The Labor Division provides general counsel and litigation services in Missouri Workers’ Compensation claims for the Missouri State Treasurer in his capacity as custodian of the Second Injury Fund (Fund) and for the Department of Labor and Industrial Relations in its role administering the Fund. The Labor Division similarly provides general counsel and litigation services for the Missouri’s Office of Administration, Central Accident Reporting Office (CARO) in defending workers’ compensation claims filed against a multitude of state agencies by their employees.
In 2022, the Labor Division processed 2759 new claims that were filed against the Fund and 495 new claims that were filed against CARO for a total of 3254 new claims processed. They closed 3310 Fund claims and 637 CARO claims for a total of 3947 claims in 2022.
The Labor Division also prosecutes cases involving fraud and noncompliance with the Missouri Workers’ Compensation Act, as referred by the Fraud and Noncompliance Unit of the Division of Workers’ Compensation, filing charges in 189 criminal cases and obtaining 54 guilty pleas in 2022.
Frequently Asked Questions
What is the Second Injury Fund?
Established by the Missouri General Assembly, the Second Injury Fund is a fund contributed to by all employers obtaining workers’ compensation insurance in the state of Missouri. The Second Injury Fund provides benefits to employees who have sustained workers’ compensation injuries in certain instances. The Missouri State Treasurer is the custodian of the Second Injury Fund, which is administered by the Division of Workers’ Compensation; claims made against the Fund are defended by Assistant Attorneys General from the Attorney General’s Office.
When can an employee file a claim for benefits?
Anyone may file a claim against the Second Injury Fund if they believe they are entitled to benefits.
Examples of when claims might be made for workplace injuries occurring on or before January 1, 2014, include:
- If an employee is working for an employer which should have obtained workers’ compensation insurance, but did not.
- If an injured employee works for more than one employer, and sustains an injury at one of those jobs causing the injured employee to miss time from work at his other job as well.
- If an injured employee is receiving certain physical rehabilitation services following a serious injury following the time in which he or she receives medical aid.
- If an injured employee has previously sustained a disability, which might be combined with the work-related disability to create a greater disability than the simple sums.
Examples of when claims might be made for workplace injuries occurring after January 1, 2014, include:
- If an injured employee is receiving certain physical rehabilitation services following a serious injury following the time in which he or she receives medical aid.
- If an injured employee has previously sustained a qualifying disability, which might be combined with the work-related disability to result in the employee being permanently totally disabled.
- If an employee is injured while working for a sheltered workshop and the disability from that injury might be combined with the employee’s preexisting disability to result in the employee being permanently totally disabled.
In this context, being permanently totally disabled means that an employer on the open labor market would not reasonably be expected to hire the employee in his or her current physical condition.
How do I file a claim against the Second Injury Fund?
A Claim for Compensation is filed with the Division of Workers’ Compensation. The Claim for Compensation has a specific place to indicate that the employee is alleging a claim against the Second Injury Fund and to list what particular circumstances the employee believes qualifies him or her for benefits from the Second Injury Fund.
What happens after I file a claim for compensation against the Second Injury Fund?
After a Claim for Compensation is filed with the Division of Workers’ Compensation, the Division forwards the claim to the Attorney General’s Office on behalf of the Missouri State Treasurer. The Attorney General’s Office has 30 days to file an answer to the claim with the Division, which forwards a copy of the answer to the employee who filed the claim and his or her employer. The Attorney General’s Office may also send a letter to the employee or his or her attorney stating the specific information the Office needs in order to evaluate the employee’s claim against the Fund. This information could include records of medical treatment for prior disabilities or for the work-related injury; independent medical evaluations done on behalf of either the employee or the employer; copies of medical bills; information about missed work time and lost wages; and information about the circumstances of the injury. Affidavits (signed statements) from the employee may also be required.
How do I obtain the documents to provide to the Second Injury Fund?
The Attorney General’s Office does not, and cannot, represent injured employees. If an employee has an attorney representing him or her, the attorney will know how to obtain the necessary information. If an employee needs to obtain the required documents on his or her own, they can normally be obtained by contacting the provider, which may include doctors, hospitals, physical therapists, or other providers depending on the nature of the injury being claimed. This may require submitting forms and may involve a charge for the records. Copies of Stipulations settling Claims for Compensation with employers can be obtained by contacting the Division of Workers’ Compensation at 573-751-4231 or online.
Why does the Second Injury Fund need this information?
In order to determine if the alleged disabilities fulfill the requirements of the law for Second Injury Fund liability, the Attorney General’s Office must have the records regarding the treatment received for each injury being claimed against the Fund as well as knowledge regarding the amount of permanent disability determined to exist from the injury that occurred while the employee was working for the employer.
In permanent total disability claims, the law says that an employee may be entitled to permanent total disability benefits from the Second Injury Fund if the employee is unable to compete in the open labor market due to a combination of the employee’s prior disabilities and a subsequent work-related disability. In order to determine an employee’s ability to compete in the open labor market, many times it is necessary for the Attorney General’s Office to take a deposition (or sworn statement) of the employee to fully understand the extent of his or her disabilities as well as to determine the potential ability of the employee to return back to the open labor market in some capacity.
For workplace injuries occurring on or before January 1, 2014, an employee may file an uninsured claim. In uninsured claims, the Second Injury Fund may be liable for payment of medical bills incurred as the result of an injury sustained by an employee of an employer who should have had workers’ compensation insurance but failed to properly insure its liability. In order to ascertain the necessity of the health care provided and evaluate the bills claimed, the Attorney General’s Office must have both the medical records and bills to review. It is also necessary that the Attorney General’s Office have information regarding the employer so that it can ascertain whether or not the employer was subject to the Workers’ Compensation Law and indeed failed to properly insure its liability.
For workplace injuries occurring on or before January 1, 2014, an employee may file a second job wage loss claim. In a wage loss claim, the Attorney General’s Office will need to know whether or not both jobs were with “employers” as defined by the Workers’ Compensation Law. The Office will need medical information to see whether a medical provider has kept the employee off work from that second job as a result of the injury at the first. The Attorney General’s Office will need wage and other information regarding both the employee’s jobs in order to calculate any wage loss benefits that might be owed.
How do I close my claim against the Second Injury Fund?
Claims can be closed in one of four ways: A voluntary dismissal at the request of the employee; an involuntary dismissal entered by the Division of Workers’ Compensation if an employee fails to appear at a pre-hearing; a voluntary settlement between the employee and the Second Injury Fund; or an award entered by an Administrative Law Judge after a hearing is held in the case.
What if I don't agree with an offer from the Second Injury Fund?
If the parties are unable to reach a voluntary agreement on their own, any party may request a mediation or a final hearing with the Division of Workers’ Compensation. At a mediation, an Administrative Law Judge will discuss the claim with the employee, the employer, their attorneys, and the attorney for the Second Injury Fund. At a mediation, an Administrative Law Judge may assist the parties and their attorneys in understanding and resolving the issues. If no mediation is requested or if the mediation does not result in a resolution of the issues, the claim may be decided following a final hearing. At a final hearing, evidence is offered and accepted pursuant to formal rules of evidence. An award is then entered by an Administrative Law Judge based upon the evidence presented. Such an award is binding on all parties unless a timely appeal is made.
How do I appeal an Award?
Appeals from awards by Administrative Law Judges are made to the Labor and Industrial Relations Commission. Forms are available for such appeals through the Division of Workers’ Compensation. Appeals from a decision of the Labor and Industrial Relations Commission are made to the Missouri Court of Appeals.
Do I need an attorney?
There is no requirement in a workers’ compensation proceeding to have an attorney representing an employee. However, understand that if you hire an attorney, Supreme Court Rules prevent the Assistant Attorneys General representing the Second Injury Fund from communicating to you directly, and they can only communicate to you through your attorney.