Helmig v. Chick: Past medical bills (and attorney fees) revisited, but likely more to come.

Last March, I wrote an article criticizing a portion of the Michael Irwin opinion where the Western District Court of Appeals awarded the full value of medical benefits directly to the Employee.  My criticism centered on “why the case was not remanded back to the LIRC to determine the mechanism of payment, especially given the Western District’s prior opinion in State ex Rel. Peters v. Fitzpatrick, a 2023 Western District case, and Helmig v. Springfield R-12 School District, a Southern District opinion from 2024.”  On March 24, the Western District issued its decision in Chick v. City of Centralia.  In Chick, the Court again awarded full medical benefits directly to the Employee, but this time explained its reasoning.  Unfortunately, there is still a disconnect between what appears to be a clear mandate from the Western District and decisions from both the Commission and the Southern District.

In Chick, the Missouri Court of Appeals for the Western District tackled what has become a recurring issue in Missouri workers’ compensation law: who gets paid when an injured employee secures medical care on their own after their employer wrongfully refuses to authorize necessary medical treatment. Chick suffered a 2014 workplace injury that ultimately required multiple surgeries after the City refused further treatment. The Labor and Industrial Relations’ Commission recognized that Chick sustained $32,526.48 in past medical expenses but directed payment straight to providers instead of reimbursing him, while also excluding those amounts from the attorney’s fee lien. On appeal, Chick challenged this approach, arguing it violated both Missouri statutes and basic fairness principles. The Western District agreed with Chick in its March 24, 2026 ruling, which expressed a clear message to practitioners – at least in the Western District -- about the limits of Commission authority when it comes to directing payment of past medical bills.

The Chick Decision

Chick, who had been employed with the City from 1995 to 2016, suffered a slip-and-fall accident in 2014 that caused numbness and pain in his right arm. After reporting the injury, he received authorized medical treatment for some time.  At some point, the City declined to provide additional care, and Chick began treating on his own.  Following a hearing, the ALJ issued an award finding that Chick’s February 2014 work injury was the prevailing cause of a brachial plexus injury, but not other claimed conditions, and denied liability for past and future medical care. The ALJ also found that Chick was not permanently and totally disabled and awarded limited TTD, PPD, and disfigurement benefits.

On review, the Commission largely affirmed but modified the award as to past medical expenses, finding Chick met his burden to prove $32,526.48 in treatment related to the compensable injury. However, rather than ordering payment of those expenses to Chick, the Commission directed the employer to resolve the charges directly with the medical providers and excluded those amounts from the 25% attorney’s fee applied to the remainder of the award. A partial dissent argued that past medical should have been paid to Chick and his counsel consistent with prior practice and governing law, citing section 287.270 and Farmer-Cummings v. Pers. Pool of Platte Cnty., 110 S.W.3d 818, 822 (Mo. banc 2003).

On appeal, Chick challenged the Commission’s handling of past medical expenses and attorney’s fees, arguing that it exceeded its authority by directing payment to providers rather than to him, and that this approach improperly circumvented attorney’s fee recovery and violated public policy. He further asserted a due process violation, claiming the Commission decided these issues without adequate notice or opportunity to be heard. Chick also raised additional issues—including the denial of permanent total disability and the refusal to draw an adverse inference from alleged spoliation of surveillance evidence—but those matters are not pertinent to this discussion.

Chick successfully argued that the Commission’s method of awarding past medical expenses—by directing payment to providers rather than to him—was contrary to Missouri law because it effectively granted the employer a prohibited credit for payments made by collateral sources, including his private health insurance, in violation of section 287.270. Under section 287.140.1, employers must provide reasonably necessary medical treatment, and when they fail to do so, the employee may obtain treatment independently and recover those costs. Missouri courts have consistently held that such expenses are compensable and must be reimbursed to the employee. See Erwin v. Midway Arms, Inc., 710 S.W.3d 548, 554–55 (Mo. App. W.D. 2025); Pruett v. Fed. Mogul Corp., 365 S.W.3d 296, 307 (Mo. App. S.D. 2012). While Farmer-Cummings v. Personnel Pool of Platte County, 110 S.W.3d 818, 821–23 (Mo. banc 2003), recognizes a limited defense where an employee’s medical liability has been extinguished (e.g., through write-offs), it expressly preserves the collateral source rule, prohibiting employers from benefiting from payments made by sources independent of the employer. Further, that limited defense is an affirmative one, and it is the Employer’s responsibility to prove that the amounts written off are no longer “owed,” and, in this case, the Employer failed in that endeavor.

Here, the Commission found Chick met his burden to prove $32,526.48 in compensable medical expenses.  However, it directed payment to the providers because much of the treatment had been paid by private insurance. The Court of Appeals held that this approach exceeded the Commission’s authority, as it both violated section 287.270 and failed to actually reimburse Chick for expenses he incurred, including deductibles and co-pays. As the Court noted, “It is not altogether clear why the Commission directed medical expenses paid in the manner that it did or the legal authority it believed it had for doing so.”  The Court remanded the case to the Commission and ordered it to reimburse the Employee the full value of the medical bills.  As to the attorney fee, the Court again remanded the case to the Commission, but instructed it to “address attorney’s fees on the award of past medical in accordance with the principles set forth in section 287.260.1 and 8 CSR 50-2.010(15).”

The Helmig Decision

Contrast the Western District’s handling of Chick with that of the Southern District’s in Helmig.  The two cases were factually similar as it pertains to the past medical bills.  In both, the Employer originally authorized treatment but later refused to provide care.  Both employees sought and received care on their own.  In Helmig, however, the ALJ concluded that her unauthorized treatment was reasonably required to cure and relieve the effects of her work injuries and awarded $152,935.67 in past medical directly to the employee. On review, the Commission agreed that Helmig incurred fair, reasonable, and customary charges in the amount of $152,935.67 for medical treatment sought on her own after her employer stopped authorizing treatment. However – as in Chick -- the Commission allowed the employer to resolve the bills directly with the providers.

On appeal, Helmig argued that the Commission denied her statutory due process by modifying the required method of payment of the past medical award and by removing the past medical expenses from the scope of the 25% attorney's fee because the employer's Application for Review did not challenge either issue, and nothing in the record showed that the Commission gave Helmig appropriate notice and an opportunity to be heard on either issue.  The Southern District agreed, and remanded the case to the Commission without instruction, and, seemingly, with the ability to rule the same way intact: “[W]e recognize that the Commission may, on remand, decide not to pursue the challenged modifications.  All we are holding is that, if the Commission does decide to do so, it must give Claimant and her attorney appropriate notice and an opportunity to be heard as to each non-appealed issue the Commission wants to examine.” (citations omitted).

It’s unclear why the Southern District did not take the same approach as the Western District in Chick.  The Chick court tried to distinguish their opinion from Helmig’s remand by explaining Helmig as merely a due process decision, but that does not seem to square with the permissive language in the Helmig court’s remand instruction quoted above.  Regardless of the reason, the Commission took advantage of the Southern District’s permissive language and, once again, ordered the employer to pay the providers directly.  This time, however, the Commission explained its reasoning, and – to say the least – it does not align with the Western District’s view.

First, the Commission quoted the language in Section 287.140, and stated that “under strict construction, the only right provided for in [that section] is that the employer/insurer is responsible for paying past medical bills awarded.”  It then stated that the payment of those bills “is not an automatic opportunity for the claimant to receive additional benefits,” and cited State ex Rel. Peters v. Fitzpatrick, 681 S.W.3d 566 (Mo. App. 2023) for this proposition.  It then quoted Sterling v. Mid America Car, Inc., 456 S.W.3d 473, 480 (Mo. App. 2014), for the proposition that the “workers’ compensation law instructs employers to pay a claimant’s medical bills directly to the medical providers.” (emphasis added by Commission).  Finally, it quoted from Gill v. Massman Constr. Co., 458 S.W. 2d 878, (Mo. App. 1970) for the proposition that paying the employee directly could result in the employer being liable twice. 

In its remand decision, the Commission did not mention or try to distinguish Farmer-Cummings v. Personnel Pool of Platte County, 110 S.W.3d 818, 821–23 (Mo. banc 2003).  It did not reference § 287.270 RSMo., the collateral source rule.  The only plausible explanation is the Commission felt that the strict construction language included in the legislative changes from 2005 made Farmer-Cummings irrelevant. 

Chick, however, clearly states the opposite.  Two things about the Commission’s opinion on remand in Helmig must be noted:  First, the Commission’s remand opinion in Helmig was not appealed to the Southern District.  We don’t know whether the permissive language from the Southern District directed to the Commission suggests a lean toward the Commission’s approach, or whether it was simply boiler-plate remand language.  Second, Chick was decided after the Commission’s decision in Helmig was issued.  None of the Commission decisions since Chick came down have dealt with the issue, and it will be interesting to see how they handle the Chick remand.  I’m sure there will be more to come, and practitioners with issue should prepare accordingly.

To read the Chick decision from the Western District, click here.

Disclaimer:  The information provided on this legal update is for general informational purposes only and is not intended to be legal advice. While we strive to ensure the accuracy and timeliness of the content, laws and regulations are constantly evolving, and the application of law can vary based on specific facts and circumstances.

Reading this legal update does not create an attorney-client relationship between you and the author, Lanham Legal Services LLC, or any affiliated individuals. You should not act or refrain from acting based on any information in this blog without seeking professional legal counsel tailored to your situation.

If you need legal advice, please consult a qualified attorney licensed in your jurisdiction.

© 2026 Lanham Legal Services LLC