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MISSOURI
WORKERS' COMPENSATION CASE LAW UPDATE
October
2025 - December 2025
ALJ
Could Not Award Permanency Over and Above only Permanency Rating
Admitted into Evidence
Barnett
vs. Kawasaki Motors Manufacturing Corporation, US, Injury No.
23-040406
FACTS:
The claimant sustained an injury to his right shoulder. Dr. Mall
performed an arthroscopic right shoulder rotator cuff repair with
biceps tenodesis. Thereafter, he underwent physical therapy, and he
was placed at MMI. The claimant reported continuing complaints, and
he was returned to the doctor and he reported an intervening incident
when he fell from a bicycle and now had pain over the AC joint which
was not part of the original injury. The doctor did not believe the
claimant needed any additional treatment and that any current
complaints were related to this intervening bike incident. Dr. Mall
provided a rating of 7% disability.
The
judge noted that the claimant is not required to submit his own
disability rating and he is familiar with Dr. Mall's ratings having
reviewed his reports in hundreds of cases and thereafter awarded 25%
disability to the shoulder. He did note the finder of fact consider
all evidence in determining the amount of an employee's PPD and is
not obligated to award the same percentages assigned by experts. He
noted it was within the province of the fact finder to determine what
weight it will accord expert testimony on medical causation. The
employer appealed noting that the award was against the weight of the
evidence.
HOLDING:
The Commission
noted that the ALJ determined that the claimant had disability 18%
higher than the only medical opinion on permanent disability at the
Hearing. The Commission noted that the statute states that permanent
partial disability or permanent total disability shall be
demonstrated and certified by a physician. The Commission further
went on to note the courts have held that the employee has the burden
of proving not only that an accident occurred and that it resulted in
injury but also that a disability resulted and the extent of the
disability. The Commission concluded that the claimant failed to
carry his burden of proving the extent of his disability due to the
work injury because he produced no credible, persuasive evidence that
supported a greater level of disability than assessed by Dr. Mall.
The ALJ exceeded his authority by substituting his own lay opinion of
treatment records and vaguely alluding to his experience with Dr.
Mall in other cases to justify and award 3x greater than Dr. Mall's
opinion. Therefore, the Commission modified the award of the ALJ and
awarded 7% of the shoulder.
Medical
Provider Met Burden of Proof that Fees Were Reasonable and Employer
Required to Pay Additional Monies
S
& B Hauling and Construction & Utah Business Insurance
Company of America vs. Center for Surgical Specialties P.C., Case No.
WD88030 (Mo. App. WD 2025)
FACTS:
A claimant sustained a compensable work-related injury, and surgery
was authorized with Surgical Specialties who billed the
employer/insurer in the amount of $19,763.00 and the employer/insurer
paid $11,566.52 but refused to pay the remaining balance of
$8,196.48. Surgical Specialties filed an Application for
Reimbursement of Additional Medical Fees, and the employer/insurer
filed an Answer arguing that the amount already paid to Surgical
Specialties represented the usual and customary rate for the medical
services provided. The only issue at the Hearing was whether the
medical bills submitted by Surgical Specialties were fair and
reasonable.
At
the time of the Hearing, Surgical Specialties' business manager
testified that 99% of the doctor's practice is comprised of
workers' compensation referrals. The claimant was referred to
Surgical Specialties by a nurse case manager who directed and
authorized the surgery. The business manager testified that the bill
issued to the employer/insurer reflected the charges and fees that
Surgical Specialties routinely billed for that particular surgery
performed regardless of who is billed for the procedure.
There
was testimony on behalf of the employer/insurer, specifically a
doctor with WellRithms, a company that contracts with workers'
compensation insurers to assume legal and financial exposure in
exchange for payment based on a percentage of liability assumed. That
doctor testified that based on his review of the bill Surgical
Specialties should have been paid the $11,566.52 based on standard
billing and reimbursement practices. The ALJ found that Surgical
Specialties had the burden of proof regarding reasonableness of its
medical charges and the evidence and testimony submitted sustained
this burden and awarded the facility the additional charges. The
employer/insurer appealed, stating that the charges were unreasonable
and unfair.
HOLDING:
The Commission
affirmed and adopted the Award of the ALJ. The Court looked to prior
case law and determined that Surgical Specialties sustained its
burden of proof and persuasion as the Award of the ALJ and the
Commission found that the business manager's testimony was credible
and persuasive and they are bound by the Commission's credibility
determination. Therefore, the employer/insurer was ordered to pay the
outstanding $8,196.48.
Claimant's
Claim Against Mo. Dept. of Social Services Barred Based on Sovereign
Immunity
Woodrum
vs. Missouri Department of Social Services, Case No. SD38940 (Mo.
App. SD 2025)
FACTS:
The claimant alleged that the Missouri Department of Social Services
retaliated against him by constructively terminating his employment
soon after he began seeking workers' compensation benefits after a
work injury. The Circuit Court granted summary judgment in favor of
Social Services on the grounds that the claimant's retaliation
claim is barred by sovereign immunity. The claimant appealed
contending that the applicable provisions of the Missouri workers'
compensation law expressly waives sovereign immunity for retaliation
claims involving the state.
HOLDING:
The Appellate
Court affirmed the Circuit Court's judgment noting that the state
has expressed an affirmative intent to preserve its sovereign
immunity by way of a separate and controlling statutory provision
which is outside of the workers' compensation law.
Hicks
vs. Commercial Metals Company, et al, Case No. WD87598 consolidated
with WD87627 (Mo. App. WD 2025)
FACTS:
The claimant began working for CMC as a rebar bender operator on
January 17, 2017. From the time she started, one of the objectives of
management was "no recordables and no lost time". The claimant's
interpretation of that objective was "you don't want to get hurt
or, if you do, you suck it up and keep going." She sustained an
injury on January 15, 2018 and was knocked unconscious. The shop
superintendent did not call an ambulance, but took her to the
emergency room, and stayed with her. After leaving the ER he took the
claimant to the company clinic to be drug-tested. The next day, he
picked her up from home and took her back to the company clinic to be
evaluated. She was to return to work with restrictions and he drove
her to the plant and placed her in a darkened room for her eight-hour
shift. Although the safety manager testified that the claimant was
given job duties, the claimant testified that she did nothing but sit
in a chair or lie on the floor in the room during her entire shift.
She was again seen by a doctor and for the next three weeks sat alone
in a dark room or took vacation, sick days or PTO. Other than breaks,
she was not allowed to have access to her cell phone and the claimant
testified that this work-around was created so that her time off
would not count in the company records as "lost time and a
recordable."
The
shop superintendent testified that once Hicks went on full medical
leave, she also went on short-term disability. However, the claimant
never applied for short-term disability. She was in fact told that
she could not receive both benefits. Although the claimant did not
know it, the employer initiated FMLA and short-term disability on
Hicks' behalf in March of 2018. The claimant continued to receive
workers' compensation benefits and she received a termination
letter from the employer on August 31, 2018. Before and after her
termination, she continued to receive treatment and her nurse case
manager presented to her appointments and provided the employer
updates. The claimant was released from all work restrictions on
September 13, 2018.
There
was testimony that a meeting was held with corporate employees to
discuss the claimant's employment and it was agreed upon that a
letter would be sent to the claimant to reach back out to the
employer in order to discuss her employment and she needed to respond
immediately. However, the claimant testified that she did not receive
any communication from the employer before her actual termination
letter. There was testimony that the claimant lived less than two
miles from the plant and the shop superintendent had picked her up
from her home to take her to work following the accident and no one
from the company tried to reach her at her home. The employer claimed
that the basis for the claimant's termination was failure to
communicate and provide proof of disability.
After
the claimant's termination, she remained unemployed for the
remainder of 2018 and 2019 and in 2020, she had multiple short-term
jobs. There was testimony that her demeanor changed, she lost
confidence and had become withdrawn. The claimant filed a suit
alleging employment retaliation.
After
a three-day trial, the jury returned a verdict in favor of Hicks and
awarded her $90,000 for back pay and $300,000 for noneconomic
damages. The employer moved for judgment notwithstanding the verdict
or a new trial or modification of the judgement, and the trial court
overruled all of the motions. CMC again moved for a new trial
alleging jury misconduct. The employer's attorney advised that he
had learned of the alleged misconduct a few days after the conclusion
of the trial but failed to explain why these issues were not
addressed in the prior motion for a new trial. It was alleged that
the claimant's attorney's father spoke with two jurors outside
the courthouse during the trial. The employer had sworn affidavits of
two of their employees confirming the same. The claimant's attorney
requested video surveillance which contradicted the employees'
allegations. At a hearing on a motion for sanctions, the two
employees testified that they "misremembered" all of the events
but neither came forward until the surveillance surfaced. The trial
court sanctioned the employer, finding that they acted in bad faith
and committed fraud on the court. The trial court awarded sanctions
in the amount of $312,450 which equated to the full amount of Hicks'
hourly attorney's fees for the trial. The employer appealed,
arguing that the claimant offered no evidence that her receipt of
workers' compensation benefits was a motivating factor in her
termination.
HOLDING:
The Court noted that in order to prevail on her retaliation claim,
she needed to prove that she was employed by the employer before the
injury, she exercised her rights by filing a claim for workers'
compensation, the employer terminated the claimant and there was a
causal relationship between the claimant filing her claim and
termination. The employer only argued that the claimant did not meet
the fourth element, that she proved a causal relationship between her
workers' compensation claim and her termination. The Court noted
that the claimant proved a causal relationship by showing that her
workers' compensation claim was a motivating factor in her
discharge and it actually played a role in the discharge or
termination and had a determinative influence on the discharge or
termination. Essentially, the employer's evidence focused on the
claimant's alleged lack of communication about her health status
and timing for returning to work, but the claimant presented evidence
that the employer was aware of the same as the nurse case manager was
sending updates to the employer. After reviewing the evidence in the
light most favorable to the claimant, there was sufficient evidence
to submit the claimant's retaliatory discharge claim to the jury.
Also, the Appellate Court found no abuse of discretion in the amount
of sanctions imposed. The court also affirmed the jury's back pay
award and non-economic damages award, noting that they could not say
the jury's verdict was excessive nor that the trial court abused
its discretion.
Dismissal
Set Aside as No Evidence Claimant Received Actual Notice
Tippit
vs. State of Missouri, Second Injury Fund, Case No. ED113466 (Mo.
App. ED 2025)
FACTS:
The claimant sustained an injury on September 25, 2015 and filed a
claim against the employer and the Fund in January of 2016. The
claimant and the employer reached a settlement in December of 2016
and his case against the Fund remained open. The claimant's
attorney died in December of 2020 and in June of 2021 the claimant
hired a new attorney, but the Division records did not show that he
entered his appearance with the Division. The Division sent the
claimant a Notice to Show Cause Why the Claim Should not be Dismissed
which was set on September 14, 2022. It was sent certified and showed
that someone at the claimant's residence received the same. The
claimant did not contact the ALJ on the date of the show cause
setting and the ALJ dismissed the case. The Order of Dismissal was
sent certified and again delivered to an individual at the claimant's
residence.
A
week later the claimant's attorney filed a second Entry of
Appearance on the claimant's behalf on September 27, 2022. Then on
May 20, 2023 the claimant filed an Application for Review with the
Commission requesting that the Order be set aside as neither he nor
his attorney received the Order of Dismissal until May 10, 2023. He
also alleged that he never received the notice of show cause setting.
The Commission reinstated the claim against the Fund for the sole
purpose of remanding the matter to the Division for a Hearing before
an ALJ to allow the claimant to present evidence on his allegations
that he did not receive the Order of Dismissal or show cause notice.
After
the Remand Hearing, the Commission found that the Division sent the
September 19, 2022 Order of Dismissal to the claimant via certified
mail but the claimant did not file his Application until eight months
later which was untimely. Since it was untimely, the Commission did
not have any jurisdiction over the case and dismissed the Application
for Review. The claimant appealed.
HOLDING:
The Court found
the basis for the Commission's dismissal was that the Division
properly mailed the September 19, 2022 Order of Dismissal to the
claimant by certified mail but noted that this was not supported by
sufficient competent evidence in the record. The court noted that the
certified mail tracking number showed that the document was placed in
the mail on September 15, 2022 but the ALJ did not sign and enter the
order until September 19, 2022 and therefore, the document mailed
could not have been the Order of Dismissal as it did not exist at the
time. The Court noted that while the ALJ signed and entered the
"Dismissal Memorandum" on September 14, 2022 this document merely
stated that the ALJ "moved for the issuance of an Order of
Dismissal" and on it's face was not the Order of Dismissal. The
Court went on to note that there was no testimony at the Hearing that
could clarify this inconsistency in the Division records. The Court
noted there was no evidence in the record that the claimant received
an actual notice of the Order of Dismissal until May 10, 2023.
Therefore, the Commission erred in dismissing the Application as it
was not supported by sufficient competent evidence. Therefore, the
Commission's decision was reversed.
Kell
vs. Walker Recycling Company, LLC, Case No. ED113338 (Mo. App. ED
2025)
FACTS:
Kell sustained an injury while working at Walker Recycling. The
employer was represented by Attorney Roberts until he withdrew on
January 28, 2022 citing another attorney had entered his appearance
for the employer. The ALJ granted Attorney Roberts' leave to
withdraw. On February 22, 2022, the other attorney entered his
appearance on behalf of the employer but misnamed the employer as
Walker Recycling, LLC. That same day, the ALJ approved the settlement
in which Walker Recycling agreed to pay Kell a lump sum of
$50,079.53. Again, the employer was misnamed as Walker Recycling,
LLC. The settlement was signed by Kell and his attorney, Walker
Recycling's attorney, and the ALJ.
In
November of 2023, Kell filed an amended petition in circuit court
requesting that the court correct the clerical mistake in the
settlement. Walker Recycling, once again represented by Attorney
Roberts, responded it had received the settlement prior to approval,
was aware the settlement named "Walker Recycling LLC" and
approved its attorney entering into the settlement based on that
information. Walker Recycling argued that the circuit court lacked
jurisdiction to correct an administrative agency order, or the
stipulation.
A
bench trial was held and Kell offered a certified copy of the
workers' compensation case as an exhibit. Walker Recycling moved
for a directed verdict. The circuit court entered a judgment in favor
of Kell and modified the employer's name in the settlement
stipulation to "Walker Recycling Co., LLC", and entered a
judgment against Walker Recycling in the sum of $50,079.53 plus costs
in accordance with the settlement. Walker Recycling filed the motion
to set aside the judgment which the court denied and Walker Recycling
again appealed.
HOLDING:
The Court noted that before discussing the merit of Walker
Recycling's appeal, it is pertinent to note that Walker Recycling
argues it should not be bound by the settlement to which it agreed
because of a clerical error. The court noted its arguments are
meritless at best and at worst they allude to fraud and ethical
violations and are easily refuted by the record. The court noted that
the judgement was supported by substantial evidence. Walker Recycling
appears to argue that it noticed the clerical error and authorized
its attorney to enter into the settlement because it was against a
different entity. The court noted that even if Walker Recycling LLC
was a real entity, the Division would not have had the authority to
bind it to the terms of settlement because it was not a party to the
workers' compensation case. Walker Recycling was the only employer
involved. Aside from the clerical error in Walker Recycling's name,
the settlement contained the same injury, the same injury date and
the same claim number to which Walker Recycling had been a party all
along. Therefore, the judgment was affirmed.
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