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.

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.

The Risks of Not Reporting a Work Injury in Minnesota

A work injury can happen to anyone, at any time.  Injuries happen to people on the first day of a new job or after 20 years of injury-free employment.  There just isn’t any rhyme or reason to when an injury occurs.

An injury can be as trivial as a sprained thumb or as serious as a broken bone or spinal cord injury.  An injury may result in a few hours of discomfort or weeks to months of disability and lost time from work.  A serious injury resulting in medical care and lost time from work is a “no-brainer” when it comes to whether or not it should be reported.  In fact, in many cases, it doesn’t need to be reported because it was probably witnessed by coworkers or supervisors.  Those types of claims get filed, benefits are paid and the injured worker is “in the system” by no choice of his own and without any real options.

But what about the less serious injury that allows you to keep working?  How about an injury that requires a visit to the doctor but no lost time from work?  Or, what about that minor twinge you felt in your low back a few weeks ago that you barely noticed but is now becoming a more serious problem?

These are the types of injuries that many people, for a variety of reasons, choose not to report to their employer.  This topic comes to mind because I am convinced that the current scary economy is causing a lot of people to “work hurt”, without reporting work injuries.  You know who you are – you injured your back, neck, shoulder, knee – whatever – a few weeks or months ago but you haven’t turned in an injury claim.  You’re hoping that it will just get better, but it hasn’t.  You’re afraid that if you turn in the claim you might lose your job.  Or, if you go off work on comp, your job won’t be there for you after you’ve healed. So, you are one of many, many people who are “working hurt”.

What are the risks of not reporting a work injury?

Probably the biggest risk is that the injury may become more serious and it will then be too late to prove that it is a work comp claim.  For example, if you don’t turn in an injury report and six months or a year later you need surgery and are facing a prolonged period of disability, you may have a very difficult time establishing a work comp claim.  The insurance company will claim that you failed to give proper notice and that its now too late to file a claim..  The insurance company will also claim that you cannot prove your problems are related to an incident which occurred six months ago that you didn’t report.  Another problem will arise if you weren’t telling your doctor the whole story and there is nothing in your medical records about the injury happening at work.

While you may have health insurance to cover most of the medical bills, you will not be able to receive wage loss benefits, vocational rehabilitation assistance or reimbursement of your medical mileage.  These are all benefits which are provided under workers’ compensation.

What should you do if you get hurt at work and are afraid to report the injury?

My recommendation would be to contact an experienced work comp attorney.  A little information goes a long way in the work comp system. Most attorneys will provide you with a free initial consultation concerning your claim.  Once you understand your options, you can then make an informed decision about whether to report the injury or not.  It sounds like a simple solution, and it is.  Get some information about your potential claim and then make a decision.

For additional information on this topic, here are a couple of previous posts or other references:

Workers’ Compensation Frequently Asked Questions

Can I Get Fired for Filing a Work Comp Claim?

As always, thank you for visiting our blog and please tell your friends that we are a source of good work comp information for workers injured in northern Minnesota and anywhere on the Iron Range.