Fill - Free fillable MISSOURI Report Of Injury (National American Insurance Company) PDF form

WC-1-EDI (02-16) AI

MISSOURI DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS

DIVISION OF WORKERS’ COMPENSATION

REPORT OF INJURY

P.O. Box 58

Jefferson City, MO 65102-0058

(To complete form,

see attached instructions)

GENERAL

EMPLOYER (NAME, ADDRESS, INCL ZIP CODE)

CARRIER ADMINISTRATOR CLAIM NUMBER

REPORT PURPOSE CODE

JURISDICTION

JURISDICTION CLAIM NUMBER

INSURED REPORT NUMBER

EMPLOYERS LOCATION ADDRESS (IF DIFFERENT)

LOCATION #

SIC CODE

EMPLOYER FEIN

PHONE #

CARRIER

CLAIMS ADMIN

CARRIER (NAME, ADDRESS & PHONE NO.)

POLICY PERIOD

CLAIMS ADMINISTRATOR (NAME, ADDRESS & PHONE NO.)

CHECK IF APPROPRIATE

SELF INSURANCE

CARRIER FEIN

INSURANCE POLICY NUMBER

ADMINISTRATOR FEIN

AGENT NAME & CODE NUMBER

EMPLOYEE

NAME (LAST, FIRST, MIDDLE)

DATE OF BIRTH

SOCIAL SECURITY #

DATE HIRED

STATE OF HIRE

ADDRESS (INCLUDE ZIP)

SEX

MALE

FEMALE

UNKNOWN

MARITAL STATUS

UNMARRIED

SINGLE DIVORCED

MARRIED

SEPARATED

UNKNOWN

OCCUPATION JOB TITLE

EMPLOYMENT STATUS

PHONE #

# OF DEPENDENTS

NCCI CLASS CODE

WAGE

RATE

PER

DAY

WEEK

MONTH

OTHER

# OF DAYS WORKED/WEEK

FULL PAY FOR DAY OF INJURY?

DID SALARY CONTINUE?

YES NO

OCCURRENCE

TIME EMPLOYEE BEGAN WORK

DATE OF INJURY / ILLNESS

TIME OF OCCURRENCE

LAST WORK DATE

DATE EMPLOYER NOTIFIED

DATE DISABILITY BEGAN

CONTACT NAME PHONE NUMBER

TYPE OF INJURY ILLNESS

PART OF BODY AFFECTED

DID INJURY ILLNESS EXPOSURE OCCUR

ON EMPLOYER’S PREMISES? YES NO

TYPE OF INJURY/ILLNESS CODE

PART OF BODY AFFECTED CODE

ZIP CODE OF THE LOCATION WHERE THE ACCIDENT OR ILLNESS EXPOSURE

OCCURRED

ALL EQUIPMENT, MATERIALS, OR CHEMICALS EMPLOYEE WAS USING WHEN ACCIDENT OR

ILLNESS EXPOSURE OCCURRED

SPECIFIC ACTIVITY THE EMPLOYEE WAS ENGAGED IN WHEN THE ACCIDENT OR

ILLNESS EXPOSURE OCCURRED

WORK PROCESS THE EMPLOYEE WAS ENGAGED IN WHEN ACCIDENT OR ILLNESS EXPOSURE

OCCURRED

HOW INJURY OR ILLNESS/ABNORMAL HEALTH CONDITION OCCURRED. DESCRIBE THE SEQUENCE OF EVENTS AND INCLUDE ANY OBJECTS OR

SUBSTANCES THAT DIRECTLY INJURED THE EMPLOYEE OR MADE THE EMPLOYEE ILL.

CAUSE OF INJURY CODE

DATE RETURN TO WORK

IF FATAL, GIVE DATE OF DEATH

WERE SAFEGUARDS OR SAFETY EQUIPMENT PROVIDED?

WERE THEY USED?

YES NO

TREAT-

MENT

PHYSICIAN HEALTH CARE PROVIDER (NAME & ADDRESS)

HOSPITAL (NAME & ADDRESS)

INITIAL TREATMENT

0 - NO MEDICAL TREATMENT

1 – MINOR: BY EMPLOYER

2 – MINOR CLINIC HOSPITAL

3 – EMERGENCY CASE

4 – HOSPITALIZED > 24 HOURS

5 – FUTURE MAJ. MED. LOST TIME ANTICIPATED

OTHERS

WITNESS (NAME & PHONE #)

DATE ADMINISTRATOR NOTIFIED

DATE PREPARED

PREPARER’S NAME & TITLE

PHONE NUMBER

WC-1-EDI-2 (02-16) AI

NOTE: This form constitutes the detailed report of injury required by §287.380, RSMo, and rules

applicable thereto. An injury that requires immediate first aid, but does not result in further

medical treatment or lost time from work, need not be reported to the Division. Employers should

report all injuries to their workers’ compensation insurance carrier or third-party administrator

(TPA) within five days of the date of the injury or within five days of the date on which the injury

was reported to the employer by the employee, whichever is later. See §287.380, RSMo. If the

employer has been granted self-insurance authority by the Division pursuant to §287.280, RSMo,

and rules applicable thereto, please report all injuries to your TPA or Service Company to enable

them to file this report with the Division.

PRINT QUALITY: All reports of injury and supporting documents received by the Division will be

processed electronically. All forms submitted to the Division MUST be of clear and legible quality.

Handwritten forms will not be accepted. Computer generated forms shall use a minimum type

size of 10 points. All documents not meeting the above criteria will be returned.

TO BE ANSWERED ONLY IN CASE OF DEATH

DATE OF DEATH

EMPLOYEE’S DEPENDENTS

NAME OF

DEPENDENT

RELATION TO

EMPLOYEE

ADDRESS OF DEPENDENT

ADDRESS

CITY

STATE

ZIP CODE

Missouri Division of Workers’ Compensation is an equal opportunity employer/program. Auxiliary aids and services

are available upon request to individuals with disabilities. TDD/TTY: 800-735-2966 Relay Missouri: 711

WC-1-EDI-3 (02-16) AI

Data Element Dictionary for Hard Copy Report of Injury

Data Element

IAIABC Data Definition

Missouri Notes

Mandatory

Field

Employer (Name

& Address)

The name of the employer where the employee was

employed at the time of the injury.

This is the name the employer does business under followed by

the FULL address including mailing address, city, state and zip

code.

Industry Code

The code which represents the nature of the employer’s

business which is contained in the North American Industry

Classification System Manual published by the Federal

Office of Management and Budget.

See implementation note below:

The industry code selected should represent the primary

nature of the employer’s business. If the employer is

assigned multiple industry codes, use the code that relates

to the specific business operation for which the employee

was employed at the time of the injury. The data element

may contain an SIC code or NAICS Code. SIC code will be

identified with the characters ‘SC’ as the last two characters

of the data element. If SC is not present, the code is

presumed to be NAICS.

This is the Standard Industrial Classification Code for the

employer. SIC/NAICS codes can be found at

www.census.gov/epcd/www/naics.html

Employer FEIN

The FEIN of the employer where the employee was

employed at the time of the injury.

Must be the primary FEIN for the Employer listed above.

Report Purpose

Code (RPC)

Defines the specific purpose of the report being filed with the

state of Missouri.

00 = Original FROI

02=Change

CO=Correction

AQ=Acquired Report of Injury

AU=Acquired Unallocated Report of Injury

The Report of Injury that the employer is required to file with the

Division of Workers’ Compensation (Division) through the

insurance carrier or third party administrator (TPA).

Claims

Administrator’s

Number

Identifies a specific claim within a claim administrator’s

claims processing system.

Number used by the organization adjusting the claim (insurance

company, third party administrator, etc.).

Jurisdiction

The governing body or territory whose statute applies.

This must always be Missouri.

Jurisdiction

Claim Number

The injury number assigned by the Division upon receipt of the

First Report of Injury with all mandatory information provided. The

reporting entity is to leave this field blank.

WC-1-EDI-4 (02-16) AI

Data Element

IAIABC Data Definition

Missouri Notes

Mandatory

Field

Insured Report

Number

A number used by the insured to identify a specific claim.

Employer’s

Location

Address

List the physical address of where the employee sustained

the accident or illness if that location is different from where

the employer wishes to have correspondence sent.

Insured Location

Number

A code defined by the insurer/employer, which is used to

identify the employer’s location of the accident.

Phone Number

List a phone number of the employer location where the

employee worked at the time of the accident.

Carrier (insurer)

Name & Address

The name and mailing address of the carrier or self-insured

entity assuming the employer’s financial responsibility for

the workers’ compensation claim.

If the employer is individually self-insured, the individual self-

insured employer’s name and mailing address would be indicated

in this field. The FEIN and Name must match.

If the employer is self-insured by a trust, the trust’s name

would be submitted in this field.

Carrier (insurer)

FEIN Number

The FEIN of the carrier or self-insured assuming the

employer’s financial responsibility for the workers’

compensation claim(s).

Carrier Policy

Number

The number assigned to the contract/policy for the employer

or association group.

A number assigned by the insurance company, (Not a number

assigned by a TPA) for the specific workers’ compensation

policy for that employer.

Not a required field for Division approved self-insureds.

Policy Period

List the effective and expiration dates of the contract/policy.

The date that the policy became effective and the date the policy

expires or is no longer in effect.

No date is required in this field if the injury falls within the Division

approved self-insurer’s self-insurance period.

Self-Insured

Indicator

An indicator that identifies the employer as one who is

authorized by the state of Missouri to retain the risks arising

from their operations and bears the financial responsibility.

Y=Yes, N=No

Condition – Must indicate Y(Yes) ONLY for an individual employer

or a member of a self-insured trust authorized by the Missouri

Division of Workers’ Compensation to self-insure under § 287.280,

RSMo. It does not include uninsured employers or employers under

deductible insurance policies.

Claim

Administrator

(TPA) Name &

Address

The name and mailing address of the Third Party

Administrator (TPA), independent administrator, contracted

to adjust the claim on behalf of the carrier or self-insured.

Name and mailing address of the Third Party Administrator (TPA),

independent adjuster, contracted to adjust the claim and phone

number of the office adjusting the claim. If there is not a TPA,

independent adjuster/administrator, contracted to adjust the claim

please leave blank.

WC-1-EDI-5 (02-16) AI

Data Element

IAIABC Data Definition

Missouri Notes

Mandatory

Field

Claim

Administrator

(TPA) FEIN

Number

The FEIN of the Third Party Administrator (TPA),

independent adjuster/administrator, contracted to adjust the

claim on behalf of the carrier or self-insured.

FEIN number for the company hired as a TPA. Note: If there is no

Third Party Administrator, please leave blank.

Agent Name &

Code Number

List the name and code number of the carrier or claim

administrator agent who administers the workers’

compensation claims for the employer.

Employee Name

The injured worker’s legally recognized name which is used

on legal documents, employment, Social Security, banking,

records, etc.

Name to include last, first and middle initial.

Employee Date

of Birth

The date the injured worker was born.

Must be a valid date.

Social Security

Number

A number assigned by the Social Security Administration

used to identify the employee.

If a SSN is not available please call 573-526-3542.

Date of Hire

The date the injured worker began his/her employment with

the employer under which the claim is being filed. If there

have been multiple periods of employment, this would be

the beginning date of the current employment period.

Must be valid date.

State of Hire

List the state where the employer hired the employee.

Employee

Address

The mailing address used by the injured worker.

The address should not be listed as unknown. Please include the

last known address provided by the injured worker that is on file

with the employer.

Employee Phone

A telephone number where the injured worker can be

reached.

This is an optional field, although if the employer or insurance

company has this information, please report it to the Division.

This will improve communication between the parties. This will be

a numeric field only 5736367777.

Gender Code

The code which indicates the sex of the employee.

Gender of employee F=Female M=Male U=Unknown

Number of

Dependents

The number of dependents as defined by the administrating

jurisdiction.

Spouse, minor children or others if known. Required if date of

death is entered. Numeric field 0-9.

Marital Status

Code

The code, which indicates the marital status of the

employee.

U = Widowed, divorced, single, unmarried, M = Married,

S = Separated, K = Unknown

WC-1-EDI-6 (02-16) AI

Data Element

IAIABC Data Definition

Missouri Notes

Mandatory

Field

Occupational/

Job Title or

Description

Identifies the primary occupation of the employee at the time

of the accident or injurious exposure.

Employment

Status Code

Indicate the employee’s primary work code status at the

time of the injury with the covered employer.

NCCI Class

Code

A code, which, corresponds to the primary occupation in

which the employee was engaged at the time of the

accident/injury or injurious exposure.

MO uses NCCI codes.

Wage

The reported employee’s pre-injury wage for the wage

period.

Implementation Note:

This amount may include commission, piecework earnings,

and other forms of income converted to a normal scheduled

work week, plus the estimated value of lodging, food,

laundry and other payments in kind; and concurrent

employment earnings, as prejurisdictional requirement.

“Gross Wages” includes, in addition to money paid by the

employer for services rendered by the employee, the reasonable

value of board, rent, housing, lodging or similar advance by the

employer, except if it continues to be provided to the employee for

the period of disability, it is not included in calculating the average

weekly wage. “Wages” also includes gratuity received in the

course of employment from individuals other than the employer

that are reported for income tax purposes. “Wages” does not

include fringe benefits such as retirement, pension, health and

welfare, life insurance, training, Social Security or other employee

or dependent benefit plan provided by the employer.

Please See Special Notes #1

Wage Period

A code indicating the time period during which the wage was

earned.

Please use the weekly wage rate paid to the employee.

Number of Days

Worked

The number of the employee’s regularly scheduled

workdays per week.

Full Wages Paid

for the Date of

Injury Indicator

Indicates whether full wages for the date of the

accident/injury or illness were paid by the employer.

Salary

Continued

Indicator

The employer has paid or is paying the employee’s salary in

lieu of compensation during an absence caused by a work-

related injury.

Did the employer continue to pay salary to the employee after the

injury? N=No Y=Yes

Time Employee

Began Work

Time at which the employee began work on the day of the

accident/injury or illness.

Date of

Injury/Illness

For traumatic injury, the date on which the accident

occurred. For occupational disease or cumulative injury, the

date of injury is the date of last injurious exposure to the

cause or substance creating the condition, unless otherwise

defined by statute.

Date that injury/illness occurred or became known to employee;

whichever is later.

WC-1-EDI-7 (02-16) AI

Data Element

IAIABC Data Definition

Missouri Notes

Mandatory

Field

Time of

Occurrence

The time at which the accident occurred.

To the extent that the time of the occurrence of the accident/injury

is available, you should provide it to the Division. Please indicate

a.m. or p.m.

Date Last Day

Worked

The last paid workday prior to the initial date of disability as

defined by jurisdiction.

Must be valid date.

Date Employer

Notified

The date that the injury was reported to a representative of

the employer.

Date Disability

Began

The first day on which the employee originally lost time from

work due to the occupational injury or disease or as

otherwise defined by jurisdiction.

Date of disability must be greater than Date of Injury.

First date employee starts losing time from work after the date of

injury. This is the day after the date of injury or the first day of

work missed, if later. The three-day waiting period is calculated

from the first date of lost time and the lost time does not need to

be consecutive days.

Please See Special Notes #2

Contact Name &

Phone Number

List the name and phone number for a representative of the

employer.

Type of

Injury/Illness

List the type of injury/illness sustained by the employee.

Part of Body

Affected

List the part of body to which the employee sustained injury.

Employer

Premises

Indicator

An indicator to denote whether the accident occurred at the

employer’s address provided.

If the injury/illness occurred on the employer’s property indicate

“YES.” If it occurred elsewhere indicate “NO.”

Type of

Injury/Illness

Code

The code, which corresponds to the nature of the injury

sustained by the employee.

Choose from the list of code numbers, which corresponds with the

nature of the injury.

A list of codes with description of each code is available at

www.wcio.org/Document%20Library/InjuryDescriptionTablePage.

aspx Please See Special Notes #2

Part of Body

Affected Code

The code, which corresponds to the part of the body to

which the employee sustained injury.

Choose from the list of code numbers, which corresponds with

the part of body injured. A list of codes with a description of each

code is available at

www.wcio.org/Document%20Library/InjuryDescriptionTablePage.

aspx

WC-1-EDI-8 (02-16) AI

Data Element

IAIABC Data Definition

Missouri Notes

Mandatory

Field

Zip Code of the

Location Where

Accident or

Illness Exposure

Occurred

The zip (postal code) that corresponds to the location where

the injury occurred.

The code is required to assist with docket setting if needed.

All Equipment

Using

List all the equipment; materials or chemicals the employee

was using at the time of the accident/injury or illness

exposure occurred.

Specific Activity

Engaged In

Describe the specific activity that the employee was doing at

the time the accident/injury or illness exposure occurred.

Work Process

Engaged In

Describe the work process the employee was doing when

the accident/injury or illness exposure occurred.

How the Injury or

Illness Occurred

A free form description of how the accident occurred and the

resulting injuries.

Describe how the injury/illness occurred. Please include the

events that led to the injury/illness and any objects or substances

that directly injured the employee or made the employee ill.

Maximum of 150 characters, including spaces.

For example: Employee was on ladder putting away product, fell

on chemical barrel breaking lower arm; arm lacerations; exposed

to chemical liquid and fumes (141 characters).

Cause of Injury

Code

The code which corresponds to the cause of injury.

Choose from the list of code numbers, which corresponds with

the cause of the injury. A list of codes with a description of each

code is available at

www.wcio.org/Document%20Library/InjuryDescriptionTablePage.

aspx (Struck by, fell, auto accident, exposure, etc.)

Date Returned to

Work

The first date on which the employee returned to work

following the injury.

Must be a valid date. Must be entered if employee lost days of

work and returned to work before first report of injury is filed.

Employee Date

of Death

The date the injured worker died.

Must be a valid date.

Safeguards

Indicate whether safeguards or safety equipment was

provided by checking “Yes” or “No.”

Were They Used

Indicate whether the safeguards or safety equipment was

used by the employee by checking “Yes” or “No.”

Physician/Health

Care Provider

List the name and address of the physician or health care

provider who provided initial medical treatment to the injured

employee after the accident/injury or illness.

WC-1-EDI-9 (02-16) AI

Data Element

IAIABC Data Definition

Missouri Notes

Mandatory

Field

Hospital

List the name and address of the hospital where the

employee received initial medical treatment.

Initial Treatment

A code used to identify the extent of medical treatment

received by the employee immediately following the

accident.

0= No medical treatment

1= Minor on-site remedies by employer medical staff

2= Minor clinic/hospital medical remedies and diagnostic

testing

3= Emergency evaluation, diagnostic testing, and medical

procedures

4= Hospitalization > 24 hours

5= Future major medical/lost time anticipated

First Aid includes the administration of immediate and temporary

medical aid to the employee that a lay person may provide, such

as the application of Band-Aid to treat a minor scratch or the

removal of a splinter that would not result in the need for a referral

to a doctor or other health care professional for additional medical

treatment or would not result in further lost-time from work. The

on-site company nurse or physician may be the individual that

provides the first aid. If the company nurse or physician provides

service beyond first aid, then the injury must be reported even if

the treatment occurs on-site.

Please see Special Notes #2

Witness

List the name and address of all witnesses who were

present when the employee sustained the accident/injury or

illness.

Date Reported to

Claims

Administrator

The date the claim administrator who is processing the claim

received notice of the loss or occurrence.

Date Prepared

List the date that the representative for the claims

administrator prepared this report of injury.

Preparer’s Name

and Title

List the name and title of the claims administrator’s

representative who prepared this report of injury.

Phone Number

List the phone number of the representative preparing this

report of injury.

M – Mandatory – Cases missing mandatory information will NOT be accepted by the Missouri Division of Workers’ Compensation system.

C – Conditional – Data Elements with Conditional fields indicate a value is required based on another Data Element or pre-existing condition.

Examples: When a death case is reported then the death date would be required.

If the employee has returned to work prior to the report being filed, the date of return to work would be entered.

O – Optional – Data Elements identified as Optional may be entered but are not required.

WC-1-EDI-10 (02-16) AI

Special Notes

1) Wage Instructions

A) Missouri Notes: Report the wage information as the average weekly wage (AWW) of the employee. These rules apply for calculating the average weekly

wage.

1) If the employee’s wage is fixed by the year, the AWW is the yearly wage divided by 52;

2) If the employee’s wage is fixed by the month, the AWW is the monthly wage multiplied by 12 and divided by 52;

3) If the employee’s wage is fixed by the week, that amount is the AWW;

4) If the employee’s wages are fixed by the day, hour or output, the numerator is the actual gross wages earned by the employee in the last thirteen

calendar weeks immediately preceding the week in which the injury occurred; and the denominator is 13 to calculate the AWW.

i) The formula is: Actual gross wages earned in prior 13 weeks/13=AWW. For example, the employee’s hourly wage is $9.00/hour. The overtime rate

is $13.50/hour. The employee works 40 hours per week at $9.00 an hour plus occasional overtime. Employee worked overtime of 44 hours in the

13-week period immediately preceding the week of the injury. The employer has employed the employee for 2 years.

The gross wages are $9.00 X 40 hours X 13 weeks = $4,680. You also need to include the overtime 44 hours. Therefore, $13.50 X 44 hours =

$594. The total wages are $4,680 plus $594 = $5,274. The AWW is $5,274/13=$405.69.

ii) If the employee misses nonconsecutive workdays during the 13-week period in multiples of 5 those days shall be subtracted from the denominator.

For example: if the employee misses 5 days, one week is subtracted from 13 and the denominator becomes 12; if the employee misses 10 days,

two weeks are subtracted from 13 and the denominator becomes 11; and so on.

iii) Partial weeks of time missed by the employee do not count to change the denominator. For example: if the employee misses 4 days, the

denominator is 13; if the employee misses 6 days, one week is subtracted from 13 and the denominator becomes 12; and so on.

iv) If the employee works less than 13 weeks but more than 2 weeks, the AWW is the same formula with the numerator as the gross wages calculated

for the number of weeks of employment and the denominator is the number of weeks of employment. For example, the employee worked for the

employer 8 weeks prior to the week of the injury. The employee was paid $9.00 per hour and worked 40 hours per week. The employee worked 13

hours of overtime. The overtime rate is $13.50. The gross wages are $9.00 X 40 hours X 8 weeks plus $13.50 X 13 hours = $3,055.50. The AWW is

$3,055.50/8=$381.94.

5) If the employee works less than two weeks the AWW shall be equivalent to the AWW for the same or similar employment. However, if the employer has

agreed to a certain hourly wage, then the hourly wage agreed upon multiplied by the number of weekly hours scheduled shall be the employee’s AWW.

B) When the Date Returned to Work is more than three days from the Date Disability Began, the workers’ compensation case will be considered an

indemnity case. You will receive a request for the cost of medical treatment, the date returned to work, and the total amount of temporary total

disability benefits paid to the employee.

C) When Initial Treatment Code is reported as equal to 00, 01 or 02, the case will be considered as a medical only case. If the time period between the Date

Disability Began and the Date Returned to Work is three days or less, the case will be classified as a medical only case. You will receive a request for the

cost of medical treatment and the date returned to work, if not supplied. After all required information has been filed and there is no further activity on a case

for six months, the case may be administratively closed. When the Initial Treatment Code is reported as equal to 03, 04 or 05, the case will be considered

as an indemnity case. You will receive a request for the cost of medical treatment, the date returned to work, and the total amount of temporary total

disability benefits paid to the employee.

WC-1-EDI-11 (02-16) AI

2) Initial Treatment Code, Date Disability Began and Date Returned to Work:

A) When Initial Treatment Code is reported as 00, 01 or 02, the case will be considered a medical only case. If the time period between the Date Disability

Began and the Date Returned to Work is three days or less, the case will be classified as a medical only case. You will receive a request for the cost of

medical treatment and the date returned to work, if not supplied. After all required information has been filed and there is no further activity on a case for six

months, the case may be administratively closed.

B) When the Initial Treatment Code is reported as 03, 04 or 05, the workers’ compensation case will be considered an indemnity case. You will receive a

request for the cost of medical treatment, the date returned to work, and the total amount of temporary total disability benefits paid to the employee.

1) When the Date Returned to Work is more than three days from the Date Disability Began, the workers’ compensation case will be considered an

indemnity case. The three-day waiting period is calculated from the first date of lost time and the lost time does not need to be consecutive days. You

will receive a request for the cost of medical treatment, the date returned to work, and the total amount of temporary total disability benefits paid to the

employee.

C) The following are examples of First Aid treatment:

a) Use of non-prescription medication at non-prescription strength.

b) Cleaning, flushing or soaking wounds on the surface of the skin.

c) Using wound coverings such as bandages, Band-Aids, gauze pads, etc. or using butterfly bandages or Steri-Strips. (Other wound closing devises

such as sutures, staples, glues, etc. are considered medical treatment.)

d) Use of any non-rigid means of support such as an elastic bandage, wrap, or non-rigid belt. (The use of devices with rigid stays or other systems

designed to immobilize body parts is considered medical treatment.)

e) Use of temporary immobilization devices (e.g., splints, slings, neck collars, etc.) while transporting an accident victim.

f) Removing splinters or foreign material from areas other than the eye by irrigation, tweezers, cotton swabs, or other simple means.

g) Use of finger guards.

h) Drinking of fluids for relief of heat stress.

3) Mesothelioma Liability: Several changes to the Workers’ Compensation Law went into effect January 1, 2014. Pursuant to §287.200.4, RSMo,

employers may elect to accept mesothelioma liability in one of the following ways:

a. Insuring their liability by purchasing a workers’ compensation policy;

b. Meeting the requirements of the Division of Workers’ Compensation to qualify as a self-insurer;

c. Joining a Group Insurance Pool that complies with §287.223. (An employer may become a member of the Missouri Mesothelioma Risk

Management Fund);

d. Rejecting mesothelioma liability under the Missouri Workers’ Compensation Law.

Please note that if an employer has rejected mesothelioma liability coverage under the Workers’ Compensation Law, the exclusive remedy provision of the

Workers’ Compensation Law, §287.120, RSMo, does not apply.

4) Occupational diseases: Occupational diseases due to toxic exposure have been defined effective January 1, 2014. The “occupational diseases due to toxic

exposure” includes the following: asbestosis, berylliosis, coal worker’s pneumoconiosis, bronchiolitis obliterans, silicosis, silicotuberculosis, manganism, acute

myelogenous leukemia and myelodysplastic syndrome. The reporting requirements relating to other occupational diseases such as carpal tunnel syndrome, etc.

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