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.