.1984).
The courts have consistently held that an award of past medical expenses is supported when the employee provides (1) the bills themselves; (2) the medical record reflecting the treatment giving rise to the bill; and (3) testimony identifying the bills. Martin v. Mid-America Farm Lines, Inc., 769 S.W.2d 105, 111-12 (Mo. 1989).
The pertinent case law requires employee to prove that the past medical expenses were “due” to support an award of interest. McCormack v. Stewart Enters., 956 S.W.2d 310, 314 (Mo. App. 1997). As explained in McCormack, this means employee must show that he actually paid the bills, or received demands that he pay interest on the bills, or suffered some other loss, such as a doctor refusing to provide additional treatment until employee paid his bill. Id.
Law Office of James M. Hoffmann
314 361 4300
James Hoffmann, attorney
314 361 4300
[email protected]
Gold bless
James Hoffmann, attorney
314 361 4300
Law Office of James M Hoffmann
St. louis, MO injury attorney
314 361 4300
Many employees feel intimidated by the supervisor and continue working in pain. Others believe the supervisor who said you don’t have a claim if you don’t know the exact date and time. Then you seek treatment from your doctor, but the receptionist won’t schedule an appointment because you said it is a workers’ compensation injury. Or, you seek treatment from your doctor and tell him that it is not a work comp injury (because you believed your supervisor).
This Works:
To protect yourself and your claim, you can write your claim even though your employer refused to do so. Type a letter or write a note. Confirm your conversation with your supervisor: “Yesterday, on December 10, 2012, I reported a work injury. You refused to give me an incident report. I asked for medical care, and you refused it, too. As I told you, I hurt my back lifting box after box, day after day. You said I didn’t have a workers’ compensation claim because I couldn’t tell you my injury’s exact date and time. I have not hurt my back outside of work. All of my back pain started at work lifting boxes. I told you my back hurts from lifting boxes and asked for breaks. Again, please send me to a doctor.” Give a copy to his boss and keep a copy yourself. Missouri Workers’ Compensation strictly forbids an employer to retaliate in any way against an employee for pursuing a work comp claim. If you think your supervisor is mad at you for pursuing your claim, type another note: “John, I have always been a hard worker. We have gotten along for years. I have a great record here. Recently, after filing my work comp claim, you and the other bosses have been disrespectfully treating me. I feel harassed and put down. I believe this is due to my work comp claim and ask that you stop this immediately.” Keep a copy and deliver copies to all of the bosses.
Some injuries can be traumatic, and it is easy to know the exact date and time the incident occurred. Other injuries/pain are caused over time by repetitive work duties: daily sore back from lifting boxes, sore shoulder from overhead work, and knee pain from constant squatting. Both types of injuries are valid claims under Missouri Workers Compensation law. Missouri Work Comp law mandates the employer to file a report of injury with the Division of Workers Compensation in Jefferson City for every injured employee. For injuries or pain caused by repetitive work conditions, no one knows the exact date. Missouri only requires that you provide the month and year: for example, you’ve been seeing your doctor for 6 months for a sore back. You’ve complained that carrying concrete and tools at work is hard on your back. Finally, in December of 2011, your doctor said for the first time: your work is wearing out your back and causing you pain; yes, you have degenerative changes in your back, but your job is making it worse and causing the degenerative changes to be symptomatic. In that scenario, your claim would be for a repetitive use back injury with a date of injury: December 2011.
Appealing a Denied Work Comp Claim in Missouri
In Missouri, all employers are legally bound to have workers’ compensation insurance and pay for valid claims made by any employee injured at work. However, it is not uncommon for employers to deny workers’ compensation benefits as it increases their premiums.
Injured workers who have filed a claim and have been denied compensation should first seek to understand and investigate why their claim was denied.
If a clerical error on the part of the insurance company or the employer has led to a denial of a compensation and benefits claim, the claimant can reverse the decision by making a simple phone call.
An injured worker should consult a St. Louis workers’ compensation lawyer for any other reason for denial. Legal assistance is best for certain legal procedures and processes, such as filing an appeal.
Filing an Appeal
First, the claimant must understand the process of filing an appeal. The procedure is as follows in Missouri:
- A written application requesting a review of the claim should be filed with the Missouri Labor Commission within 20 days of receiving the notification of denial of the claim.
- Suppose the Missouri Labor Commission denies the application. In that case, the claimant should send a notice of appeal to the Missouri Court of Appeals within 30 days of receiving the denial notification from the Labor Commission.
- The appeal should provide proof to counter the reason for denying the claim. This essentially means that if the claim has been denied because the employer claims that the injury did not occur at work, evidence such as videos from surveillance cameras, original accident reports, and even statements from colleagues can work as evidence. Similarly, if the insurance company denies a claim because the injury is not serious enough, proof of medical reports, test results, photographs, doctors’ statements, etc., are valid proof of evidence.
The Law Office of James M. Hoffmann
An experienced workers’ compensation lawyer should always gather evidence and conduct interviews with employers, co-workers, and witnesses to ensure that correct accounts are provided and documentation is done accurately to ensure a just and fair settlement.
Our St. Louis Workers’ Compensation Attorneys can provide the information necessary to choose the best medical care, benefits, and income. Do not let the carrier deny you benefits. Call us at (314) 361-4300 or fill out our online contact form to request a free consultation.