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.

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.

How Much Is a Permanent Partial Disability Rating Worth in a Minnesota Work Comp Claim?

This is a very common question for someone who is in the work comp system and has been assigned a disability rating by a physician. The rating might come from your own doctor or from a doctor you have seen for an Independent Medical Examination (IME)  at the request of the insurance company. Either way, the dollar value will be the same. In most cases, however, you can pretty much assume that the insurance company doctor will give you the lowest possible rating he can find under the disability schedules.

As we have explained in some previous posts, the Minnesota work comp laws have changed pretty dramatically over the past 30+ years. The date of your injury controls most of the benefits to which you may be entitled, so if you have an older injury your benefits will be based upon the older laws which were in effect on the date  you were injured. In order to keep this post relatively short and to provide a basic understanding of the issue, we are discussing  injuries which have occurred since about 1995.

What is a disability rating?

A disability rating (sometimes also called an impairmant rating) is a percentage (%) rating given under the disability schedules which is intended to compensate you for some loss of the permanent use of a specific body part. It is referred to as a Permanent Partial Disability (PPD) rating or an Impairment rating. It is not intended to represent “pain and suffering”, nor does it necessarily reflect how the permanent impairment has negatively affected your life or your ability to perform certain activities. In other words,  a 10% disability does not necessarily mean you can still do 90% of everything you could do before, which is a common misconception. In fact, there are some fairly serious injuries which don’t have any disability rating at all.

Where do disability ratings come from?

A disability rating comes from the Minnesota Department of Labor and Industry Worker’s Compensation Disability Schedules. The actual schedules are in the Minnesota administrative rules, chapter 5223, and can be found here.   (The schedules for injuries occurring on or after July 1, 1993 begin at 5223.0300)  A doctor will look at the specific portion of the disability schedules which relates to your affected body part and find the category or categories which best describes your condition. There will be a percentage listed for each category and that is where the rating comes from.

How much do I get paid for a disability rating?

This has changed somewhat over the years, but the current compensation system for disability ratings has been in place for all injuries occurring on or after October 1, 2000. It is a schedule which multiplies your disability/ impairment rating (a percentage) by a particular dollar amount. It is not tied to your average weekly wage, so a 10% rating is the same for everyone, regardless of whether you are a high wage earner or a part-time minimum wage employee.

For example:  a 10% disability rating is multiplied by $80,000, resulting in a payment of $8000.

Higher disability ratings are multiplied by higher dollar amounts to reflect more serious disabilities.

Therefore, in another example:  a 25% disability rating is multiplied by $95,000, resulting in a payment of $23,750.

You can find the chart which explains these dollar values here (see Subd. 2a.)

 

Do I have to accept a disability rating from the insurance company doctor?

No. If the insurance company is not disputing your claim, they are required to pay you, as a minimum, whatever rating their doctor gives. However, you can file a claim for any additional rating which is supported by another doctor. So if your own doctor or surgeon gives a higher rating, you can file a claim for that percentage and take the issue before a compensation judge for determination. The ratings can be very complicated and are open to some amount of interpretation, so the insurance company’s doctor will always give the lowest possible rating. That is, after all, what the insurance company is paying him for.

Conclusion

There can be a number of other issues which arise relating to disability ratings and compensation, particularly with older claims or injuries to multiple body parts. This was only intended to give a general overview of the issue and answer some fairly common questions.

If you have any questions about a disability rating or any other aspect of your claim, please feel free to contact us.  We provide an absolutely free consultation for any injury claim. We will always give you our honest opinion about whether you need a lawyer or whether there is anything we might be able to do for you. Insurance companies have experienced claims adjusters and attorneys working for them and they are not interested in paying you any more than they have to. In a work comp claim against a huge insurance company, it can be very helpful for you to have a good understanding of the benefits available to you and your rights within the work comp system.

If you found this post to be helpful, please share this site with your friends and co-workers as a good source of work comp information for the working men and women of northern Minnesota and the Iron Range.

Thank you for visiting our blog.