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Employers, Insurers, and TPAs

Employers, Insurers, and TPAs

Insurance

In the state of Missouri you are required to carry workers’ compensation insurance if you have five or more employees, unless you are in the construction industry, then you must carry workers’ compensation insurance if you have one or more employees. Employers that don’t have the required number of employees or who have employees in the exempt categories may “elect” to come under the law and carry workers’ compensation insurance. Exempt employers that decide not to purchase workers compensation insurance or to self-insure remain exposed to civil lawsuits brought by employees who are injured during work. Sole proprietors and partners are not themselsves covered unless they elect to be covered; close family member-employees and members of a limited liability company are presumed to be covered unless they opt out.

Related: Workers' Compensation Insurance
Related: Workers' Compensation Requirements For the Missouri Construction Industry
Related: Check to Verify Coverage for Subcontractors
Related: Religious Exceptions/Industry Exemptions
Related: 2013 Workers' Compensation Rates

Injuries, Benefits & Disputes

After an injury has occurred, the injured worker should notify the employer in writing of the injury; the written notice should include the date, time and place of injury, the nature of the injury and the name and address of the person injured. The employer must then report the injury to the insurance company or TPA within five days of the date of injury or within five days of the date on which the injury was reported to the employer by the employee, whichever is later.The insurer, TPA, or Division-approved service company for a self-insured employer or group trust is responsible for filing a First Report of Injury with the Division within 30 days after knowledge of the injury.

In addition to medical benefits, an employee may be entitled to temporary total disability benefits and permanent partial or permanent total disability benefits. Upon the death of a worker who has suffered a compensable work injury, certain surviving individuals may be entitled to weekly benefits from the employer/insurer. The employer/insurer is also responsible for paying funeral expenses up to $5,000. If an employee believes that he/she has not received all benefits due to them or has issues relating to the benefits that are owed, there are several different options available to resolve the issues. Both the employer and the employee may wish to consider other options to resolve the issues.

Related: Disability Schedule and Benefit Limits (WC-110)
Related: Injury Reporting Responsibilities
Related: Benefits for Injured Workers
Related: The Legal Process

DISCLAIMER - More Information

The Employers, Insurers, TPAs section of the Workers' Compensation portion of this web site is targeted specifically to employers, insurers and third party administrators and is intended to be a resource throughout the workers' compensation claim process. It is NOT intended to be a substitute for legal representation.

Injured workers seeking information about the workers' compensation process should use the Injured Workers section of the Workers' Compensation web site to find information targeted specifically to them.

Additional information about Missouri Workers' Compensation laws, the Division of Workers Compensation, the Second Injury Fund and more may be found via the Workers' Compensation home page.