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.

How Long Does a Minnesota Work Comp Claim Stay Open?

A few times each year I get calls from people with questions about an old Minnesota work comp claim. Most often, they have either had some type of flareup or progressively worsening symptoms from a work injury which had occurred several years in the past. The questions usually relate to whether the insurance company is still responsible to pay medical bills or other benefits.

There is no simple answer to this type of question but there are some general guidelines which might be helpful. The facts of each case are always different and whether your claim is still “open” will depend on some of these factors:

Was the Original Injury Reported to the Employer and Accepted by the Work Comp Insurer?  This is the starting point for determining whether the claim is still open or whether any ongoing benefits are available. When a work injury claim is reported to your employer’s work comp insurer, the insurer will decide whether to accept or deny the claim. Soon after reporting the injury you should receive a form from the insurance company entitled Notice of Insurer’s Primary Liability Determination. The form will tell you if the claim is accepted or denied and should also provide the basis for any denial.

If the claim is accepted, you may be eligible for various types of benefits under the work comp system, including wage loss, medical benefits and vocational rehabilitation services. The insurer can still fight with you or deny various types of benefits for any number of reasons, but if the claim is accepted a major battle is eliminated right at the beginning of your claim.

If the claim is denied by the insurer, you must formally file a Claim Petition with the Department of Labor and Industry-Workers’ Compensation Division before the statute of limitation (deadline) expires, or the claim is barred forever. If you have had a claim denied by a work comp insurer my recommendation would be to contact an experienced work comp attorney immediately to see what statute of limitation or deadline might apply to your case. If you wait too long, you will lose all workers’ compensation rights related to the injury.

Assuming that your claim has been accepted by the work comp insurer, these are some of the other issues which help determine whether you have any remaining benefits available:

Did You Make a Settlement?  Many work comp claims in Minnesota ultimately result in a settlement of some type. If you reached a settlement in your case, with or without an attorney, the settlement terms will generally be set forth in a document called a “Stipulation for Settlement” which is signed by the parties and approved by a workers’ compensation judge. A settlement can resolve some, or all claims related to an injury.

Frequently, a settlement will close out all future claims in exchange for a lump sum payment, but will leave open future medical expenses related to your injury. In other cases, a settlement closes all future claims, including future medical. Under the terms of that type of settlement you would not have any remaining benefits available to you from the original work injury. (For more information, see Types of Settlements in Minnesota Workers’ Compensation Claims)

Have You Been to a Hearing Before a Work Comp Judge?  If there were disputed issues in your case you may have ended up at a work comp hearing where the issues were decided by a judge. The judge’s decision may affect what benefits are available to you in the future. If you were represented by an attorney, he or she should be able to explain what potential benefits remain available to you.

How Long Ago Was Your Injury?  There have been significant changes to Minnesota’s work comp laws over the past 30 + years, particularly in 1984, 1992 and 1995. As a general rule, the law in effect on the date of your injury will control what benefits are available to you. Over the years, there have been limits or caps imposed on wage loss, medical and vocational rehabilitation, so the date of your injury is a very important factor to consider when evaluating what benefits may be available on your claim.

Were You Ever Given a Permanent Partial Disability (PPD) rating?  A PPD rating is usually given by your surgeon or treating physician upon completion of your treatment or recovery from your injury. If you qualify for a rating under the disability schedules, the doctor provides the applicable percentage (%) rating from the schedules and you are entitled to be compensated by the insurer based upon that percentage. Not every injury results in a ratable disability but if you had surgery or have permanent restrictions or symptoms, you may qualify. This benefit is often overlooked and not paid, particularly if the injured worker did not have an attorney providing guidance. (For more information on this subject, please check out our previous post explaining Permanent Partial Disability Ratings)

Have you had a new injury or aggravation? Let’s say you had a back injury in 1998 which was accepted by the work comp insurer and you received wage loss and medical benefits following the injury. Assuming you went back to work at some point and are now having low back problems again, the original insurer is not likely to resume payment of medical or other benefits without some updated information from you, such as:

-Do your current problems involve the same part of your back that was injured in 1998?

-Have you had any new back injuries since 1998 (work injuries, car accidents, slip and falls, etc)?

-Have your work activities since 1998 aggravated or accelerated your back problems?  (if so, you might have a new work comp claim  against your current employer. For more information about a gradual, repetitive injury claim see our previous article here)

-Have you been getting regular medical care over the years for your back and do the medical records support your claim that the problems are related to the 1998 injury?

There are many other factors which may affect whether you have any claims remaining from an old work comp injury. These are just a few of the considerations that might come into play. If you have questions about an old injury claim and were represented by an attorney, you should start by contacting the attorney’s office to see if they still have your file or could provide you with documents or information. If that’s not an option or if you did not have an attorney, we would be happy to offer a free consultation to answer your questions and provide whatever guidance that we can. Some helpful information for you to gather before any consultation would be the date of injury, name of the work comp insurer and copies of any settlements or other legal decisions relating to your claim.

Thank you for visiting our blog. 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. If you found this information helpful, 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: Ankle Injury on a Flat, Dry Floor

Type of Case: Workers’ Compensation

Legal Issue or Dispute: Denial of ankle injury claim which occurred at work

Facts: Our client was employed with one of the mining companies in northern Minnesota. His job duties required him to maintain and repair equipment within the facility. On the day he was injured, one of the machines in the plant malfunctioned and began to spew waste material into the air and onto the plant floor. Our client received a radio call to get to the machine, evaluate the problem and assist in any maintenance or repairs which might be necessary.

As he was hurrying across the concrete plant floor and approaching the malfunctioning machine, he rolled his ankle and suffered a severe ankle sprain. The floor was not wet and he did not recall stepping on, or tripping over, any hoses or other debris. He wasn’t even sure what happened except that he was hurrying because of the emergency and was looking up at the malfunctioning machine rather than at the floor.

The claim was completely denied by the employer and its workers’ compensation insurer on the grounds that the injury was not related to the employee’s work activities because he was simply walking across the plant floor at the time of the injury and there was no unsafe or dangerous condition in the plant or on the premises which caused the injury.

The case proceeded to trial before a workers’ compensation judge where we argued that the employee’s work environment caused or contributed to the injury because he was hurrying to deal with an emergency situation and not paying attention to the floor. His job duties required him to deal with the malfunctioning machine as quickly as possible and those factors are what caused or contributed to the injury.

Result: The compensation judge ruled in favor of our client and determined that his ankle injury was covered by workers’ compensation. The case was appealed by the employer/insurer and the Minnesota Workers’ Compensation Court of Appeals affirmed the judge’s decision and awarded benefits to our client.

The insurance company was also required to pay our attorney fees and costs.

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 more than 30 years. If you’ve been injured, we can help.

Thank you for visiting our blog.

What Should I Do If I Receive a Notice of Intention to Discontinue Benefits on My Minnesota Work Comp Claim?

At some point in almost any work comp claim where you are paid wage loss benefits, you will receive a Notice of Intention to Discontinue benefits, commonly referred to as an NOID. An NOID is simply a form which the insurer is required to serve and file whenever they will be discontinuing wage loss benefits. The form provides you with notice that your benefits will be ending at a certain time and explains the reason why.

Some reasons why you might receive an NOID form

1. You have returned to work. If you have been off work and receiving wage loss benefits from work comp, you have been receiving Temporary Total Disability (TTD) benefits. These benefits are paid at the rate of 2/3 of your average weekly wage on the date of injury. (For more information on TTD benefits, see our blog post here)

The notice tells you that the insurance company will be discontinuing those benefits because you are back to work and no longer entitled to TTD benefits. If you are returning to work, with restrictions from your injury but earning less than your preinjury wage, you may be entitled to partial wage loss benefits (TPD) and the NOID form should reflect that you will be paid TPD benefits upon returning to work. It doesn’t matter whether you are going back to work for the same employer or whether you have found a new job since the injury.

2. You have exhausted your TTD benefits. For dates of injury between 10/1/95 and 9/30/08, you are limited to 104 weeks of TTD benefits. This means that even if you are still out of work because of the injury, you cannot receive more than 104 weeks of TTD and your benefits will end. For injuries on or after 10/1/08, the maximum number of TTD benefits was increased from 104 to 130 weeks.

3. Your weekly earnings have reached or exceeded your preinjury wage. If you have been working at a wage loss and receiving TPD benefits, those benefits will end once you get back to your preinjury wage, because you no longer have a wage loss.

4. You have reached Maximum Medical Improvement (MMI). If you are receiving TTD benefits, those benefits will end 90 days after you are provided with notice that you have reached MMI. An MMI opinion can come from one of your treating physicians or from a doctor who has examined you for the insurance company (this is called an Independent Medical Exam (IME), more information about an IME can be found here). The explanation for why your benefits are being discontinued must be included on the NOID form.

5. You no longer have work restrictions. If your treating physician, or the IME doctor, gives an opinion that you have no work restrictions as a result of the work injury, you are no longer eligible for wage loss benefits. Most often, this occurs following an IME where the insurance company doctor writes a report and gives the opinion that you have fully recovered from the work injury or that any restrictions you have are not related to the work injury. Sometimes, your own doctor may lift all restrictions without fully understanding how this might affect your claim. (For more information about choosing a physician for a work comp claim, click here).

What you can do if you receive an NOID

Your options after receiving an NOID are explained on the form and will depend upon the reasons for the discontinuance. If you disagree with the discontinuance of benefits or the reasons given, you can request a telephone conference with a work comp judge to argue your position. The time frame to dispute a discontinuance if you want an immediate conference is generally 12 days. The NOID form provides you with a phone number and address and explains how to request the conference.

If you have an attorney, you should obviously make sure that he or she has received a copy of the NOID form and will be requesting a conference on your behalf if you disagree with the discontinuance of your benefits. If you don’t have an attorney, this would be a very good time to contact one. At the discontinuance conference, the insurance company will be represented by either a claims adjuster or an attorney. The discontinuance of your benefits is a serious matter and you should have an experienced work comp attorney representing you at that conference.

If you win at the conference and the judge agrees that your benefits should not be discontinued, the insurance company may appeal but they will have to continue paying your benefits until a formal hearing is scheduled. However, if you lose at the conference, you may appeal but you will not receive any benefits while you wait for the formal hearing and a decision. Having an attorney represent you at the initial conference will generally give you a much better chance to win.

There are some other reasons why your benefits might be discontinued, but these are the most common situations that we typically see.

Contact Us If You Have Questions about Your Claim

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. If you have questions or concerns about the cost of hiring an attorney, you can check out this previous post- How much does it cost to hire a workers’ compensation lawyer in Minnesota?

At Bradt Law Offices, we have been providing assistance to injured workers all across northern Minnesota and the Iron Range for more than 32 years.

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

Beware of a New Attack on Benefits for Injured Workers

It’s  bad enough that state legislatures, including ours right here in Minnesota, have chipped away at the rights and benefits of injured workers over the past 30 years. Now, some states are getting rid of workers’ compensation altogether and creating their own systems for compensating workers injured on the job. The argument made by business owners is, of course, that this is good for the injured working man or woman. Don’t believe it. If it’s being proposed by business you can bet that the motivation is strictly the bottom line – employers save money and the injured worker loses rights and benefits.

For more details about this scary prospect and how it is happening in other states, click on the link to read this excellent article : Inside Corporate America’s Campaign to Ditch Workers’ Comp.

As a work comp attorney representing injured workers for more than 30 years here in northern Minnesota, I find this to be a very scary development. If it is being pushed through in other states, you can be assured that it may eventually be tried here. Please feel free to share this article with anyone you feel might be interested.

Thank you for visiting our blog and please feel free to contact us at any time if you have questions about a work comp claim or would like to set up a free consultation to discuss your rights if you’ve been injured on the job in Minnesota.