Missouri Workers Compensation Update
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Missouri Workers Compensation Update
There are currently 2 bills pending in the Missouri Legislature that would have a dramatic impact on how workers compensation claims is Missouri are defended:
SB 1052 — Establishing a Workers’ Compensation Medical Fee Schedule
HCS HB 2375 — Comprehensive Amendments to Chapter 287
Here is my bottom-line take on both bills:
SB 1052 — Establishing a Workers’ Compensation Medical Fee Schedule
This bill would create a Division promulgated medical fee schedule for Missouri. The schedule would apply to services provided under Chapter 287 and would cap provider charges at the amounts allowed by the Division. It would also apply to Commission appointed impartial examinations and, as written, is broadly framed to cover services provided pursuant to the statute, which may encompass IMEs directed by Employer/Insurers under §287.210. (Unclear from the exact wording of the bill)
While a fee schedule can improve financial predictability in a workers compensation claim, there are potential downsides for Employers and Insurers:
Market discipline already tempers many prices. In non emergency settings, if Provider A’s prices are high, Employers/Insurers can steer care to Provider B. A universal schedule may reduce that flexibility. A more targeted schedule limited to emergency department care and non authorized care could address outlier charges without constraining the rest of the market.
Possible reduction in available treating physicians. In several Missouri markets (including Greater St. Louis and Greater Cape Girardeau), finding quality physicians is already challenging. By mandating a fee schedule, some physicians may opt out of workers’ compensation entirely, shrinking the pool of high quality providers. Employers and insurers want top tier care to expedite RTW and MMI; a broad schedule could undermine that.
IME availability. If medical fee limits apply to medical examinations under §287.210, the pool of orthopedic surgeons willing to perform IMEs could narrow, making it harder to avoid the “usual suspects” that some judges view as “defense doctors.”
Bottom line: I would prefer a narrowly tailored schedule for ED and non authorized care rather than one that applies to all care and medical examinations.
HCS HB 2375 — Comprehensive Amendments to Chapter 287
This bill would accomplish three things I’ve advocated for years:
Effectively supersede Tillotson by requiring that the Employer/Insurer is responsible for medical care only when employment is "the prevailing factor", not just in the injury, condition, and disability, but also in the need for treatment. (The bill does not name Tillotson, but the “need for treatment” change would reverse that holding as a practical matter.)
Narrow exposure for treatment tied to pre existing degenerative conditions by applying the prevailing factor test to the need for treatment. (Note: The bill also clarifies that gradual deterioration attributable to workplace risks/hazards can be compensable when those risks are the prevailing factor.)
Create a 180 day “Motion to Dismiss” mechanism so Employers/Insurers can be dismissed on threshold grounds (e.g., untimely notice/filing, not in course and scope, intoxication, not employed by the named employer, or other failure to state a valid claim) without waiting for a final hearing that could take years to reach.
I’ll track both bills as they move through the Legislature. Please reach out with questions or if you’d like to discuss these in more detail.
