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.