I am working for a company out of the State of Texas. They told me they have workers' compensation insurance with Texas Mutual Insurance. Will this cover me in Missouri?

Probably not. Texas Mutual Insurance normally covers injuries that occur in Texas or Texas residents working out-of-state. If you are working for any out-of-state employer, it is always wise to contact the insurance company who issued the workers' compensation policy and verify you are covered. Coverage does not always carry over from one state to the next. If you find out you are working for an employer who is not covered in Missouri, please feel free to call us and we will investigate the matter. (Feb 04)

I have business locations in Missouri and Kansas. The Missouri location has 3 employees and the Kansas location has 5. I was informed I didn't have to have Missouri workers' compensation insurance because I only have three employees. Is that correct?

Short answer, NO! In the state of Missouri employers with 5 or more employees must carry workers' compensation insurance. The only exception is for the construction industry. If you are in the construction industry and have one or more employees you are required to carry workers' compensation insurance. The statute does not differentiate between full-time or part-time employees. Neither does it state that the five employees have to be in Missouri. If an employer has locations in various states, they need to count the total number of employees they have. If the sum of those employees equals 5 (1 or more for construction), then the employer must carry workers' compensation for the Missouri employees. Whether or not you need to provide coverage for the employees in the other states would depend on their specific laws. In this particular case, the employer has 8 employees thus requiring coverage. (June 2003)

I am representing a client who the insurance company is stonewalling. I can't seem to get them to negotiate a settlement. If I file a complaint with the Fraud and Noncompliance Unit and the matter is then resolved, can I withdraw my complaint.

No. The Fraud and Noncompliance Unit was created to investigate criminal violations of Missouri's workers' compensation law (RSMo 287). If a complaint is filed, the unit will investigate the matter to determine if a criminal violation has occurred. If the unit is able to substantiate a violation, the Division director may refer it to the Office of the Attorney General for prosecution. If no violation is substantiated the case is administratively closed. The unit was not intended nor does it participate in the administrative settlement side of the workers' compensation system (June 2003).

I was looking at my pay stub and realized my employer is deducting money for workers' compensation insurance. Can they do that?

If you are an employee and not a subcontractor, it is illegal for an employer in the state of Missouri to charge you for workers' compensation insurance. In accordance with RSMo 287.290, "No part of the cost of such insurance shall be assessed against, collected from or paid by any employee." Not only is it wrong to shift the burden of workers' compensation insurance onto employees, it gives the employer an unfair economic advantage over their competitors. If you are an employee, being charged for workers' compensation insurance by your employer, you can contact the Fraud and Noncompliance Unit and they will investigate the matter.

I was hurt at work and informed my supervisor about the injury. They refuse to file an injury report. Can they do this?

In Missouri, every employer or his/her insurer is required to file an injury report, with the Division of Workers' Compensation, within ten days after knowledge of an accident resulting in personal injury to any employee. If the employer has coverage through an insurance company they have five days to report it to that carrier and the insurance company is then required to report the injury to the division. The Fraud and Noncompliance Unit would investigate such a complaint either as an alleged premium fraud violation or as a violation of RSMo 287.380.1, depending on the reasons for the employer/insurer's failure to report the injury.

I have an injured employee who is collecting TTD and is working at another job. Is this fraud?

It depends on a number of factors. Merely collecting TTD and working at another job, does not in and of itself, constitute fraud. One of the criminal elements of fraud is a misrepresentation of a material fact (a LIE) in order to obtain a benefit. If a claims adjuster, medical provider or an employer asked the injured employee if they are working and the employee denies it, then there could be a violation of Missouri's workers' compensation statute.

I have an injured employee, on videotape, violating their doctor's restrictions. Have they violated Missouri's workers' compensation laws?

Maybe! Violating your doctor's work restrictions may or may not be a violation of Missouri's workers' compensation laws. For example, an injured worker goes to the doctor and indicates they are in a lot of pain. When asked how severe, the injured employee states, "8 out of 10". You have the employee on videotape building a barn. They are carrying 4' x 4' posts, bags of cement, hammering, climbing a ladder, etc. This scenario would not be fraud! Why? Where is the lie?

Using the same scenario with the exception of the doctor's visit. This time, the doctor asks the injured employee, "How has the injury affected your ability to perform daily functions". The injured employee responds, "prior to the injury I could climb ladders, mow my grass, go horse back riding and work in my garden. Now, I can't even pick up a bag of flour". Now you have a possible fraudulent act. Why? You have a lie! The injured employee indicated they could not perform at a certain level and there is evidence that they could. The fraudulent statement must be made to someone in a position to determine if benefits are paid. That can be the medical provider, the employer or the insurer.

I am a carpenter and was injured at work on Friday at a construction sight and reported it to my supervisor. He asked me to wait until Monday to file an injury report because he doesn't have workers' compensation insurance. He said he would buy it today and I would be covered on Monday. Is that legal?

No! First of all, any employer in the construction industry is required to carry workers' compensation insurance if they have one or more employees'. If your employer does not have coverage, they are non-compliant with Missouri's workers' compensation law and the Fraud and Noncompliance Unit would investigate that violation. When an employer applies for coverage they are asked about prior accidents. If they admit to your injury, it won't be covered under the policy they purchase on Monday. If they don't admit to the injury and then have you file a fraudulent claim on Monday, you and your employer could be committing workers' compensation fraud.

I work for an employer who has seventeen employees. She pays seven of us in cash but I know she has workers' compensation insurance. Is this legal?

No. The employees who are being paid cash will not have taxes taken out of their pay. This will have an effect on their social security and unemployment insurance. It could also affect the employer's workers' compensation premium. Insurance companies determine how much to charge for workers' compensation by using three main categories. They are: type of job performed, amount of payroll and how many injuries the employer has over a period of time. By reducing their reported payroll, the employer would not be paying the proper premium for the risk the insurance company is covering. In addition, it gives that employer an unfair financial advantage over the other employers who are paying the proper rate. The Fraud and Noncompliance Unit would investigate the employer for premium fraud.

I work for a construction company and was told by the owner I am an independent contractor. He gives me a 1099 at the end of the year. I am concerned because I am paid by the hour, he provides the tools and supplies, sets the hours and finds the jobs. Am I really an independent contractor? (July 05)

Based upon the information you provided it sounds like you are an employee. The Fraud and Noncompliance Unit would look at areas such as: control the employer has over the workers', does the alleged "independent contractor" own their own business and/or have the ability to make a profit/loss on the job, who provides the equipment, sets the work hours, etc. We would be interested in checking further to determine if the employer has workers' compensation insurance.

I recently hired a subcontractor to put a roof on a house I am building. I obtained a copy of their Certificate of Insurance (COI) for workers' compensation insurance. My insurance company recently audited me and now I have to pay more in premium because the COI was no good. Is there anything you can do? (July 05)

Yes, we would be interested in investigating this. Presently, we would check into two areas. First, we would determine if the subcontractor has workers' compensation insurance. Second, we would investigate their submitting a false or forged certificate of insurance. Effective August 28, 2005 submitting a false/forged certificate of workers' compensation insurance becomes a class D felony. By avoiding their obligation to provide coverage they are denying their employees workers' compensation benefits in the event they receive a work place injury. In addition, they are making more difficult for employers who obey the law to compete in the market by being able to under bid them on jobs.

One of my employees is out on a workers' compensation claim. She brought in an "off work" slip she said she got from her doctor. The form indicates she is to be off of work for 7 days because of her injury. I called the doctors office and they said they never gave her an "off work" slip. Is this a crime? (June 05)

Probably. It is a criminal violation for someone to misrepresent a material fact (Lie) in an attempt to obtain a workers' compensation benefit. If the injured worker forged or had someone else forge the document and then she submitted to you we would investigate the matter. If we are able to prove it was done to obtain a workers' compensation benefit, the Division Director could refer the matter to the Office of the Attorney General.