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.

What is Maximum Medical Improvement (MMI) in a Minnesota Work Comp Case?

At some point in your work comp claim, you will almost certainly receive a letter or notice from the insurance company advising you that you have reached Maximum Medical Improvement (MMI).   After receiving such a notice, these are some of the questions you may have:

What is MMI?

Will it have an effect on my benefits?

Can I dispute a finding of MMI?

What is Maximum Medical Improvement (MMI)?  The concept of MMI was added to Minnesota work comp law in 1984. It applies only to injuries which occur on or after October 1, 1984, which basically means pretty much all claims that are ongoing these days.  The most recent definition contained in the work comp statutes (subdivision 13a.) states:

“Maximum medical improvement” means the date after which no further significant recovery from or significant lasting improvement to a personal injury can reasonably be anticipated, based upon reasonable medical probability, irrespective and regardless of subjective complaints of pain.”

Simply put, it means that you are not expected to get any better, even though you may have ongoing pain or work restrictions related to your injury.  If there are no additional treatment recommendations, no pending surgeries and no reasonable expectation of significant improvement, then you have probably reached MMI.  The fact that you may get worse does not mean you haven’t reached MMI.

What effect will a finding of MMI have on your work comp benefits?  The most direct affect will be on your receipt of weekly wage loss benefits, specifically, Temporary Total Disability benefits (TTD). The law provides that TTD benefits will cease 90 days after you have been provided with notice of MMI.  “Notice” means that the insurance company must provide you with a written report or documentation of MMI. Typically, this means that the insurance company mails you a copy of a medical note or report which gives the opinion that you have reached MMI.  This opinion can come from your own physician or from a doctor which the insurance company sends you to for an Independent Medical Exam (IME).

Can my TTD benefits be discontinued based upon MMI even if I remain out of work and still have restrictions?  Unfortunately, yes.

Does a finding of MMI affect my temporary partial disability benefits (TPD)?  No.  If you still have restrictions from the work injury and are working but earning less than your pre-injury wage, a finding of MMI does not affect your partial wage loss benefits.

Will a  finding of MMI affect my entitlement to ongoing medical care for the work injury?  Technically no, but some insurance companies will take the position that if you have reached MMI you don’t need any additional medical care.  You may need to hire a lawyer or fight with the insurance company for payment of additional medical bills or authorization for medical care.

Can I dispute or fight a finding of MMI?  Yes you can.  If an insurance company doctor says you have reached MMI but your treating physician disagrees, you may have a good chance at a hearing to overturn the MMI finding.  The insurance company doctor will almost always give the insurance company the opinion they want (and are paying for) but it isn’t always consistent with the medical evidence or the opinions of your treating doctor. If you are fortunate enough to have a treating doctor who is supportive of your claim and willing to write a report, you have a very good chance of winning at a hearing. That’s why it’s very important to choose your physician carefully when you have a work comp claim.

Our Recommendation

The concept of MMI can be confusing and can have a significant  impact on your work comp claim.  It is important to know that you have the right to contest an MMI finding and to fight the insurance company if you disagree with any determination they make on your claim.  It’s a good idea to consult an experienced work comp attorney anytime the issue of MMI arises on your claim.  Most attorneys will be happy to provide you with information or a free consultation about your claim and whether you need legal assistance.  At Bradt Law Offices, we have been providing work comp help to injured workers throughout northern Minnesota for 30 years. Please feel free to contact us at any time with questions about your claim or the work comp system.  Your initial consultation is always free and you will always get an honest opinion about your case and whether you need a lawyer.

Thank you for visiting our blog and please read through some of our other blog posts for more information on a variety of work comp topics.

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.

An Independent Medical Exam In Your Minnesota Work Comp Case

If you have been involved in a Minnesota work comp case lasting more than a few months, you may have had the experience of being ordered to attend an Independent Medical Examination (usually referred to as an IME).  Not everyone with a work comp claim will be subjected to an IME.  If your claim involves a relatively minor injury or you make a quick recovery, the insurance company may not spend the time or expense to have you examined by their own doctor.

However, in my experience, the longer your claim remains open, the more likely it becomes that the insurance company will send you for an independent medical examination.  If you are reading this article,  you probably have some questions.  Let me try to help.

What Is an Independent Medical Examination (IME)?  First of all, at Bradt Law Offices, we refer to these exams as AME’s, not IME’s.  In my world as  an employee’s attorney, AME stands for an adverse medical examination.  After representing injured workers for over 28 years, I have come to the conclusion that these examinations are anything but “independent”.  They are simply an opportunity for the insurance company to hire a doctor to give an opinion which favors the insurance company.

But I digress.  An independent medical examination is an evaluation performed by a physician chosen by the work comp insurance company. Because the majority of work injuries involve the back, neck, bones and joints, the physician will often be an orthopedic surgeon.  If your injury is something more unusual, the insurance company may have you seen by some other type of specialist.

Do I have to attend an IME?  As a general rule, yes.  The law in Minnesota states that  “The injured employee must submit to examination by the employer’s physician, if requested by the employer, and at reasonable times thereafter upon the employer’s request.”  (Read the actual statute here).  If you fail to attend a scheduled IME, unless you have a good reason (such as illness or an emergency) you could jeopardize your claim.  The insurance company will argue that you have failed to cooperate with them and will probably attempt to discontinue your wage loss, medical benefits or both.

How far do I have to travel for an IME?  The general rule requires that the examination must be scheduled within 150 miles of your residence.  However, you may be ordered to attend an IME beyond the 150 mile range if:

  • You are already treating with a doctor of your choice beyond the 150 mile range, or
  • The insurance company can convince a compensation judge there are no specialists available within the 150 miles, or
  • The insurance company can persuade a  judge that some other good reason exists to schedule the exam beyond 150 miles

Does the insurance company have to pay my mileage and expenses for traveling to the IME?   Yes

Why does the insurance company need an IME?  An insurance company is always trying to pay as little as possible on any injury claim. Even though your treating physician or surgeon may be in the best position to give opinions about your case, the insurance company might not agree with your doctor’s opinions.  For that reason, they need a contrary medical opinion which will allow them to cut off your benefits, limit your medical care, deny a surgery, establish more lenient work restrictions or give a lower permanent partial disability (PPD) rating.  For that contrary opinion, they hire an “independent” (adverse) doctor to examine you and write a report.

How do I fight against an independent medical examination report?  An experienced work comp attorney will usually be able to get reports from your treating doctors to support your claim.  Your treating physicians will generally have more credibility than the insurance company’s  “hired gun” at a workers’ compensation hearing.  In some cases, your own attorney may even send you to a medical specialist for an independent medical examination and report, if necessary,  to combat the insurance company doctor’s opinions.

If a deposition is taken of the insurance company doctor, your attorney will get a chance to cross examine him and point out how frequently he does examinations for insurance companies and how he almost never writes a report which supports the injured employee.

What We Recommend

If you have a work comp claim and receive a notice from your insurance company that you are being scheduled to attend an IME, that might be a good time to touch base with a lawyer. A workers’ compensation claim can be a confusing, frightening and frustrating ordeal.  Please don’t be afraid to contact us,  anytime,  if we can answer some questions for you.  It won’t cost you anything and we will give you our honest assessment about whether you need a lawyer to represent you.

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.

If you decide to hire us,  whether now or at some later time, there are no costs or expenses to you.   We don’t ask for any money up front and we only get paid if we win.  For more information about hiring us and how we get paid,  please see this earlier post.

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

Was this post helpful?  Did it answer your questions?  If you would like to contact us for a free consultation or to send us an emailCLICK HERE.

Or, leave a comment below.

Thanks again for visiting our blog.

When Should I Hire a Lawyer for My Minnesota Workers’ Compensation Claim?

A very common question.  In fact, a question that I am asked nearly every time I meet with someone about a work comp claim for the first time.  A very good question but one with no easy answer.  An easier question to answer would be  “when is it a good idea to talk to a lawyer about my work comp claim?”   Talking to a lawyer is not necessarily the same as hiring a lawyer.

We regularly speak with people who simply have questions about a claim or a potential claim.  They are just looking for information about the work comp system and where their claim might be heading.  Unless you’ve been through the system before, a work comp claim can be stressful and confusing.  At Bradt Law Offices, there is never a charge for a phone call or an office consultation to answer those types of questions.  Whether you have a claim that the insurance company is already paying or whether you are considering filing a claim, there are many situations where it’s a good idea to check with an attorney.  These are just a few:

You aren’t sure whether to file an injury report:   You’ve been hurt or have a medical condition that you feel is related to your work or job duties, but you just aren’t sure.  Give us a call.

Your claim has been denied:   The insurance company has denied your claim, for whatever reason. This is one situation where you definitely need to speak with a lawyer, and the sooner the better, because claims have deadlines. Don’t give up your claim without talking to an attorney.

You think the insurance company has calculated your wages wrong:   All wage loss benefits paid to you are based upon your “average weekly wage” on the date of injury.  Calculating the average weekly wage can be complicated and may include overtime and other compensation.   If the insurance company gets this wrong, they may be paying you less than they should.

Your benefits have been discontinued:   Your wage loss benefits have been discontinued but you disagree with the reasons given for the discontinuance.  Definitely give us a call – you only have a short time to object to the discontinuance and request a hearing.

There is a dispute over your work restrictions:   The insurance company may send you to one of their own doctors for an “Independent” Medical Examination (referred to as an IME).  Almost always, that doctor will disagree with your treating doctor about everything from diagnosis to treatment and restrictions.  The insurance company will then frequently use the IME doctor’s report to cut off your wage loss and/or medical benefits.

The insurance company won’t pay a medical bill:  This can occur for many reasons, but often occurs shortly after you receive the IME report.

The insurance company won’t approve a medical procedure:  The insurance company will not agree to authorize surgery, injections, physical therapy, an MRI,  a second opinion, a change of treating doctor, a referral to a specialist, etc.

A QRC is assigned to your case:   A QRC is a Qualified Rehabilitation Consultant, who will provide vocational rehabilitation services to you if you are off work because of your injury.  (For more information about QRC’s,  see this article.)  The choice of QRC is yours,  not the insurance company’s.  Unfortunately, they don’t usually explain this to you and most injured workers have no idea where to find a QRC they can trust.  We have a number of QRC’s that we work with regularly and can strongly recommend.

The insurance company offers you a settlement:  If the insurance company wants to settle your case, make sure to at least consult with an attorney before you do so. An insurance company claims adjuster is far more knowledgeable about workers’ compensation than you are. Any settlement must be approved by a workers’ compensation judge.  (For more information about settlements, read this earlier post)

Or, maybe you just have a few questions…

A workers’ compensation claim can be a confusing, frightening and frustrating ordeal.  Please don’t be afraid to contact us,  anytime,  if we can answer some questions for you.  It won’t cost you anything and we will 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 how the work comp system works can make a big difference for you in your dealings with the insurance company.

If you decide to hire us,  whether now or at some later time, there are no costs or expenses to you.   We don’t ask for any money upfront and we only get paid if we win.  For more information about hiring us and how we get paid,  please see this earlier post.

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

Was this post helpful?  Did it answer your questions?  If you would like to contact us for a free consultation or to send us an email, CLICK HERE.

Or, leave a comment below.

Thanks again for visiting our blog.

Bradt Law Offices Case Report: Repetitive Thumb Injury and Surgery

Type of Case:   Workers’ Compensation

Legal Issue or Dispute:  Denial of claim for a repetitive thumb injury requiring surgery

Facts:   Our client worked for a large healthcare provider in northern Minnesota.  His job duties over many years involved repetitive work with his hands and thumbs. He developed a condition which required a significant hand surgery and the workers’ compensation insurer denied the claim.  They sent our client to an orthopedic surgeon for an independent medical exam (often referred to as an IME), who gave the opinion that our client’s problems were hereditary and unrelated to his work activities.  The case was scheduled for trial before a workers’ compensation judge in Duluth.

Result:   We obtained a medical report from the treating surgeon which stated that our client’s work activities were a substantial contributing cause of the development of his problems. Shortly before trial, we took the deposition of the insurance company’s doctor.  In his deposition under oath, he was forced to admit that  (1) there was no documented medical basis for his opinions regarding the hereditary factors he relied on for his opinions,  (2) there were no medical studies to support his opinions, and  (3) he had no special training or knowledge of genetics.

Less than one week before the scheduled trial, the insurance company accepted the claim in full, agreed to pay for our client’s surgery and paid him wage loss benefits while he was off work.  The insurance company was also required to pay our attorney fees for obtaining the surgical approval and wage loss benefits.