8 CSR 20-3.010 - Jurisdiction
(1)
The Division of Workers' Compensation shall have and exercise the following
powers, duties and functions on behalf of the commission in the administration
of the Workers' Compensation Law, section
287.410, RSMo:
(A) The receiving and filing of all reports
of injury, claims for compensation, answers to claims for compensation,
receipts, notices of termination of compensation, and all other forms,
instruments, and documents required to be used or filed in connection with
Workers' Compensation claims before the time of the issuance of a final award,
order, or decision of any administrative law judge;
(B) The receiving, filing, processing, and
recordkeeping of all exempted employers' acceptances of the Workers'
Compensation Law and withdrawals of exempted employers' acceptances of the
law;
(C) The duties and
responsibilities given the commission by the legislature under section
287.280, RSMo relative to
employers who carry their own insurance (self-insurers);
(D) The duties and responsibilities given the
commission by the legislature under section
287.220, RSMo relative to the
Second Injury Fund;
(E) The duties
and responsibilities given the commission by the legislature under section
287.810, RSMo relative to a
change of administrative law judge; and
(F) All documents and instruments referred to
in subsections (1)(A)-(E) and required to be filed by either the employer or
employee shall be filed with the division.
(2) Original Hearings-Administrative Law
Judges, Authority and Power.
(A) All original
hearings in contested cases shall be heard by the administrative law judges of
the division. In any case which has been regularly assigned to an
administrative law judge by the director of the division, that administrative
law judge shall have full power, jurisdiction and authority to issue all
interlocutory orders necessary to the proper and expeditious handling of the
case.
(B) Those interlocutory
orders, including formal dismissal of unnecessary parties, shall be entered in
the minutes of hearings and shall become final upon the issuance of a final
award by the administrative law judge.
(C) An administrative law judge shall not
have any authority to change or modify a final award issued by an
administrative law judge after the lapse of twenty (20) days from the date of
issuance of an award or after an application for review (see
8 CSR
20-3.030) has been filed with the commission in
connection with any final award, order, or decision of an administrative law
judge.
(D) Any administrative law
judge shall have authority and power to approve motions for settlement of
workers' compensation claims; provided, the claim is pending in the division
for adjudication. No administrative law judge shall have authority to approve
settlement of workers' compensation claims pending before the
commission.
(3) Original
Hearings-Compromise Settlements.
(A) No
original hearings in contested cases shall be heard by the commission or any
member of the commission. No compromise settlement of a workers' compensation
claim shall be accepted for consideration by the commission or any of its
members for approval if the claim is pending in the division.
(B) All motions for settlement of claims
pending before the commission shall be submitted to the commission for
approval.
(C) All compromise
settlements of workers' compensation claims pending in the circuit or appellate
courts shall be submitted to the commission for approval. Before filing the
settlement for consideration by the commission, the parties seeking to settle
the claim shall first petition the court for an appropriate order remanding the
matter or otherwise restoring jurisdiction to the commission for consideration
of the settlement. The commission cannot act on any request to consider a
settlement until the court so disposes of the matter.
(4) Modifying Benefit Awards. The commission
shall have sole authority to modify final awards allowing benefits to employees
or dependents. The commission may modify benefit awards from time-to-time upon
motion by an interested party. All motions for modification of final awards
shall be made to the commission and the movant shall have the burden to submit
proof of the change of condition or status of the parties receiving the
benefits, and will also be responsible for providing to the commission, with
the motion, contact information for the employee, and/or each dependent
affected by the motion, including current addresses. Moving parties are advised
that if the commission is unable to provide due notice of the sought
modification to each interested party, the commission will not take any action
to modify the award. Proof of the remarriage of the dependent surviving spouse
shall be made by filing a copy of the marriage license of the remarried
dependent surviving spouse or affidavit of the surviving spouse admitting
remarriage. Proof of the death of the employee or any dependent shall be made
by filing a copy of the death certificate of the employee or dependent.
Evidence of the remarriage of the dependent surviving spouse or the death of
the employee or dependents may be made by deposition or other evidence as the
commission may specify.
(5) Lump
Sum Payment of Compensation (Motion for Commutation).
(A) A motion for commutation of compensation
due may be filed with the division or one of its administrative law judges at
the time a hearing is held and evidence shall be heard on the motion. If
payment of compensation is awarded by the administrative law judge, a decision
shall be made by the administrative law judge relative to the motion for lump
sum payment.
(B) The commission has
jurisdiction over any motion for commutation in all cases in which the award
has become final.
(C) Where the
motion for commutation is not jointly agreed by the parties, the moving party
has the burden to:
(1) file a copy of the
motion for commutation with the commission; and
(2) serve a copy of the motion to all
interested parties.
(D)
When interested parties are notified of the motion, they may file a response
with the commission within twenty (20) days of notification. If no objection is
filed, the commission will review the motion upon the facts and evidence
submitted by the movant and make a decision without ordering a formal
hearing.
(E) If objections to the
commutation are filed, the commission may remand the matter to the division for
a hearing. Upon return of the file, the commission shall review the evidence
and render its decision.
(F) The
commission shall send an order allowing or denying the motion by United States
mail to all interested parties.
(G)
A commutation of compensation due a minor dependent shall not be approved or
ordered until a legal guardian for the dependent has been appointed by the
probate court of the county in which the dependent resides and proof of the
appointment of a guardian and a certificate of the probate court certifying
that the guardian has qualified shall be filed with the commission.
(H) In cases where there is a prior award of
benefits or a duly approved settlement that has finally resolved the parties'
respective rights and duties with regard to periodic benefits payable in the
claim, the commission cannot consider a joint motion for payment of a lump sum
as a compromise settlement under section
287.390, RSMo, unless the
parties are able to identify, in their motion, a legitimate, presently
justiciable dispute, over which the commission would have jurisdiction. In the
absence of such dispute, and where the parties desire merely to close out or
redeem the remaining obligations under the award or settlement via payment of a
lump sum, the commission will treat the motion as one for commutation pursuant
to section 287.530, RSMo.
(I) Where a motion for commutation is jointly
agreed by the parties, the commission will consider the motion provided it
includes the following:
1. For motions to
commute permanent total disability or death benefits:
A. The employee or dependent's date of birth
and presumed life expectancy, including, in the event the parties are
requesting that the commission presume a life expectancy that substantially
differs from that indicated in the most recent edition of the National
Vital Statistics Reports published by the U.S. Department of Health
& Human Services, a written opinion from a medical professional explaining
why the life expectancy so differs;
B. The discount rate and actuarial
assumptions utilized by the parties in calculating the present-day or
commutable value of the future installments that may be expected under the
award or settlement;
C. The
specific facts and circumstances that would support a determination by the
commission that commutation will be in the best interests of the employee or
dependents; or will avoid undue expense or undue hardship to either party; or
that the employee or dependent has removed or is about to remove from the
United States; or that the employer has sold or otherwise disposed of the
greater part of its business or assets; and
D. In the event the parties are seeking
commutation on the basis that such will be in the best interests of the
employee or dependents, or will avoid undue expense or undue hardship to either
party, the specific facts and circumstances that would support a determination
by the commission that unusual circumstances exist in the case that warrant a
departure from the normal method of payment; and
2. For motions to commute open future medical
benefits where the underlying award or settlement does not expressly preserve
to the employer/insurer the discretionary right to close future medical
benefits by funding an annuity or Medicare Set-Aside trust account-
A. The employee's date of birth and presumed
life expectancy, including, in the event the parties are requesting that the
commission presume a life expectancy that substantially differs from that
indicated in the most recent edition of the National Vital Statistics
Reports published by the U.S. Department of Health & Human
Services, a written opinion from a medical professional explaining why the life
expectancy so differs;
B. The
medical expenses incurred by the employee in connection with the claim for at
least the last five (5) years, if any, listed by date, provider, treatment, and
amount;
C. The discount rate and
actuarial assumptions utilized by the parties in calculating the commutable
value of the future installments of medical expenses that may be expected under
the award or settlement;
D. Whether
the employee is currently, or reasonably anticipated to become, within the next
thirty (30) months, a Medicare beneficiary, and if so, whether Medicare has
made any conditional payments for medical treatment related to the work
injury;
E. If a Medicare Set-Aside
trust account is proposed to commute the future installments of medical care,
whether all reasonably anticipated future medical expenses are of the type that
will be covered by Medicare upon exhaustion of the commutation funds, or, in
the alternative, an identification of what additional sums are being paid to
cover expenses not covered by Medicare, including any evidence, attestation, or
other information that would support a finding by the commission as to the
sufficiency of such additional sums;
F. A signed statement from the employee
memorializing his or her understanding and agreement that the funds from the
proposed commutation should be used exclusively for the purpose of paying for
medical treatment related to the work injury, and that failure to expend the
commutation funds for such purpose may jeopardize the employee's later ability
to obtain any financial assistance (via Medicare, private insurance, or
otherwise) for future medical expenses related to the work injury;
and
G. The specific facts and
circumstances that would support a determination by the commission that
commutation will be in the best interests of the employee or dependents; or
will avoid undue expense or undue hardship to either party; or that the
employee or dependent has removed or is about to remove from the United States;
or that the employer has sold or otherwise disposed of the greater part of its
business or assets.
(6) The commission retains jurisdiction over
disputes pertaining to the parties' respective rights and obligations with
regard to future medical treatment whenever a final award or settlement in the
case leaves the issue of future medical treatment "open" or otherwise
indeterminate. See State ex rel. ISP Minerals, Inc. v. Labor &
Indus. Rels. Comm'n, 465 S.W.3d 471 (Mo. 2015). The commission will
only consider issues falling within its statutory authority, such as whether a
disputed treatment is reasonably required to cure and relieve the effects of
the work injury for purposes of section
287.140, RSMo, and will not
entertain requests to "compel" or "enforce" any award or settlement, because
such powers are reserved to the judiciary.
(A)
Upon receipt of a motion identifying a dispute pertaining to future medical
treatment, the commission will allow opposing parties to respond within twenty
(20) days from the date of the commission's correspondence acknowledging the
motion; provided, however, that the commission, in its discretion, may extend
or accelerate the period for filing such a response. If the commission
determines that there is a presently justiciable dispute between the parties
over which the commission would have jurisdiction, and that the movant has
alleged a prima facie claim for relief of a type that the
commission would be authorized to provide, the commission will remand the
matter to the division of workers' compensation for a hearing to take evidence
on the parties' allegations set forth in the motion and responsive pleadings,
if any. Otherwise, the commission may dismiss the motion.
(B) Parties will be entitled to reasonable
discovery in advance of the hearing. Any disputes pertaining to discovery
should be brought to the commission's attention for a ruling. The
administrative law judge will hold in abeyance any action in connection with
the commission's order of remand until the discovery dispute is resolved. The
administrative law judge will hear and rule upon all evidentiary objections
made at the hearing, and will allow the proponent to make an offer of proof
where evidence is ruled inadmissible. At the close of the hearing, the division
will return the file to the commission for a determination of the disputed
issues.
(C) Mediation may be
pursued at the discretion of the administrative law judge assigned to the
matter. If such mediation is successful, the administrative law judge may sign,
if the parties so request, an informal memorandum of understanding outlining
and memorializing the parties' agreement, which should be executed by all
parties and/or their attorneys; provided, however, if the parties desire
approval of a formal settlement agreement resolving the disputed issue of
future medical treatment, such should be forwarded to the commission for
approval pursuant to section
287.390, RSMo. Any formal
settlement agreement should be submitted to the commission in accordance with
the guidelines for compromise settlements set forth in these rules.
(D) If, at any time, the dispute becomes
moot, the parties are directed to advise the commission, and also the division
in the event proceedings are pending in connection with an order of remand from
the commission, that no further action is necessary in connection with the
motion, whereupon the commission will dismiss the motion.
(E) Where the parties' dispute pertains to
future medical treatment which is alleged to be imminently necessary to prevent
harm to the health or well-being of the employee, the commission will entertain
a request to hear the dispute on an expedited or hardship basis. Such request
should include a written opinion from a medical professional explaining why the
requested medical treatment is imminently necessary to prevent harm. Where the
commission grants such expedited review, the commission may issue an order
resolving the dispute based on its own review of the documentary evidence
submitted by the parties, without the formality of ordering an evidentiary
proceeding before the division. To be considered, such documentary evidence
should be certified or otherwise sworn to be authentic via affidavit.
(F) All parties to awards or settlements are
hereby advised that the commission generally disfavors the practice of ordering
further proceedings in open future medical cases except where strictly
necessary; and that the process set forth in this rule does not constitute an
invitation or opportunity to relitigate issues in the case that were previously
adjudicated or stipulated. Accordingly, if the record before the commission
reveals that any party has failed, without reasonable ground, to fully and
faithfully comply with its obligations under the law pursuant to an award or
settlement previously entered in the case, the commission may assess an award
of costs and attorney's fees against said party, pursuant to section
287.560, RSMo. All parties are
thus strongly encouraged to resolve their disputes without recourse to the
commission except in those extraordinary cases where intervention by an
impartial, fact-finding tribunal is necessary.
Notes
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