Missouri WC carpal tunnel claim denied because of a 2024 EMG that showed "mild slowing" - employer carrier (Travelers) calling it preexisting. how does the prevailing factor standard actually get applied at hearing?

need help from anyone who has dealt with MO workers comp on a repetitive trauma claim, particularly the "prevailing factor" analysis. trying to figure out if i have a real case or if i should just take the small settlement they are dangling and move on with my life.

quick facts. im 47, software engineer / heavy data entry. been at the same employer in st louis for 14 years. mouse and keyboard 9-10 hours most days, sometimes longer during release cycles. started having bilateral wrist pain and numbness in the median nerve distribution late 2023, classic carpal tunnel symptoms - waking up at night with numb hands, dropping coffee cups, the pins-and-needles routine. PCP referred me to a hand surgeon early 2024 who ordered an EMG / nerve conduction study. EMG showed bilateral median nerve slowing at the wrists, characterized as "mild" - distal motor latencies right at the threshold for carpal tunnel diagnosis. surgeon said conservative management (splints, ergonomic setup, stretching, NSAIDs as needed). i didnt file a WC claim at the time because honestly i thought it was manageable and the company is decent to work for.

fast forward to march 2026. symptoms had been creeping back up through late 2025 and got significantly worse over Q1. constant numbness now, weakness in thumb abduction (cant pinch a button on a shirt some mornings), waking up multiple times a night. saw a new hand surgeon (different practice, different system). he ordered a repeat EMG. results: bilateral severe carpal tunnel, with significant interval worsening compared to the 2024 study. he is recommending bilateral open release surgery as soon as possible, and noted in his report that the progression is "consistent with continued occupational exposure to forceful repetitive activity."

i filed a WC claim with my employer. employers carrier is Travelers. they denied on two grounds: (1) the 2024 EMG establishes a "preexisting condition" so the surgery is not compensable, and (2) my job duties do not constitute "forceful repetitive activity" sufficient to be a prevailing factor in the injury. they offered a $4,800 closing settlement to drop the claim. surgery cost estimate is in the $28k-$42k range plus 4-6 weeks of post-op recovery for each side (so basically 3 months of partial or full disability).

here is what i think i understand about MO workers comp law but want gut checks on.

(1) MO requires that the occupational exposure be the "prevailing factor" in the injury per RSMo 287.020.3 - i.e. greater than 50 percent contribution. the 2005 reforms and Hampton v Big Boy Steel made this a much higher bar than the old "any contribution" standard, and Bond v Site Line Surveying and subsequent cases have applied it pretty strictly.

(2) for repetitive trauma cases, the medical causation opinion has to specifically address prevailing factor - just saying "consistent with occupational exposure" is not enough. the treating doctor or an IME doctor needs to opine to a reasonable degree of medical certainty that occupational exposure was the prevailing (greater than 50 percent) cause.

(3) a preexisting EMG showing mild changes does NOT automatically defeat a claim if the work activity was the prevailing factor in the worsening / aggravation - but you have to specifically frame it as an aggravation claim and the medical opinion has to address it that way. otherwise you walk into the hearing and lose on causation.

(4) repetitive keyboard / mouse use HAS been compensable in MO carpal tunnel cases but the line is fact-specific. ive seen citations to cases like Gordon v City of Ellisville and a couple of admin LIRC decisions that went both ways.

questions for the panel. (a) is the analysis above roughly right? (b) what is the actual standard threshold for "forceful repetitive activity" in a desk-job carpal tunnel case in MO - have keyboard / mouse cases won, or do you basically need manual labor / assembly line type work? (c) what type of expert opinion actually moves a MO ALJ on a desk-job carpal tunnel claim? is a treating surgeons opinion enough or do i need a separate IME from an occupational medicine doc that specifically addresses the prevailing factor analysis? (d) is the Travelers $4,800 offer in the ballpark of what these cases settle for if liability is contested, or am i being significantly lowballed? (e) is this the kind of case a MO WC attorney will even take on contingency, or are they only taking the clear-cut industrial accident cases?

any input from a MO WC attorney or someone who has been through a similar fact pattern would be hugely appreciated. trying to make a decision in the next 2-3 weeks because the surgery is being scheduled.