Commission dismisses named insurer from hardship award

 Paul Reboul v Richards Welding and/or Monty Richards

Inj. No. 24-019220

Release date  March 18, 2024

Claimant worked as a welder and injured his shoulder handling a heavy pipe and underwent shoulder surgery.  No medical bills were paid by the employer but claimant recieved $15,000 in temporary benefits.  In a hardshp hearing for further benefits, no one appeared for the employer/or alleged insurer.

The Commission reversed a finding that the named carier  CompSource carried insurance for the employer at the time of the accident, noting the lack of a cetification of insurance offered by either party and no credible or persuasive evidence to suport coverage.  Comp Source argued due process violations due to lack of notice and that claimant was not a covered employee due to lack of jurisdiction from an out of state injury.  The ALJ had found claimant was a 'covered' employee under Missouri law and the employer was both Richards Welding (apparently a disolved corp) and Monty Richards (the owner).   

The Commisison affirmed an award against the uninsured employer for future medical aid (no back medical was requested) and 15 weeks of unpaid TTD. The supporting documents suggest the corporation which employed claimant was dissolved due to the failure to pay taxes.  

Atty - Platter (employee) Munsell (employer, post-award)

Court denies SIF total noting it was regrettable no one preserved the bigger issue

 Jerry Thomas v Collns & Hermann and Second Injury Fund

No. ED 112795

Filed March 18, 225

The Court of Appeals affirms the Commission's denial of SIF fund benefits, which had reversed a PTD award by the ALJ.   2024 MO WCLR LEXIS 20 (ALJ Schaefer). 

The Court finds the Commission properly found that claimant failed to demonstrate his prior knee injury was a compensable injury as defined by 287.020.  The experts improperly included the non-qualifying condition in their PTD opinion.  Claimant failed to preserve his third error that he was left without a remedy if he could not recovery against the Fund.

Claimant had a prior right knee injury that required surgical repair from an injury in another state in 1993.  In 1994 he injured his left knee  in Missouri which resulted in a settlement of 25% fo the knee with a loading factor.  

Claimant had a shoulder injury in 2015 which required surgical repair.  Claimant obtained expert opinion from a Dr. "V" that he had a combo due to work restrictions of the shoudler and the knee.  A Dr. "S" assigned permanency for psychiatric conditions resulting from the shoudler.  A Dr. "D.G." opined clailant was a total due to a comibnation.  The Fund relied upon a psych restrictions alone rendered claimant unemployable on h baiss of the last accident.

The ALJ concluded claimant's knee disaiblity was greater than his settled amounts becuase the conditions because "worse" over time.  the Commisson excluded claimant's out of state injury did not count nor was  was it compensable under 287,.020 as defined. 

The court addressed the merits of the appeal but noted cliaman's points did not articulate the reasons for reversible error nor did the SIF move to dismiss the appeal.   

The Court found SIF interpretation under 287.020 too narrow and did not limit recoveries only to misosuri accident.  The Court found claimant failed to demonstrate prevailing facotr or put evidnece that it came from a hazard or risk unrelated to employment between the work activity an the injury other than occurring on property, which was insufficient.  

Regarding the threshold issue of 50 weeks, the commisison did not reach this issue and the court considered it immaterial for its deicison.

Claimant argued the employer would be liable if claimant was totally disabled and there was no recovery against the Fund.  The court found the alleged point was not preserved.  Judge Hess indicated it was 'regrettable' the question was not properly before the court. 

 The opinion hides the identity of the experts, although anyone in comp in Missouri should have a pretty good idea who is Dr. "V" and Dr. "S".

Atty:  Sievers, Voigt, Frazier

 

Court awards medical bills when claimant demanded care

 Erwin v Midway Arms

2025 Mo. App. Lexis 131

release date:  March 4, 2025

The Court of appeals reverses the Commmission based on a misapplication of law and awards medical bills for a surgery which the employer's expert eventually concluded was reasonable including the need for future medical for psych and orthopedic conditions. 

Employee declined employer's request to provide records and furnished them only after claimant underwent surgery.  The court found claimant had made requests for medical care, and had no duty in its aburden of production of medical records or reports to refute an earlier finding of MMI to trigger a further duty to provide care. The case is distinguishable in which claimant did not provide any notice.   

The Commission reversed an award of nearly $60,000 in sanctions against the employer noting employer relied upon a medical, even if it was not adopted by the Commission.  The Court refused to award sanctions based on the finding of  the Commission that both sides acted unreasonably by the employer not seeking further medical opinion and the claimant withholding medical records.