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.

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.

Questions to Ask Before You Hire A Lawyer for Your Minnesota Work Comp Case

You‘ve been injured at work.  You are either thinking about filing a claim or have already done so.  Perhaps you are dealing with an insurance company claims adjuster you don’t really trust.  Maybe the insurance company has scheduled you for an independent medical exam (IME), or assigned a QRC to your case.  No matter the reason, you are looking for an attorney who can answer some questions for you and protect your interests, if necessary.

You have looked in the phonebook or done a Google search and found dozens of lawyers and law firms who advertise themselves as work comp lawyers.  Minneapolis.  St. Paul.  Duluth.  The Iron Range.  Who to call?  What questions to ask?

These would be some good questions to ask if you are looking for an experienced attorney to help you with your case:

Do you specialize in work comp cases?  What you really want to know is if the attorney focuses his or her practice primarily on workers’ compensation claims.  You probably don’t want someone who dabbles in work comp, along with divorces, DUIs, wills, real estate, etc.  While a general practice law firm can be very helpful on a number of matters, work comp is a complicated and specialized field of practice.  We develop skills and knowledge about work comp matters only after years of experience with a variety of injury claims.  If work comp is just one of many practice areas an attorney advertises, you may want to look elsewhere.  My practice is limited exclusively to workers’ compensation, injury and Social Security disability matters.

Have you taken many cases to trial?  There is no substitute for experience.  If an attorney has taken lots of cases to trial over a number of years, you can assume that you are talking to someone with a lot of experience.  Taking cases to trial is important for several reasons.  For one thing, at trials we appear before a variety of different judges and learn what to expect in each judge’s courtroom.  It’s also important to take cases to trial because sometimes that’s the only way to get a fair result.  If the attorney for the insurance company knows that your lawyer will take a case to trial, they are much more likely to make a fair settlement offer.  I’ve been trying work comp cases for my injured clients all across northern Minnesota for over 28 years.

Do you have experience with my type of injury?  Over the past 28 years, I have had experience with just about every kind of injury one could imagine.  So, when a new client comes to me and asks if I’ve ever handled a shoulder surgery claim, a lead poisoning claim,  a cervical fusion case, a brain injury claim, a quadriplegia case or a carpal tunnel claim, I can answer  “yes”.  I can also suggest a variety of surgeons or medical specialists who might be able to help my client with medical treatment and a supportive letter or medical report for the claim.

Are you familiar with northern Minnesota?  Why is this important?  Well, it certainly helps if your attorney knows the local medical providers, vocational rehabilitation consultants and employment services and opportunities.  It helps to know all about the mining industry, construction industry, tourism and logging industry across northern Minnesota, and what my clients do at those jobs.   It might even help if your attorney has actually operated a forklift, a loader, a chainsaw or a jackhammer.  (Or delivered Hamm’s beer from Eveleth to Ely, which I did many years ago : )   If you are looking for a new job after a work injury, you need every advantage you can get in a tough economy.  As an Eveleth native and resident of northern Minnesota for over 50 years, I know my way around the Iron Range – and that’s good for my clients.

What We Recommend

If you feel that it’s time to have someone in your corner while you battle the insurance company, or if you simply have a few questions about your claim or the work comp system, please give me a call.  Don’t be afraid to contact us, anytime, if I can answer some questions for you.  It won’t cost you anything and I will always give you my 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 have questions about how much it costs to hire us (nothing), this earlier post should answer those questions for you.

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 and please spread the word that we are a source of good work comp information for workers injured in northern Minnesota and anywhere on the Iron Range.

When Do You Get a Work Comp Settlement in Minnesota?

We probably all know someone who was hurt on the job,  filed a workers’ compensation claim and eventually received a settlement.  In the 28 years that I have been handling work comp claims,  I have come to learn that most people assume  a “settlement” is a standard, guaranteed and inevitable result in a Minnesota work comp claim.   It isn’t.

What, no settlement?

Let me explain.  In the majority of cases where a lawyer is involved or there are disputes,  there will eventually be a settlement  –  but not always. There is no guarantee or entitlement to a “settlement” in a Minnesota workers’ compensation claim.  Instead,  settlements occur at some point in a claim because the parties mutually agree to settle their disputes in exchange for a certain amount of money.  In that regard, it’s no different than any other type of legal action where the parties agree to compromise and end their dispute.

Many claims  just run their natural course and will end,  without any type of  “settlement”.   For example,  let’s assume that you injured your shoulder at work, had successful arthroscopic surgery and missed 3 months of work.  The work comp insurance company  voluntarily paid your wage loss benefits and  all medical and vocational rehabilitation expenses.  You return to your previous job at your previous wage.  Your surgeon then gives you a 6% Permanent Partial disability (PPD) disability rating and the insurance company pays that.  The claim would end at that point without any additional payment of benefits and no “settlement”.   If you need additional medical care or lose more time from work at some point down the road,  your claim could be reopened and additional benefits paid at that time.

When, how and why do work comp settlements happen?

To understand why a case might end with a settlement,  you’ll need at least a basic understanding of the benefits available in a Minnesota work comp claim.  As I explain to my clients during our first meeting, there are only four basic types of monetary benefits that you might receive under  Minnesota workers’ compensation laws (these are very brief descriptions, you can find more details in some of our other blog posts or here).

Temporary Total Disability benefits (TTD).  These are benefits paid to someone who is off work completely because of a work injury.  (I won’t go into more detail  about TTD benefits for the purposes of this article – this topic will be a separate future post).

Temporary Partial Disability benefits (TPD).  These are partial wage loss benefits paid to someone who is working after an injury, with physical restrictions, but earning less than his or her pre-injury wage.

Permanent Total Disability (TTD).  These are benefits paid to someone who is off work completely because of a work injury and is permanently unemployable.  (See this previous post for details)

Permanent Partial Disability (PPD).   This is compensation paid if you have suffered a permanent impairment which can be rated (as a percentage) under the workers’ compensation disability schedules.

Every case and every injury is different,  so some or all of the available types of benefits might be payable in any given case.  There are limits on the number of weeks you may receive TTD and TPD  benefits and there are also triggering factors and events which  might allow the insurance company to discontinue wage loss benefits.   (That’s also the subject for another post.)

In addition to these monetary benefits,  an injured worker can also be reimbursed for certain travel expenses related to medical treatment or vocational rehabilitation and job search,  including retraining.  There is no payment or compensation for pain and suffering in a Minnesota workers’ compensation claim.  The benefits mentioned above are set by law and strictly limited.  So, with that basic benefit explanation,  here are some situations where settlements frequently occur:

Shortly before a workers’ compensation hearing

In my experience, this is the most common time for a case to settle.   If there is a hearing scheduled before a compensation judge,  it means that there are disputed issues.  The disputes might involve compensation benefits, medical issues, vocational rehabilitation issues or a combination of many issues.  If a judge decides the case, someone will win and someone will lose.  In a work comp case, because the available benefits are clearly defined, the value of most claims can be relatively easy to calculate.  Therefore, both the employee’s attorney and the insurance company attorney will usually have a pretty good idea as to what the “best case” and “worst case” outcomes might be.  Obviously, everyone likes to win and nobody wants to lose.  A compromise settlement at that point often makes sense for both parties.

At a settlement conference or mediation

If there are disputed issues and the case is proceeding toward a hearing, the Office of Administrative Hearings will usually schedule a  settlement conference.  A settlement conference involves the attorneys, the employee and a workers’ compensation settlement judge.  The conference may be held in person or by telephone, depending upon where the parties and attorneys reside.  Participation is voluntary and the settlement judge will assist and encourage the parties to reach a settlement of the disputed claims.  If they are able to do so, the claim (or at least the claim in dispute at that point) is settled.

A mediation is simply a different format for attempting to resolve disputed claims.  The parties will usually select an experienced workers’ compensation attorney to serve as a mediator.  A meeting is held, typically at the mediator’s office, and the parties exchange settlement proposals and offers back and forth through the mediator.  Again, if the parties can agree to reasonable terms, the case is settled.

While an appeal is pending

Sometimes the parties are unable to resolve the disputed claims and the case proceeds to a hearing.  After a compensation judge issues his or her decision, the losing party might file an appeal to the Worker’s Compensation Court of Appeals.  Cases are sometimes settled while the appeal is pending but before a decision is made by the Court of Appeals.

After an injured employee has returned to work

Many cases are settled after the injured worker has completed medical care and treatment and returned to work.  At that point, the parties may be able to project the potential future and ongoing wage loss benefits that might be payable to the employee.  If the employee has returned to work, with physical restrictions, but at a job which pays less than he was earning when injured, the insurance company may have to pay partial wage loss benefits into the future.  In this situation, the insurance company is often interested in paying a lump sum to settle out potential future benefits.

These are only some of the many situations where a settlement might be reached in a workers’ compensation claim.  Every settlement will have its unique terms and conditions, depending upon what the issues are and what claims are in dispute.  There are also many factors which affect the amount and terms  of a settlement, including:

  •  The employee’s average weekly wage on the date of injury
  •  How many weeks of benefits have been paid and how many weeks are potentially remaining?
  •  How strong or weak are the insurance company’s defenses?
  •  How strong or weak is the medical or vocational evidence?
  •  How old is the employee and what are his or her employment plans?
  •  And many other factors and circumstances specific to an individual case

Summary

This post was not intended to discuss how much your claim might be worth or whether you should settle it.  As mentioned above, every case must be evaluated based on its particular facts.  An experienced attorney would need to evaluate the medical evidence, the history of the claim, the nature of any disputed issues, your credibility and a number of other factors before coming up with a fair settlement value.

If you have been offered a settlement of your work comp claim,  I would strongly recommend that you contact an experienced attorney before you ever agree to settle.  A claims adjuster or insurance company attorney is far more knowledgeable than you are about the value of a workers’ compensation claim.  Even though any settlement has to be approved by a work comp judge, you should always consult with an attorney regarding the possible settlement of any  portion of your claim.

If you have questions about a settlement or any other aspect of your northern Minnesota work comp claim,  please feel free to contact me at Bradt Law Offices  with any questions.  I am happy to speak with you anytime about your claim or make an appointment for a free consultation in our Grand Rapids office or wherever it would be convenient for you.

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.

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