My Minnesota Work Comp Claim Was Denied Because of a Prior Injury. Now What?

This is another of the common problems we often deal with when helping people who have been injured on the job across northern Minnesota.

Typical situation:  you have been working for several years without any physical problems, work restrictions, lost time or any other difficulties or limitations. Then one day at work, you are lifting or carrying something and suffer an injury to your back (or neck, shoulder, knee, elbow, etc.). You report the injury to your employer, explaining exactly what happened and you make an appointment to see your doctor or chiropractor.

Maybe you fill out some more paperwork for your employer or maybe you receive a call from a claims adjuster from the work comp insurance company, asking for more details about the injury and your medical history. Perhaps you are off work on doctor’s orders and receiving therapy or other treatment while you try to heal and get back to work.

One day in the mail you receive a notice from the work comp insurance company explaining that your work comp claim has been denied. DENIED?!?! Apparently, you had received medical treatment for a back injury 15 years ago and the insurance company has decided that your current problems are a pre-existing condition. Claim denied!

Claim Denied. Options?

At this point, you may have already lost several weeks of wages and run up hundreds, or thousands, of dollars in medical bills.  You had reasonably assumed that everything would be taken care of by work comp because your injury had occurred on the job. Now what do you do? Well, you basically have two options:

Option #1:  Walk away. If you have health insurance or are willing to go back to work and “tough it out”, you can simply let the matter drop and walk away from the claim. Your employer and the work comp insurance company would be very happy if you make that choice. In fact, insurance companies count on the fact that many people will simply walk away after a claim is denied, instead of even contacting an attorney for legal advice or a consultation. The downside of this option is that your claim will never be recorded as a work injury and you will have no protection if it turns out to be a long-term or serious problem. In addition, all claims have deadlines, also called statutes of limitation, which require you to formally file a work comp claim with the Minnesota Department of Labor and Industry, Workers’ Compensation Division, within a certain time frame. If you fail to legally file your claim before the deadline expires your claim will be barred forever. An experienced attorney can tell you when the deadline might be for your particular claim.

Option #2:  Fight the insurance company for the benefits to which you are entitled under Minnesota’s workers’ compensation laws. Your first step would be to contact an experienced work comp attorney for a consultation to see if you have a claim worth pursuing. After that, the attorney will pursue the claim by gathering medical records and reports, filing whatever claims you might have and fighting with the insurance company on your behalf until the claim is resolved.

Can My Claim Be Denied Because I Had a Prior Injury To the Same Body Part?

There are any number of reasons that the insurance company may use to deny a claim and this is one of them. Unfortunately, many people believe that a pre-existing condition or prior injury disqualifies them from a work comp claim if they later injure the same body part. Again, this is the type of misinformation the insurance company relies on when they deny claims and hope that the person simply walks away.

 

Aggravation of a Pre-existing Condition

The law in Minnesota does not disqualify you from work comp benefits if you have a prior injury or medical condition which has been reinjured at work. A pre-existing condition which has been substantially aggravated or accelerated by a work injury or even regular work activities, is still covered by workers’ compensation. It doesn’t matter if it is an injury to your back, neck, head, shoulder, knee or any other part of your body. It doesn’t matter if you need surgery or have previously had surgery. The issue is simply whether your work injury or activities have substantially contributed to your present condition. This is good news for people injured on the job but it usually still requires that you find an attorney to help you fight with the insurance company.

The burden of proof in a Minnesota work comp claim is on the employee. This means that, where a claim is denied or disputed, the employee must prove that the injury is covered under the work comp law. This is generally accomplished by filing a claim, obtaining a medical report which supports the connection between the work activities and the injury and then either taking the case to a hearing or reaching a settlement.

Conclusion

If this describes your situation or the situation of someone you know, then the initial step would be to consult with an attorney. Equally important is having a doctor who is willing to assist and support your claim in the dispute with an insurance company. Not every doctor is willing to take the time to review medical records and prepare a medical report at the request of your lawyer. That’s why it’s also very important to carefully select your treating physician in a work comp claim. For more information on this topic please see our previous post- Choosing a Doctor for Your Minnesota Workers’ Compensation Claim.

If you have been injured on the job and have questions about your claim or the Minnesota work comp system, please don’t hesitate to give us a call. You can contact us, anytime, with questions about your case or to arrange an absolutely free consultation. It won’t cost you anything and we will always give you our honest assessment about whether you need a lawyer to represent you. If you have questions about how much it costs to hire a lawyer for a Minnesota workers’ compensation case, you can check out this previous post.

Remember, you are dealing with an insurance company which handles hundreds or thousands of claims every day. They have experienced claims adjusters and attorneys managing their files. Even if you don’t need a lawyer at the moment, a little information about the work comp system can make a big difference for you in your dealings with the insurance company. At Bradt Law Offices, we have been providing assistance to injured workers all across northern Minnesota and the Iron Range for more than 33 years.

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

Can the Insurance Company Refuse to Pay Medical Bills after a Minnesota Workers’ Compensation Settlement?

This is a question I frequently hear not only from clients but also from people who have settled a claim, with or without a lawyer, at sometime in the past. In fact, sometimes many years have gone by since the settlement before this issue arises and I receive a phone call. The question is usually something along these lines:

“I settled my work comp case but medical was left open, now the insurance company won’t pay for a doctor visit (or an MRI, surgery, etc. ) – how can they do this?”

This can be a very confusing issue after the settlement of a work comp claim, whether or not you were represented by an attorney. It would seem, from a common sense standpoint, that if future medical coverage was supposedly “left open” for your work injury, then the insurance company should have to pay any future medical bills. However, it’s not quite that simple, for several reasons:

1. The work comp insurance company always has the right to challenge whether medical treatment is reasonable, necessary and related to the work injury.  Regardless of whether an injury claim is accepted, decided in your favor by a judge or settled, the insurance company is not obligated to pay every medical bill without question. The burden of proof remains on the injured employee in a Minnesota work comp case, which means that you have to prove that any disputed medical treatment is reasonable, necessary, and related to the work injury.

This typically requires some medical support for your claim, either in the form of medical records which clearly explain the situation or in the form of a medical report from a treating physician which addresses the disputed issues and supports your position. For this reason, it is very important to have a doctor who not only understands the work comp system but is also willing to support you, if necessary, with a letter or medical report. (For more information about selecting a doctor in a work comp case, see our previous blog post here).

2. Months or even years have passed without treatment for your injuries. If you haven’t treated for your work injury in a long time, the insurance company will not have any up-to-date information regarding your claim and they will want to make sure that the medical care is still related to the work injury. Sometimes, all the insurance company needs is updated medical records which will demonstrate that your physicians are still relating your treatment to the original work injury. If the medical records do not clearly make that connection, it may be necessary to get a letter or report from your doctor. In any event, the insurance company is entitled to get updated information before deciding whether to pay a medical bill or authorize treatment.

3. You have been back to work for a different employer since the settlement. The insurance company will likely want to make sure that you haven’t had a new injury or that your new job has not aggravated the injury that was covered by your previous settlement. Again, particularly in a case where you haven’t made any medical claims for some period of time, the insurance company will need updated information before making a decision on any medical bills. In fact, if you have returned to work in a different job and your symptoms have increased or worsened, you may very well have a new work comp claim against your new employer for a permanent or substantial aggravation of your underlying medical condition.

4. Your current problems were not specifically addressed in the settlement agreement.  Let’s assume that the original injury and settlement involved your left shoulder and you are now having problems with your left elbow. Your doctor suspects that the elbow problems may be coming from the shoulder or are somehow related to the shoulder injury. The language in the settlement papers describing what injuries were covered will be very important. In this type of case, it may come down to arguing about whether the elbow problems are related to the shoulder or whether they represent a new, unrelated problem. These types of issues arise frequently and are normally going to be the subject of litigation.

5. The medical treatment being denied was closed out under the terms of the settlement.  The settlement papers you signed (a Stipulation for Settlement) described the injuries and claims you were making, the claims or defenses of the insurance company and the terms of the settlement. In many cases, even where future medical remains open, there is an agreement to close out certain, limited future medical treatment such as acupuncture/acupressure, massage therapy, health club memberships, psychiatric/psychological treatment, etc. This means that the insurance company is no longer responsible for any of those types of treatment even if they are related to your original injury.

Also, medical treatment for specific body parts may have been closed out by the terms of the settlement if there were disputes over the nature and extent of your original injuries. For example, you may have originally claimed an injury to your neck and low back but the terms of the settlement may have only left open future medical treatment for your neck, closing out any low back medical claims.

What you can do to help avoid disputes over  future medical coverage after a settlement:

-Understand exactly what body parts and what type of medical coverage remains open and what was closed out by the terms of the settlement;

-Keep a copy of your settlement papers for reference;

-Make sure any and all medical treatment for your injuries after a settlement is billed to the work comp insurer, not to your health insurance. This helps ensure that the work comp insurance company remains aware of your ongoing medical issues if something serious for expensive arises such as surgery or the need for an MRI;

-Make sure to always tell your physician that the condition you are treating for is related to a work injury and give as many details as you can, such as the date of the injury and what body parts were injured, so there is a paper trail of any ongoing medical care or treatment from your work injury.

These are just some of the potential medical scenarios which might arise after a settlement and some of the things you can do to lessen the likelihood of more litigation on your claim. It probably goes without saying that you should not settle a work comp claim without first speaking with an experienced work comp attorney.

If you have been injured on the job and have questions about the Minnesota work comp system, please don’t hesitate to give us a call. You can contact us, anytime, with questions about your case or to arrange an absolutely free consultation. It won’t cost you anything and we will always give you our honest assessment about whether you need a lawyer to represent you.

Remember, you are dealing with an insurance company which handles hundreds or thousands of claims every day. They have experienced claims adjusters and attorneys managing their files. Even if you don’t need a lawyer at the moment, a little information about the work comp system can make a big difference for you in your dealings with the insurance company. At Bradt Law Offices, we have been providing assistance to injured workers all across northern Minnesota and the Iron Range for more than 33 years.

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

Bradt Law Offices Case Report: Consequential Knee Injury

Type of Case: Workers’ Compensation

Legal Issue or Dispute: Consequential knee injury following a back injury

Facts: Our client suffered a low back injury in the course and scope of his employment. The injury was accepted by the work comp insurer and our client eventually had two back surgeries. Although the surgeries were successful, he was left with some ongoing weakness, instability and radiating symptoms down one of his legs. The instability caused him to occasionally stumble or lose his balance, which resulted in a twisting injury to his knee. After treating for several months, our client ultimately required knee surgery.

We submitted the knee injury medical bills to work comp, because the knee injury was a consequence of the original back injury. Predictably, the insurance company denied responsibility for the knee problems and we filed a formal claim. We obtained a report from the knee surgeon explaining how the knee injury was related to the back injury and the case was set for trial.

Result: Before trial, the insurance company agreed to accept the knee injury claim and paid all of the medical bills related to the knee injury and surgery. In addition, our client was reimbursed for his medical mileage and expenses, out-of-pocket medical bills related to the knee injury and the insurance company agreed to accept responsibility for any future medical care for his knee. Finally, the insurance company paid our attorney fees and expenses.

If you have questions about any aspect of your northern Minnesota work comp claim, please feel free to contact me at Bradt Law Offices at any time. I am happy to speak with you about your claim or make an appointment for an absolutely free consultation in our Grand Rapids office or wherever it would be convenient for you. We have been representing your friends and neighbors on their work comp claims 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.

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.