Can the Insurance Company Deny My Minnesota Work Comp Claim Because of a Pre-existing Condition?

Unfortunately, the work comp insurance company can deny a claim on almost any basis, no matter how flimsy. This is how insurance companies avoid paying claims, because they know that a certain percentage of people will never hire a lawyer or pursue a claim if it has been denied. This is particularly true where the injured worker has health insurance or other benefits available – many people are simply afraid to call a lawyer or don’t know where to begin when their claim has been denied.

However, getting back to the original question: Can the insurance company deny your claim because of a pre-existing condition? The answer is “maybe”. A pre-existing condition may have some impact on whether you have a legitimate work comp claim. However, the simple fact that you have had some prior back problems, for example, does not necessarily disqualify you from bringing a claim for current back problems related to a work injury or your work activities. The issue is more complicated than that.

Example: Prior Back Problems

The real question is whether your prior back problems were affecting your ability to work or limiting your physical or other activities prior to the work incident. Many people have back problems or other physical ailments which intermittently give them some problems but “come and go”. They are able to continue working and enjoying their usual and regular physical activities with only occasional flareups of symptoms. If a work injury or your regular work activities significantly aggravates or accelerates a pre-existing condition to the point where you now need medical care and may need some physical restrictions or limitations, then you probably have a work comp claim.

Prior Work Comp Claims Involving the Same Body Part

Another common issue arises where a person has had a prior work comp claim involving the same body part. We’ll continue with the example of a bad back. Let’s say you had a back injury 10 years ago which was treated as work comp. The insurance company paid you wage loss and medical benefits but you were able to return to work. Now, you have had a new back injury or your work activities have gradually caused an increase or return of your back problems. The claim could be against the same or a new employer, but there will probably be a different work comp insurance company involved since your claim from 10 years ago.

This is a work comp claim, but you can almost be assured there will be a dispute between the current work comp insurance company and the company that provided coverage 10 years ago when you filed your prior claim. In all likelihood, the claim will be covered by one insurance company or the other, but there may be a delay in obtaining benefits while the insurance companies slug it out between themselves.

When in Doubt —  Contact an Attorney

If you find yourself in a situation where your claim has been denied because the insurance company says you have a pre-existing condition, or if two insurance companies are each arguing that the other is responsible, it’s time to contact an attorney. The insurance companies have lawyers and other experts protecting their interests and they are not looking out for yours. An experienced work comp attorney should be able to review your medical records and any prior work comp records and give you an opinion as to what type of claim you have. If the insurance company wants to fight, make sure you have an attorney who is willing to go to bat for you and get you the benefits to which you are entitled.

At Bradt Law Offices, we have been representing your friends and neighbors in work comp and other injury claims for over 30 years. Our clients come from all over northern Minnesota and we are happy to discuss any claim, with anyone, at any time. Whether you just have some questions over the phone or would like to make an appointment to come in for a free consultation, don’t hesitate to call and let us help you. You will always get our honest opinion and there is never any fee unless we recover benefits for you.

Thank you for visiting our blog.

 

Laid off Boise Cascade Employees May Have Workers’ Compensation Claims

If you are an employee of Boise Cascade in International Falls who recently lost your job due to the layoffs, you may be surprised to learn that you have work comp claims. We have represented people in similar situations over the years following major layoffs at Blandin Paper Company and LTV Mining, to name a couple of examples.

In our experience,  employer’s generally do not notify employees about potential work comp claims following a layoff. The simple reason for this is that it would cost your employer money if it had to pay ongoing work comp claims. For this reason, many laid off employees simply collect unemployment compensation and then move on to another job without any idea that they may be eligible for work comp benefits.

Under what circumstances might you have a work comp claim following a layoff?  These are a few examples:

1. You suffered a work related injury at some time during your employment before the layoff;

2. The injury was accepted by the work comp insurer and medical or wage loss benefits were paid;

3. At the time of the layoff, you still had some limitations or restrictions as a result of the work injury (even if you were working at full wage at the time of the layoff);

4. Your previous work injury resulted in a permanent impairment under the work comp disability schedules, but the disability was never rated by your physician or paid by the insurance company;

5. You have a gradual or repetitive type injury which you haven’t yet reported but which is related to your work activities up to the time of the layoff;

6. Depending upon how much time has passed since your injury, you may be entitled to vocational rehabilitation assistance or retraining;

What type of benefits might be available? Again, some examples:

1. Partial wage loss benefits if you find a new job which pays you less than you were earning before the layoff;

2. Compensation for a disability rating;

3. Total wage loss benefits if you were off work and receiving work comp benefits at the time of the layoff;

4. Wage loss and vocational rehabilitation benefits if you have what amounts to a “new” injury which has not yet been reported;

What should I do now?

1. If you have an old work comp claim and were represented by an attorney, contact the attorney to find out if you have any claims which remain available to you after the layoff;

2. If you have an old work comp claim but never had an attorney, contact an experienced work comp attorney to see about your options;

3. If you believe that you have suffered a gradual or repetitive type injury as a result of your work activities which you haven’t reported to the employer, contact an experienced work comp attorney immediately. Work comp claims in Minnesota have notice and filing deadlines – if you miss one of these deadlines your claim will be barred forever.

Our Recommendation

If you have an old claim, think that you have a new claim, or just have questions about work comp benefits following a layoff, contact an experienced work comp attorney for consultation. At Bradt Law Offices, there is no charge for an initial consultation over the phone, in your home or at our office. A layoff is a traumatic, life-changing event. While you may be entitled to unemployment benefits in the near term, you may be surprised to find that you have claims for work comp benefits to help you through this transition in your life. Feel free to contact us at any time with your questions – you will always get our honest opinion and we will help you in any way that we can.

We have been helping your friends and neighbors with work injury claims across all of northern Minnesota for 30 years. Let us help you.

Thank you for visiting our blog and/or our website.

What is Maximum Medical Improvement (MMI) in a Minnesota Work Comp Case?

At some point in your work comp claim, you will almost certainly receive a letter or notice from the insurance company advising you that you have reached Maximum Medical Improvement (MMI).   After receiving such a notice, these are some of the questions you may have:

What is MMI?

Will it have an effect on my benefits?

Can I dispute a finding of MMI?

What is Maximum Medical Improvement (MMI)?  The concept of MMI was added to Minnesota work comp law in 1984. It applies only to injuries which occur on or after October 1, 1984, which basically means pretty much all claims that are ongoing these days.  The most recent definition contained in the work comp statutes (subdivision 13a.) states:

“Maximum medical improvement” means the date after which no further significant recovery from or significant lasting improvement to a personal injury can reasonably be anticipated, based upon reasonable medical probability, irrespective and regardless of subjective complaints of pain.”

Simply put, it means that you are not expected to get any better, even though you may have ongoing pain or work restrictions related to your injury.  If there are no additional treatment recommendations, no pending surgeries and no reasonable expectation of significant improvement, then you have probably reached MMI.  The fact that you may get worse does not mean you haven’t reached MMI.

What effect will a finding of MMI have on your work comp benefits?  The most direct affect will be on your receipt of weekly wage loss benefits, specifically, Temporary Total Disability benefits (TTD). The law provides that TTD benefits will cease 90 days after you have been provided with notice of MMI.  “Notice” means that the insurance company must provide you with a written report or documentation of MMI. Typically, this means that the insurance company mails you a copy of a medical note or report which gives the opinion that you have reached MMI.  This opinion can come from your own physician or from a doctor which the insurance company sends you to for an Independent Medical Exam (IME).

Can my TTD benefits be discontinued based upon MMI even if I remain out of work and still have restrictions?  Unfortunately, yes.

Does a finding of MMI affect my temporary partial disability benefits (TPD)?  No.  If you still have restrictions from the work injury and are working but earning less than your pre-injury wage, a finding of MMI does not affect your partial wage loss benefits.

Will a  finding of MMI affect my entitlement to ongoing medical care for the work injury?  Technically no, but some insurance companies will take the position that if you have reached MMI you don’t need any additional medical care.  You may need to hire a lawyer or fight with the insurance company for payment of additional medical bills or authorization for medical care.

Can I dispute or fight a finding of MMI?  Yes you can.  If an insurance company doctor says you have reached MMI but your treating physician disagrees, you may have a good chance at a hearing to overturn the MMI finding.  The insurance company doctor will almost always give the insurance company the opinion they want (and are paying for) but it isn’t always consistent with the medical evidence or the opinions of your treating doctor. If you are fortunate enough to have a treating doctor who is supportive of your claim and willing to write a report, you have a very good chance of winning at a hearing. That’s why it’s very important to choose your physician carefully when you have a work comp claim.

Our Recommendation

The concept of MMI can be confusing and can have a significant  impact on your work comp claim.  It is important to know that you have the right to contest an MMI finding and to fight the insurance company if you disagree with any determination they make on your claim.  It’s a good idea to consult an experienced work comp attorney anytime the issue of MMI arises on your claim.  Most attorneys will be happy to provide you with information or a free consultation about your claim and whether you need legal assistance.  At Bradt Law Offices, we have been providing work comp help to injured workers throughout northern Minnesota for 30 years. Please feel free to contact us at any time with questions about your claim or the work comp system.  Your initial consultation is always free and you will always get an honest opinion about your case and whether you need a lawyer.

Thank you for visiting our blog and please read through some of our other blog posts for more information on a variety of work comp topics.

Boise Announces Layoffs at International Falls Plant

Boise Inc. recently announced plans to lay off 265 paper workers at its International Falls plant.  The company will permanently terminate the 265 employees by October and will shut down two production lines. No announcement has been made at this time as to how many of the workers to be laid off will be salaried or how many will be hourly.  Approximately 580 workers will remain employed at the plant following the layoffs.

This is another significant blow for working men and women in northern Minnesota, following layoffs and shutdowns in the past several years at LTV Steel, Blandin Paper, Georgia Pacific, Verso Paper and Potlatch, among others.  Following a layoff, it can be helpful to know that there are various resources available which might provide financial assistance or help transitioning to a new job.  Many workers are surprised to learn that they may be entitled to work comp benefits from an old injury, even if they had been back to work at full wage for several years up until the layoff.

While this doesn’t necessarily apply in every case, it is certainly worth investigating by checking with an experienced  work comp attorney.  After the devastating bad news of a layoff, you might be surprised to learn that you have wage loss, medical or vocational rehabilitation assistance available to you based upon an old work injury claim.

For more information about this topic please take a few moments to review this recent article on our blog, entitled “Can I Get Minnesota Work Comp Benefits after a Layoff?”.

We hope that you have found this information helpful.  Please don’t hesitate to contact us if we can be of assistance or answer any questions for you.  Attorney Steve Bradt has been representing injured workers all across northeastern Minnesota and the Iron Range for nearly 30 years.  If you’ve been injured, we can help.

Thank you for visiting our blog.

Can I Get Minnesota Work Comp Benefits after a Layoff?

If you have ever been laid off from a job, either on a temporary basis or permanently, you know the gut-wrenching fear of suddenly being without a job and without income.  What will you do about house payments, truck payments, groceries, school expenses and tuition?  What about health insurance or other benefits that your employer may have provided?

Suddenly, you are scrambling to find other sources of income or ways to make ends meet. Obviously, you begin with a job search. You might also check into available benefits through unemployment or other sources.  At the end of the day, however, you are facing a major change in your life both personally and financially.  A possible benefit that most people tend to overlook might be workers’ compensation benefits.

Over the years, we have helped many people in northern Minnesota with work comp claims after they were permanently laid off following shutdowns or downsizing at LTV Steel, Potlatch and Blandin Paper, among other large employers.  Another large layoff has recently been announced for Boise Cascade in International Falls.

How Can I Get Work Comp Benefits after a Layoff?

There are several situations where you might be eligible for work comp benefits after you have been laid off from a job.  These situations might include if:

-You had a prior accepted work injury which resulted in surgery;

-You had work restrictions from a prior accepted work injury at the time of the layoff;

-You had a prior accepted work injury which requires additional medical care;

-You have a recent work injury that has not been reported;

-Your job duties right up until the date of the layoff have contributed to an injury or disabling condition;

The term “accepted work injury” means an injury that was reported to the employer and work comp insurer and was accepted, or admitted, by the work comp insurer as a work injury.  Typically, the insurance company would then pay medical bills or wage loss benefits depending upon the nature and extent of the injury.

If you had injuries during the years of your employment which were not reported or which were denied, the statute of limitations might prevent you from bringing claims at this time.  Consulting with an attorney would help you to establish whether it’s too late to file a claim.

You Had a Prior Accepted Work Injury Which Resulted in Surgery

If at some point during your employment you had a work injury and received work comp benefits, including surgery, you may have some ongoing claims.  If you had surgery, you may have been given a permanent partial disability rating (PPD), for which the insurance company paid you some money.  Or, maybe you have a PPD rating from a surgery and the insurance company never paid you – that claim is probably still available.

A prior surgery might also support a claim that you have ongoing restrictions related to the work injury, even if no formal restrictions were ever given to you by your treating physician.  Sometimes a friendly doctor will simply tell you to “take it easy” or “just do what you can”, without writing out specific restrictions on how much you can lift, how often you can bend, etc.  Your treating physician might be able to put some restrictions on you now, which would support a claim for wage loss benefits while you try to find a new job.  Under those circumstances, you may have a partial wage loss claim if you find another job which pays you less than you were earning when you were laid off.

You Had Work Restrictions from a Prior Accepted Work Injury at the Time of the Layoff

Even if you were working at full wage on the date of the layoff, if you had restrictions from a prior work injury, you might be able to claim partial wage loss benefits now if you find a new job that pays you less.  You may also be eligible for vocational rehabilitation services to help you find a new job.

You Had a Prior Accepted Work Injury Which Requires Additional Medical Care

In my twenty-nine years of experience handling work comp claims in northern Minnesota, I have seen many, many men and women who are “working hurt”.  These are people who suffered an admitted work injury and chose to go back to work without any formal work restrictions even though they were still suffering from back, neck, shoulder, knee, etc. pain and limitations.  Often, the work environment can be very intimidating for someone who claims an injury or needs work restrictions.  For that reason, many people simply tough it out and continue working to avoid being ridiculed by coworkers or supervisors.

However, if the medical records document that you had a legitimate work injury and there is current medical support for work restrictions, it may not be too late to file a claim for wage loss benefits now that you are laid off.  The key is to have solid medical support from a treating physician who will relate your ongoing difficulties to a work injury that was accepted at the time you reported it.

You Have a Recent Work Injury That Has Not Been Reported

If you have very recently suffered an injury at work but have not yet reported it to your employer, you should do so immediately. There are strict deadlines for actually reporting an injury once you are aware that it is related to your work activities.  If you fail to report the injury quickly enough, the claim might be barred forever.  Reporting an injury after a layoff will automatically be viewed suspiciously by the insurance company, but if you can prove that the injury is work related, you should definitely pursue it.

The notice of a work injury should be given in writing to a supervisor, human resources person or anyone else in a position of authority with the employer and should specifically state the nature of the injury and how it is related to your work.  You should also follow up right away with a doctor to document the nature of the injury and obtain treatment.

Your Job Duties Right up until the Date of the Layoff Have Contributed to an Injury or Disabling Condition

Not all work comp injuries are the result of one specific incident.  If you fall off a ladder and break your arm, that’s pretty clearly a work comp injury which occurred at a certain time on a certain date.  However, if your work activities over a period of time have gradually resulted in a painful or disabling medical condition, that can also be a work comp claim.  A good example might be someone who spends all day, everyday, bent over shoveling or lifting.  Eventually, that person develops back pain and requires medical care.  If his work activities contributed to the development of his disabling  back condition, that would be a repetitive injury work comp claim.  Another example might be someone who develops carpal tunnel syndrome from repetitive work activities involving the hands and wrists.  These types of claims are called repetitive, or Gillette injuries.  A Gillette injury can involve any body part which is subjected to repetitive stress in the course of employment.

The date of injury for a repetitive use  (Gillette)  injury, can be the first date you see a physician, the first day you become disabled or limited from the injury, or the last day you work, among other possible dates.  If you suspect that you have such a claim from your work activities, you should give written notice to your employer immediately, explaining that you have a medical condition which you believe is related to your work activities.  Again, follow-up with your physician right away and describe in detail what your job duties were and how they seemed to cause or increase your symptoms.

Deadlines and Other Limitations

As mentioned above, there are deadlines which apply to giving notice of an injury and there are additional deadlines for actually filing a work comp claim. If you had an injury at some point in the past that you didn’t report or which was denied, it may be too late to pursue any claims at this time. However, if you had an injury that was accepted by work comp, no matter how long ago, you may still have some benefits available to you, including wage loss, permanent impairment, medical or vocational rehabilitation and retraining.

There are also limitations or “caps” on certain types of benefits, so not all benefits would be available after a certain amount of time has gone by. Either way, it’s probably worth looking into now that you’ve  been laid off and will be looking for a new job.

Our Recommendation

If you have been laid off from a job and have a work related injury or disabling medical condition related to your work activities, consult with an experienced work comp attorney to see if you have any rights or claims available to you. You can be assured that the employer will not follow up with you after the layoff to remind you about any available work comp benefits.

We have been representing injured workers across all of northern Minnesota for nearly 30 years. You can contact us at any time for an absolutely free consultation.  We will always give you nothing but our honest opinion about your possible claims and will be happy to help you in any way that we can.  Call us with questions at any time.

Thank you for visiting our blog.

My Minnesota Work Comp Claim Was Denied. Now What?

So, you were injured on the job, filed an injury report and the claim has been denied by the work comp insurance company. What do you do next?

Simple. You should contact an attorney in your area who has experience in Minnesota work comp claims.  Why wouldn’t you? Most attorneys will not charge you to discuss the claim, answer your questions or even meet to review the facts and determine whether you have a case.  If you are in northern Minnesota and call us, I can promise you for certain that we won’t charge you for any of these things – ever.

There are a number of reasons the insurance company might give for denying your injury claim, including:

  • The injury didn’t  happen at work or in the course and scope of your employment;
  • You waited too long to report the injury or file a claim;
  • Your medical or physical problems are the result of a pre-existing problem;
  • You were not an “employee” as defined by the work comp laws in Minnesota;
  • There is no medical proof or support for your claimed injury;
  • Your injury was the result of your own intoxication;

There are many other defenses to a work comp claim but these are some common examples.  Sometimes the defense is valid and you don’t have a claim, but many other times the defense is bogus.  The insurance industry counts on the fact that a certain percentage of people will not pursue a claim after it has been denied.  Many people simply do not want to hire a lawyer or “make waves” with their employer.  Other people assume that if the claim is denied, the insurance company must be correct and there is no claim to pursue.  Or, it might just seem easier to let your health insurance company pay the medical bills and continue to work in pain every day.

None of these are good options if you truly believe that you were hurt on the job. Choosing to walk away from a potential work injury claim is simply a bad idea.  It benefits the insurance company by saving them money.  It hurts you if you have a legitimate claim that should be paid by work comp, not only now, but if you continue to have problems down the road with your current or a new employer. It only gets more difficult to prove a claim the longer you wait.

At the very least, it’s a good idea to consult with an attorney to see if you have a claim. Over the past 29 years handling work comp claims, I have spoken with hundreds, if not thousands, of people in your situation.  Their claim has been denied and they are intimidated by the insurance company or afraid to fight back.  Or, they are afraid that hiring a lawyer will cost them a lot of money that they don’t have. Sometimes my honest opinion is that there is no claim.  More often than not, however, people I speak with have legitimate claims that are definitely worth pursuing.

The insurance company has lawyers and experienced claims adjusters handling their cases.  They are well aware that many of the claims they deny are probably legitimate claims but the people will not pursue them.  They win, you lose.

Our Recommendation

If you have been injured on the job, or if you have a medical condition or disability which you believe was caused or aggravated by your work activities, immediately file a report of injury with your employer. If the claim is then denied or if you have any questions or concerns, contact us for an absolutely free consultation to discuss your rights and options.  You will always get our honest assessment and opinion about any possible claims.  If you decide to hire us, we only get paid if we win the case or recover benefits for you.

If you would like more information about how we get paid in a work comp case, or when you should consider hiring a lawyer, please see these earlier posts:

How much does it cost to hire a workers’ compensation lawyer in Minnesota?

When should I hire a lawyer for my Minnesota workers’ compensation claim?

We hope that you have found this information helpful. Please don’t hesitate to contact us if we can be of assistance or answer any questions for you.  Attorney Steve Bradt has been representing injured workers all across northeastern Minnesota for nearly 30 years.  If you’ve been injured, we can help.

Are Work Restrictions Important in a Minnesota Work Comp Case?

The simple answer to this question is: Heck Yes!!

As you progress through a typical work comp claim in Minnesota, you will likely be given work restrictions by your treating physician.  You may be off work completely for some period of time or you might be able to continue working within  restrictions.  At some point, your treating physician might release you back to work with “no restrictions”, thinking that he is doing you a favor.  Unless your injury was very mild and temporary, a release to work with no restrictions can create many problems for you.

What Are Work Restrictions and Why Are They Important?

Following a work injury, it is often necessary for your physician to give you restrictions, in order to allow you to continue working without further injuring yourself.  While this sounds like simple common sense, it can be a confusing issue for someone who’s never been through the work comp system.  Also, many doctors are not familiar with the work comp system or prefer not to get involved, so this can also create problems.

An example of a very simple restriction might be “no lifting more than 50 pounds”.  Maybe you sprained your back or have a sore shoulder but don’t require surgery and just need a little time to heal.  If you have a job that is not too physically demanding, you might be able to continue working with the restriction until you are fully healed.

On the other hand, if your injury is more severe, your physician may need to limit how much you can lift, how many hours a day you can work, or how much bending, twisting and turning you can do.  Other injuries might require restrictions on the use of your arms, hands or knees. You might be limited to no use of ladders, no working at heights, no use of power tools, no exposure to dust or fumes……….. the list of possible work restrictions is almost endless, depending entirely upon the nature and extent of your injury.

Why Are They Important?

Again, the common sense answer is that they are important to prevent you from aggravating your injury or re-injuring yourself as you recover. The goal of the work comp system is to return you to work at your date of injury job without wage loss.  That can’t  happen if your job duties make your injury worse.

However, the other reason why work restrictions are important is that they provide you with the ability to recover wage loss benefits under the work comp system in Minnesota.  Without restrictions related to your work injury, you do not have a claim for wage loss benefits.  The restrictions do not have to be significant, but you need some restrictions related to the work injury or the insurance company will not have to pay you a wage loss benefit.

So, if your physician releases you back to work with no restrictions and you are then laid off or the employer does not have a job for you, you don’t receive wage loss benefits.  I know this sounds crazy and unfair, because you are clearly out of work as the result of a work injury.  However, no restrictions = no wage loss.

How Significant Do the Restrictions Need to Be in Order to Get Wage Loss Benefits?

The restrictions do not have to be significant at all.  For example, if you had a minor low back injury and you are now limited to lifting no more than 75 pounds, this would be a restriction.  Your actual job might never require you to lift anywhere near 75 pounds, so you would be perfectly capable of performing all your job duties within those restrictions.  However, if the job ends or you are laid off for some reason, that 75 pound lifting restriction might allow you to claim wage loss benefits from work comp while you search for another job – or, if you find a job that pays you less than you were earning when you were injured.

What If the Insurance Company’s IME Doctor Says I Have No Restrictions?

This is very common.  The insurance company may send you for an Independent Medical Examination (an IME) in order to get opinions they can use to cut off your benefits.  The report from the IME doctor may say that you are capable of working full time without any restrictions.  The insurance company may then attempt to discontinue your wage loss benefits and refuse to pay for any future vocational rehabilitation or medical treatment.  At that point, it is very important to have a supportive treating physician who will write a letter for you or your lawyer, explaining that you still have some work restrictions which are related to your injury.  The dispute would then be decided by a work comp judge at a hearing.

What If My Employer Won’t Take Me Back to Work Unless I Have No Restrictions?

Unfortunately, some employers have a “no light duty” policy and will not take you back unless you are released to full duty with no restrictions. This obviously can put you in a very difficult situation, particularly if you have a good job with benefits and  the usual monthly financial obligations which most working people have.  Under those circumstances, I have had many clients over the years feel that they were in an impossible situation.  They felt as if they had no alternative but to ask their doctor for a release to work with no restrictions.  Usually, they then returned to work and suffered at their job, often making the underlying injury worse or aggravating their symptoms.

To make matters worse, a work comp judge in Minnesota has no jurisdiction or authority to order an employer to create a light duty job or take you back to work with restrictions.  In that situation, the employer holds all the cards and the employee has few options.

What If I Have Permanent Work Restrictions and My Employer Can’t Take Me Back?

If you have permanent restrictions from a work injury which has been accepted by the work comp insurance company, you may be eligible for a variety of work comp benefits. These would include wage loss benefits, compensation for permanent impairment, vocational rehabilitation services or even vocational retraining.  For more information on the various types of benefits which might be available to you, please see some of our previous blog posts:

-What Is Permanent Total Disability in Minnesota Work Comp?
-Retraining in a Minnesota Workers’ Compensation Case
-How Long Do Work Comp Wage Loss Benefits Last in Minnesota?
-How Much Is a Permanent Partial Disability Rating Worth in a Minnesota Work Comp Claim?

Our Recommendation

If you have any questions or concerns about the issue of work restrictions, we are happy to answer your questions at any time with a completely free, no obligation consultation.  We will meet with you in our office, in your home or on the phone to help you understand the work comp system and your rights.

Always be sure to let your doctor know about any difficulties you are having following an injury.  While it is important to be able to return to work, your doctor should understand what your job duties are and how they might affect your injury and recovery.  Simple, common sense restrictions from your doctor will protect you from re-injury on the job, but will also provide you with protection if you can’t work and need to claim wage loss benefits.

We hope that you have found this information helpful.  Please don’t hesitate to contact us if we can be of assistance or answer any questions for you.  Attorney Steve Bradt has been representing injured workers all across northeastern Minnesota and the Iron Range for nearly 30 years.  If you’ve been injured, we can help.

Thank you for visiting our blog.

Types of Settlements in Minnesota Workers’ Compensation Claims

Each day I take a few minutes to review the statistics for this blog to find out how many people are visiting and what type of search terms they are using to find us.  The overwhelming number of searches that bring people here involve questions regarding settlements.  I have previously written posts entitled:

When Do You Get a Work Comp Settlement in Minnesota, and

How Much Can I Receive for Minnesota Work Comp Settlement

Based upon what I have seen readers searching for, this seemed like a good time to write another post discussing the types of settlements you might receive in a Minnesota work comp claim.  I won’t go into details from the other posts regarding the timing of a settlement and how claims are valued for settlement purposes.  In this post, I will discuss the most common types of settlements that I have seen in my practice, handling work comp claims in northern Minnesota over the past 29 years.

To- Date  Settlement

A “to-date” settlement is just what it suggests.  It represents a settlement of disputed claims only through the date of the settlement agreement.  The dispute might involve medical issues, wage loss benefits, vocational rehabilitation issues or any combination of work comp benefits.  The claims might be disputed because the insurance company has denied primary liability or the dispute might revolve around differing opinions between treating physicians or the insurance company doctor. There are always plenty of things for an insurance company to fight about.

Regardless of the dispute, the parties agree to settle the claim only through the date that the agreement is reached.  The settlement may involve payment of some amount of disputed wage loss benefits or it might simply be an agreement to provide medical care or approve surgery.  A Stipulation for Settlement will be prepared, signed by the parties and submitted to a compensation judge for approval.  Once approved, the disputed issues are settled but no future claims are compromised, limited or surrendered.

In my experience, these types of settlements don’t occur all that often, primarily because the insurance company usually wants to close all claims completely when they make a settlement.  However, under certain circumstances a to-date settlement might be in everyone’s best interest.

Full, Final and Complete  Settlement with Future Medical Claims Left Open

This is probably the most common type of settlement.  Again, the dispute between you and the insurance company might involve one or many issues.  Perhaps the insurance company is attempting to discontinue your wage loss benefits, has denied your claim for vocational retraining or simply wants to pay you a lump sum to close your file and be done with you.  In its most common form, this type of settlement means that, for an agreed-upon lump sum payment, you have closed out, or given up, all future claims for any type of work comp benefits relating to your injury, except medical coverage or treatment.  If you can agree with the insurance company on a dollar amount and the appropriate terms, a Stipulation for Settlement is prepared, signed and submitted to a judge for approval.  The judge can refuse to approve the settlement for a number of reasons, although such refusal is extremely rare, particularly where both parties are represented by experienced attorneys.

It is also important to note that when we say you are closing out all claims, we are only speaking about claims related to the specific work injury you are presently claiming.  You cannot close out future claims related to injuries you haven’t had yet or don’t know about.

Full, Final and Complete  Settlement with Some Future Medical Claims Left Open, Some Closed

In this type of settlement, you would settle your claim on a lump sum basis and only limited future medical coverage would remain open with respect to the claimed injury.  Under the terms of this type of settlement, the parties will negotiate a closeout of certain, specific, future medical coverages.  A common example would be the insurance company’s request for a closeout of future acupuncture or acupressure expenses, health club memberships, massage therapy or other types of passive treatment.  The insurance company does not want to end up paying for this type of treatment after a settlement or, worse, fighting over this treatment with you and your lawyer and having to pay for the treatment and your lawyer’s attorney fees.

You would still be covered by the work comp insurance company for all other future medical treatment, such as doctor appointments, physical therapy, surgery, injections, MRIs, etc.  Basically, anything that is not specifically closed out remains available to you, subject to the work comp laws.  The insurance company can still challenge future medical bills and make you prove that the treatment is reasonable, necessary and related to your work injury.  Leaving future medical coverage “open” doesn’t  necessarily mean the insurance company has to pay every medical bill you ever submit for the rest of your life without challenge.

Some other common future medical benefits which are sometimes closed out are chiropractic expenses, pain clinic programs, psychological or psychiatric coverage.  All of these types of treatment or therapy are ordinarily covered under the work comp law and would be theoretically available to you after a settlement if you don’t specifically agree to close them out.  The insurance company cannot force you to close these future claims out, but often makes this a term of the settlement they are proposing.  In other words, they won’t pay the settlement money unless you agree to these terms.  Whether or not to close out any future medical benefits as part of a settlement is a decision you and your lawyer will have to make based upon all of the facts and circumstances of your particular claim and medical condition.

Full, Final and Complete  Settlement with All Future Medical Claims Closed

This is a rare type of settlement and most often occurs where the insurance company has denied the entire claim right from the beginning.  In other words, the insurance company has denied “primary liability”, and has raised one of many possible defenses to the claim.  They may be claiming that the injury is not covered by work comp, didn’t  happen on the job, is a pre-existing condition or was caused by your intoxication or horseplay.  For whatever reason, the insurer will not accept the claim or pay any benefits voluntarily.  Depending upon the medical or other evidence, the insurance company may still be willing to pay a settlement in order to avoid the risk of trial.  You may be willing to do the same.

Under those circumstances, an agreement might be reached for a lump sum payment which closes out all work comp claims relating to the injury, including future medical.  Like any other settlement, it must be approved by a compensation judge.  However, where there is a denial of primary liability and a possibility that you could end up with nothing if the case went to a trial, a compensation judge is generally going to approve such a settlement.

Structured  Settlements

While not very common, sometimes an insurance company will offer a structured settlement instead of a single lump sum. This more often occurs where the injured worker is a younger person and has a potentially large claim into the future.  The terms  would be the same as one of the settlements listed above, but instead of a single lump sum, the payment might be in the form of a structured settlement or an annuity, paid out over time in regular installments.

Summary

Every case is different and these are just the most common types of work comp settlements that I have negotiated over the years.  There are other, less common types of settlements, which might be negotiated depending on the circumstances of a particular case.  If you have a work injury claim and the insurance company wants to make a settlement, please take the time to contact an experienced attorney before you make a settlement. The insurance company hires attorneys and claims adjusters to protect their interests.  Why wouldn’t you do the same?

If you have any questions about a work comp claim, a settlement offer or any other issues relating to work comp,  please feel to contact me at any time with your questions.  I would be happy to arrange to meet with you for an absolutely free consultation at your convenience. You will always get my honest assessment of your claim and my advice as to whether you need a lawyer.

Thank you for visiting our blog.  At Bradt Law Offices, we have been representing injured workers all across beautiful northern Minnesota and the Iron Range for nearly 30 years.  If you have found this information helpful, please share this site with your friends or neighbors  who might have workers’ compensation questions or problems.

Bradt Law Offices Video

Steve Bradt introduces himself and talks about his northern Minnesota law practice in this video

What If Work Comp Refuses to Pay for Surgery on Your Minnesota Work Injury Claim?

As I try to keep this blog updated, I spend part of each day reviewing the search terms that readers are using as they search for information about Minnesota work comp issues. Among the most common search terms I see are searches like this:

“The workers’ compensation insurance company won’t pay for surgery-what can I do?”

“The work comp IME doctor says I don’t need surgery-can I fight it?”

“Who decides if work comp has to pay for my surgery?”

This is one of the more common disputes that I deal with on a weekly basis in my work comp practice here in northern Minnesota. Even if your claim has been accepted by the work comp insurance company and they are paying wage loss or other benefits, they still might refuse to pay for a surgery recommended by your treating doctor or specialist. At that point, you really don’t have any choice but to hire a lawyer and file a request for a medical conference or hearing.

How can the insurance company deny your doctor’s surgical recommendation?

In general terms, every medical dispute comes down to three factors. The factors are whether the treatment or procedure is:

- reasonable,
– necessary, and
– related to the work injury

If the insurance company questions whether the proposed surgery is reasonable, necessary or related to your admitted work injury, they have the legal right to get their own medical opinion before deciding whether to approve the surgery. This medical opinion is called an Independent Medical Exam (IME).   (For more  information about an IME, you can see this previous post- “An Independent Medical Exam in Your Minnesota Work Comp Case”)

Once the insurance company gets a report from the IME doctor, they will decide whether to approve or deny the surgery (or any other medical procedure which might be in dispute).

What are my options once the surgery is denied by the insurance company?

If you have an attorney, he will handle all of this for you. He will generally request a report from your surgeon explaining what surgery has been recommended, why the surgery is necessary and how it is related to your injury. Sometimes, the only dispute is whether the surgery is really necessary, particularly if there are other more conservative medical treatments which have not yet been tried ( physical therapy, injections, etc).

In other cases, there may be a dispute as to whether the recommended surgery is related to the work injury. The IME doctor will often give an opinion stating that your work injury was only a” temporary aggravation “ of a pre-existing condition, and that the surgery is therefore not related to the work injury, but rather to your pre-existing condition.  ( The burden of proof is on the employee to establish a medical claim, so you will need some medical support or explanation from your treating physician if that is the issue)

There are also treatment parameters which require certain conditions or prior treatment to be done before a surgical procedure is authorized under the work comp law. An insurance company may sometimes rely on these to deny prescribed surgery or treatment.

 

What are the procedures for getting surgery approved?

Generally, a surgical dispute will require a formal hearing before a work comp judge. The process begins with getting the dispute “certified”, after the insurance company has an opportunity to approve or refuse the request for surgery. Once the insurance company has refused to authorize the surgery, the dispute is officially “certified” and you may request a hearing to have the matter decided. At the hearing, a compensation judge will listen to your testimony and review all the medical records and reports before making a decision. Either party may appeal the decision, which may delay the matter even longer.

While you are not required to have an attorney to file a request for a medical hearing, it would generally be a bad idea to represent yourself. The insurance company will have an attorney representing them, which would put you at a very serious disadvantage when it comes to knowing the rules and procedures of presenting a case to a work comp judge.

Can I just have my health insurance pay for the surgery?

This is an option under certain circumstances. Obviously, you need to have health insurance to make this an option. In addition, most health insurers will not pay medical treatment related to a work injury unless the work comp insurance company has specifically denied authorization for the treatment or refused to pay medical bills. At that point, the health insurer will generally step in and pay the bills  while you continue to pursue the claim within the work comp system. If you ultimately win or settle the medical dispute, the work comp insurance company will have to  reimburse your health insurance and also reimburse you for any out-of-pocket medical expenses related to the disputed medical procedure.

Are there advantages to having work comp pay for the surgery instead of my health insurance?

Absolutely. There are a number of reasons why you are much better off having work comp pay for your surgery, rather than your health insurance. Some of these reasons are:

- work comp pays 100% of the medical bills, with no co-pays or deductibles
– work comp will usually have to pay you wage loss benefits until you can return to work after the surgery
– work comp will reimburse you for your medical mileage
– you may be entitled to a permanent partial disability (PPD) payment if it is work comp
– the injury/surgery will now be “on the books” as work comp, which protects you if you have a flareup or more problems later on

Our Recommendation

If the work comp insurance company refuses to authorize a recommended surgery, or seems to be delaying a decision or otherwise “dragging things out”, it would be a good idea to consult an attorney. Sometimes, all it takes is the involvement of a good work comp attorney to get the insurance company’s attention and make them stop screwing around with you and your claim.

A good attorney will know what medical support is needed to take a dispute to a hearing and will be able to get the records and medical reports necessary to get the surgery approved.  (Assuming you are fortunate enough to have a doctor who is cooperative and supportive of your work comp claim – unfortunately, not all doctors are. If interested, see this previous post-  “Choosing a Doctor for your Minnesota Workers’ Compensation Claim”

If you have questions about a medical dispute, or any other aspect of a Minnesota work comp claim, feel free to contact me at any time, for an absolutely free consultation. I will always try to answer your questions, give you my honest opinion about whether you need a lawyer and let you know if  there is something I can do to help you. I regularly speak with people who don’t necessarily need a lawyer and I tell them just that.

How much does it cost to hire a lawyer for a work comp claim?   See this post

I hope you have found this information helpful. If you have, please share our website or blog with anyone you know who may have questions about a work comp claim in northern Minnesota.

Thank you for visiting our blog.