If your Missouri workers’ compensation benefits have been denied or disputed, it does not necessarily mean your case is over. The issue may involve whether your injury is work-related, when it was reported, medical treatment, lost-wage benefits or another part of the claim. What you do next depends on what has actually been denied or disputed.
Getting hurt at work is difficult enough. Finding out that the medical treatment, wage benefits or workers’ compensation claim you expected to rely on is being disputed can make an already uncertain situation much harder.
And sometimes the first problem is simply understanding what has happened.
You may have been told your “claim was denied” when treatment has not been authorized. Your checks may have stopped. Your employer or its insurer may dispute whether your injury is work-related. Or you may be much further into the process and have received a decision from an administrative law judge.
Those are not necessarily the same thing — and they do not necessarily have the same next step.
Here is what Missouri workers should know about a disputed workers’ compensation claim, why problems can arise and what options may be available when benefits are not being provided.
What Does “Denied” Actually Mean in a Missouri Workers’ Comp Case?
Before asking why your workers’ comp claim was denied, it helps to identify what has actually been denied or disputed.
For example:
- The employer or insurer may dispute whether your injury is covered by workers’ compensation.
- Medical treatment may not have been authorized.
- A particular test, procedure, specialist referral or surgery may be disputed.
- Temporary disability payments may not have started or may have stopped.
- There may be disagreement about whether you can return to work.
- Some benefits may be disputed while others are being provided.
- A formal Claim for Compensation may have been filed and the parties may be disputing issues within that proceeding.
- An administrative law judge may already have issued an award.
This distinction matters.
A workplace injury report, a dispute with the employer or insurer, a formal Claim for Compensation and an administrative law judge’s award can represent different stages of the Missouri workers’ compensation process.
So the first question after hearing “denied” should often be:
What, exactly, is being disputed — and where am I in the process?
Why Might a Missouri Workers’ Comp Claim or Benefit Be Disputed?
There is no single reason a Missouri workers’ compensation case becomes disputed. The facts, medical evidence and procedural history of each case matter.
But there are several issues worth looking at.
The Injury Wasn’t Reported Promptly
Missouri law generally requires written notice of the time, place and nature of an accidental workplace injury, along with the injured person’s name and address, to be given to the employer no later than 30 days after the accident.
However, Missouri law also provides an exception where the employer was not prejudiced by the failure to receive that notice.
For occupational disease or repetitive-trauma claims, the statute addresses notice within 30 days after diagnosis, subject to its provisions.
Missouri Revised Statutes §287.420 — Written Notice of Injury
The practical lesson is simple: report a workplace injury as soon as possible and create a record of the report.
When possible, keep track of when the injury occurred, when it was reported and who was notified.
There Is a Dispute About Whether the Injury Is Work-Related
Sometimes the disagreement goes to the heart of the claim: whether the injury is compensable under Missouri workers’ compensation law.
Questions can arise about how an accident occurred, what the worker was doing at the time, whether work caused the injury or whether another condition contributed to the symptoms being reported.
This is one reason the details surrounding the injury matter.
Accident reports, medical records, witness information and the worker’s account of what happened can all become important when the circumstances of an injury are disputed.
The Medical Treatment Wasn’t Authorized
This one can catch injured workers by surprise.
Under Missouri Revised Statutes §287.140, the employer must provide medical treatment reasonably required to cure and relieve the effects of a compensable injury. Missouri law also generally gives the employer the right to select the treating healthcare provider.
An injured employee can choose another physician, but generally does so at their own expense.
Missouri Revised Statutes §287.140 — Medical Treatment
So: “I was injured at work, therefore workers’ comp will pay any doctor I choose” is not a safe assumption.
If you need treatment, additional testing, a specialist or another form of care, find out whether it has been authorized before assuming the bill will be covered.
There Is a Disagreement About Whether You Can Work
Lost-wage benefits can also become a source of dispute.
Questions may arise about whether an injured worker can return to their regular job, whether work restrictions apply, whether modified work is available and what benefits may be payable while the worker is recovering.
Medical records and work restrictions can therefore become particularly important when wage benefits are disputed.
The Facts or Evidence Are Disputed
Workers’ compensation cases do not always begin with a perfectly complete record.
There may be questions about:
- How the injury occurred
- When symptoms began
- When the injury was reported
- What the employer was told
- What the medical records show
- Whether witnesses saw what happened
- What work restrictions were imposed
- Whether the worker can return to work
- Whether treatment was authorized
A discrepancy does not automatically mean a worker has no claim. It may mean the facts need to be investigated and supported with the available evidence.
What Should I Do if My Missouri Workers’ Comp Benefits Are Denied or Disputed?
Start with the problem in front of you rather than assuming the entire case is over.
1. Find Out Exactly What Is Being Disputed
Ask specific questions.
Is the insurer refusing to authorize treatment?
Are medical bills unpaid?
Have temporary disability checks stopped?
Is there a dispute over whether the accident happened at work?
Is the disagreement about one particular procedure or benefit?
Has a formal Claim for Compensation already been filed?
Has an administrative law judge issued an award?
The word “denied” can hide a lot of important information.
Get copies of relevant correspondence and, where possible, identify the stated reason for the dispute.
2. Keep the Paper Trail
Save documents relating to your injury and claim, including where applicable:
- Accident or incident reports
- Medical records
- Work restrictions
- Emails or messages with your employer
- Correspondence from the insurer
- Wage records
- Benefit-payment information
- Names and contact information for witnesses
- Letters explaining disputed or denied benefits
Do not alter records or try to make the evidence tell a cleaner story.
Keep what exists.
A workers’ compensation dispute may eventually depend on reconstructing what happened weeks or months earlier. Records created along the way can help establish that timeline.
3. Check That Your Injury Was Reported
Reporting an injury to your employer and filing a formal Claim for Compensation are not the same thing.
If you are unsure whether the required notice was given, check your records and any accident or incident report completed at work.
Remember that Missouri’s notice requirement and the deadline for filing a formal workers’ compensation claim are separate timing issues.
4. Check Whether Your Medical Treatment Is Authorized
If the problem involves medical care, establish who authorized the treatment and what treatment is currently being approved.
Missouri law requires an employer to provide qualifying medical treatment reasonably required to cure and relieve the effects of the injury and generally gives the employer the right to select the treating provider. An employee who chooses their own physician generally does so at their own expense.
If treatment is being refused or disputed, establish exactly what has and has not been authorized before deciding what to do next.
5. Establish What Needs to Happen Next
Some disputes may involve communication with the employer or insurer. Others may require a formal Claim for Compensation or further proceedings within an existing claim.
That is why identifying where the case actually stands matters before treating every disputed benefit as though it were the same kind of “denial.”
What Are Your Options if the Workers’ Comp Dispute Isn’t Resolved?
Missouri’s workers’ compensation system provides procedures for resolving disputed claims.
Which procedure applies depends on the status and circumstances of the case.
A Dispute May Be Addressed Before a Final Decision
Some disagreements arise while the claim is still developing — for example, disputes over treatment, wage benefits or whether an injury is compensable.
Depending on the stage of the case, the parties may attempt to resolve the disagreement or the disputed issue may need to proceed through Missouri’s formal workers’ compensation process.
Filing a Claim for Compensation
A formal Claim for Compensation is different from simply reporting the workplace injury to an employer.
Filing requirements and deadlines matter because Missouri law places a time limit on proceedings for workers’ compensation.
St. Louis Workers’ Compensation Lawyer
How Long Do You Have to File a Missouri Workers’ Comp Claim?
This is where two timing requirements are easily confused.
Reporting your injury and filing a workers’ compensation claim are different things.
Notice of the Injury
Missouri Revised Statutes §287.420 generally requires written notice to the employer no later than 30 days after an accidental injury, subject to the statute’s exceptions.
Filing the Claim
Missouri Revised Statutes §287.430 generally provides that a workers’ compensation claim must be filed within two years after the injury or death, or the last payment made under Missouri workers’ compensation law on account of the injury or death.
If the employer does not file the required Report of Injury, the statute provides a three-year filing period.
Missouri Revised Statutes §287.430 — Claim Filing Deadline
So, in simple terms:
Notice to the employer:
Generally within 30 days, subject to statutory exceptions.
Formal workers’ compensation claim:
Generally within two years.
Employer did not file the required Report of Injury:
The filing period may extend to three years.
These are not interchangeable deadlines.
The statute also makes clear that filing another form, report, receipt or agreement instead of a Claim for Compensation does not stop the applicable limitation period from running.
If you are approaching a deadline, do not assume that an unresolved conversation with an employer or insurer has preserved your right to file.
What if an Administrative Law Judge Has Already Decided Your Case?
Now we are talking about an actual review of an award.
Under Missouri Revised Statutes §287.480, if an application for review is made to the Labor and Industrial Relations Commission within 20 days from the date of the award, the Commission can review the matter as provided by Missouri law.
Missouri Revised Statutes §287.480 Application for Review
This is why we don’t want to casually tell every worker whose benefits have been disputed to “appeal the denial.”
There is a significant procedural difference between:
The employer or insurer is disputing a benefit
and
An administrative law judge has issued an award in my case.
If an administrative law judge has issued an award and you disagree with it, the applicable review deadline deserves immediate attention.
What We’ve Learned When Workers Hear “Your Claim Is Denied”
When someone tells us their workers’ compensation claim has been denied, the first question isn’t necessarily:
Why did they deny it?
It is:
What exactly happened?
Was treatment refused?
Did disability checks stop?
Is the employer or insurer disputing whether the injury is work-related?
Was the injury reported?
Did a doctor release the worker back to work?
Has a formal Claim for Compensation been filed?
Has an administrative law judge already issued an award?
Those questions matter because “denied” can describe very different points in a Missouri workers’ compensation case.
And when you’re already dealing with an injury, missing work or worrying about medical bills, it is easy for all of those processes to blur together.
You do not need to understand every piece of workers’ compensation procedure before asking for help.
You do need to know that a disputed benefit is not necessarily the same thing as the end of your claim.
Do I Need a Lawyer if My Missouri Workers’ Comp Claim Is Denied?
Not every workers’ compensation question requires an attorney.
But legal advice may become particularly useful when:
- The employer or insurer disputes that your injury is work-related.
- Necessary medical treatment is being disputed.
- Temporary disability benefits have been denied or stopped.
- There is disagreement about your ability to return to work.
- Your injuries may result in permanent disability.
- A formal Claim for Compensation needs to be filed.
- You are unsure which deadline applies.
- Your case is moving toward a hearing.
- An administrative law judge has issued an award you disagree with.
A workers’ compensation lawyer can review where the case actually stands, identify the issue being disputed and explain what options may be available at that stage.
St. Louis Workers’ Compensation Lawyer
Frequently Asked Questions About Denied Missouri Workers’ Comp Claims
1. Can a Denied Missouri Workers’ Comp Claim Still Be Approved?
A dispute or denial does not necessarily mean the workers’ compensation matter is over.
What happens next depends on what has been disputed and where the case stands in the Missouri workers’ compensation process. A disagreement over treatment or benefits, for example, is procedurally different from an administrative law judge issuing an award.
2. Can Workers’ Comp Deny Medical Treatment in Missouri?
Disputes can arise over workers’ compensation medical treatment.
Under Missouri Revised Statutes §287.140, the employer must provide qualifying treatment reasonably required to cure and relieve the effects of the injury and generally has the right to select the treating healthcare provider. An employee may select another physician, but generally does so at their own expense.
3. What Happens if My Employer Says My Injury Wasn’t Work-Related?
Whether an injury is compensable can become a disputed issue in a Missouri workers’ compensation case.
The appropriate response depends on the facts and procedural stage of the case. Evidence concerning how the injury occurred, medical evidence, workplace records and other relevant information may become important when the relationship between the injury and employment is disputed.
4. How Long Do I Have to File a Workers’ Comp Claim in Missouri?
Under Missouri Revised Statutes §287.430, a workers’ compensation claim generally must be filed within two years after the injury or death or the last payment made under the workers’ compensation law on account of it.
If the employer does not file the required Report of Injury, the statute provides a three-year filing period.
This is different from Missouri’s separate notice requirement following a workplace injury.
5. How Long Do I Have to Appeal a Missouri Workers’ Comp Decision?
If an administrative law judge has issued an award, Missouri Revised Statutes §287.480 provides a 20-day period from the date of the award for an application for review to the Labor and Industrial Relations Commission.
That should not be confused with an employer or insurer disputing a benefit earlier in the workers’ compensation process.
A Workers’ Comp Denial or Dispute Doesn’t Necessarily End the Claim
Being told that workers’ compensation will not pay for treatment, that your checks are stopping or that your injury is being disputed can sound final.
It may not be.
The most useful first step is to establish what has happened, what is being disputed and where your case currently sits in Missouri’s workers’ compensation process.
From there, you can make a much clearer decision about what comes next.
If you were injured at work in St. Louis or elsewhere in Missouri and your workers’ compensation benefits have been denied, disputed or stopped, Roach Law can review what happened and help you understand your options.
