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.

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.

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.

Bradt Law Offices Case Report: Permanent total disability benefits awarded following trial

Type of Case:   Workers’ Compensation

Legal Issue or Dispute:   Permanent total disability  (even though our client was still working part-time).

Facts:   Our client was 57 years old when she went to work on a part-time basis for the employer. She had some history of low back problems but did not have any restrictions at the time she was hired and was not receiving any medical treatment for her low back. Unfortunately, within a few months after she was hired, she suffered a new low back injury which significantly limited her ability to do the job. She was eventually released to work only 6 hours per week by her treating doctor, and was restricted from  any lifting or other physical activities.

The insurance company sent her for an independent medical exam (IME), and the insurance company doctor said that her back problems were pre-existing and that she didn’t need any work restrictions from the new injury. The employer created a “job” for her, which basically only required that she show up for 6 hours per week, even if she didn’t actually perform any work activities while there. We filed a claim for permanent total disability (PTD), which was denied by the insurance company.  (see this previous post for more information about permanent total disability claims)

At the trial, our vocational experts testified that the job created for our client was not competitive employment, but was only a position created by the employer to avoid responsibility for permanent total disability benefits. We argued that our client met the definition of permanently and totally disabled, because she was “unable to secure anything more than sporadic employment resulting in an insubstantial income.” (The definition of permanent total disability in the work comp statute – see subdivision 5)

Result:   The judge rejected the opinions of the insurance company’s doctor, accepted our medical and vocational evidence and declared our client permanently and totally disabled.

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.