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Worker’s Compensation Medical Benefits, Rehabilitation Benefits and Wage Loss Recovery Medical Benefits Below is a comprehensive list of medical expenses covered at the time of injury and any time thereafter to cure or relieve an employee from the effects of the injure. They include: 1. Medical treatment. 2. Surgical treatment. 3. Hospital treatment. 4. Nursing services. 5. Dental treatment. 6. Psychological/psychiatric treatment and medications. 7. X-rays, CAT scans, MRIs, discograms, arthrograms. 8. Chiropractic treatment. 9. Podiatric treatment and orthotics. 10. Pain clinic treatment. 11. Physical therapy, including modalities such as massage, ultrasound, electrical stimulation, ice and heat therapy, supervised exercises/instruction in a formal physical therapy setting, limited use of a health club facility, and home exercise equipment, including where appropriate exercycles, Nordic tracks, rowing machine, weights and treadmill. 12. Medical appliances and supplies. 13. Artificial members, including providing, replacing or repairing artificial teeth and eyes. 14. Glasses, spectacles, hearing aids, canes, crutches, wheelchairs and shoes. 15. Medications and related supplies and treatment, including prescription medications, therapeutic injections, braces, corsets and supports. 16. Home nursing services in limited cases. 17. Medical and surgical supplies. 18. Medical mileage to and from the prescribed treatment facilities. 19. Functional Capacity Evaluations to determine appropriate restrictions. Medical Treatment Medical treatment can be provided by a health care provider including a physician (medical doctor), podiatrist, chiropractor, dentist, optometrist, osteopath, psychologist and psychiatric social worker. Other medical issues include: 1. Choice of doctor. 2. Change of doctor. 3. Referral from one doctor to another. 4. Second opinions. 5. Independent medical examinations (IMEs), which are exams by the insurance company’s doctor. Rehabilitation Fundamentally, it means assistance in preparing for or obtaining employment. The purpose of rehabilitation is to allow injured workers to return to their former employment or, if precluded from returning to their pre-injury job, to allow the injured employee to return to a modified job and also to encourage injured workers to increase their employability by acquiring new or additional skills through on-the-job training or retraining. Rehabilitation is intended to restore the injured employee so the employee may return to a job related to the employee’s former employment or a job in another work area which produces an economic status as close as possible to what the employee should have enjoyed without disability. Rehabilitation benefits include: Hiring of a qualified rehabilitation counselor (QRC). A QRC is a person who is professionally trained and experienced. A QRC develops and implements an appropriate plan of rehabilitation services for an employee. Hiring of a job placement vendor. In most instances, rehabilitation vendors are job placement specialists who work with the QRC to provide job placement assistance to the employee. Disability case manager. A disability case manager is not subject to statute and rules applying to other rehabilitation providers, such as QRCs or job placement vendors. Disability case managers are unregulated, need not be credentialed or licensed. A disability case manager is an employee or agent of the employer, insurer or insurance administrator. As an employee or agent of the employer and insurer, a disability case manager is not required to be neutral. Commencement of rehabilitation Securing and/or changing a QRC. Developing a rehabilitation plan. Securing rehabilitation plan approval and/or changes to the plan or modification of the plan. Job search. On-the-job training. Retraining. Retraining is a formal course of study in a school setting that is designed to train an employee to return to suitable gainful employment. Minn. Stat. § 176.011(23). Vocational rehabilitation shall train an employee so he/she may be returned to a job related to his/her former employment or to a job in another work area which produces an economic status as close as possible to what the employee would have enjoyed without disability. Wage Loss Recovery An essential element of the workers’ compensation system is to replace the income lost to employees who become disabled from work as a result of an occupational injury. There are various types of wage loss recovery available, which include the following: Temporary Total Disability (TTD) A person is totally disabled if his/her physical condition, in combination with his/her age, training, experience, and the type of work available within his/her community, causes him/her to be unable to secure anything more than sporadic employment resulting in insubstantial income. A total disability is temporary when it is likely it will exist for a limited period of time only. Duration of benefit This varies with the date of injury: For injuries occurring 10/1/95 to the present, injured employees are limited to a maximum limit of 104 weeks of TTD benefits. Furthermore, TTD benefits shall cease 90 days after maximum medical improvement (MMI) or completion of an approved retraining course, whichever is later. Maximum medical improvement Defined as 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. Minn. Stat. § 176.011(25). Benefit amount The amount of TTD is based upon the employee’s average weekly wage (AWW) on date of injury (DOI). The employee’s weekly TTD benefit is paid at the rate of 2/3rds of the AWW, subject to certain maximum and minimum rates. Permanent Total Disability (PTD) Totally and permanently incapacitated means employee’s physical disability, in combination with employee’s age, education, training and experience, causes employee to be unable to secure anything more than sporadic employment resulting in an insubstantial income. Minn. Stat. § 176.101(5)(b). As of 10/1/95, the statute requires that additional thresholds of disability apply to Minnesota PTD claims. Under Minn. Stat. § 176.101(5), for dates of injury on or after 10/1/95, the following additional thresholds apply in order to prove PPD: (i) employee has at least a 17% PPD rating of the whole body; (ii) employee has a PPD rating of the whole body of at least 15% and is at least 50 years old at the time of the injury; and (iii) employee has a PPD rating of the whole body of at least 13% and is at least 55 years old at the time of the injury, and has not completed grade 12 or obtained a GED certificate; the requirement regarding completing grade 12 or obtaining a GED is not based upon employee’s status at the time of the injury. Duration of benefits: • Permanent total disability payments cease at retirement. “Retirement” means that a preponderance of the evidence supports a conclusion that employee has retired. The subjective statement of employee that employee is not retired is not sufficient in itself to rebut objective evidence of retirement, but may be considered along with other evidence. Minn. Stat. § 176.101, subd. • The 1995 amendments added a new retirement defense that is specifically applicable to PTD claims. Minn. Stat. § 176.101, subd. 4 provides that PTD shall cease at age 67 because employee is presumed retired from the labor market. This presumption is rebuttable by employee. • In 2000, a second clause was added to Minn. Stat. § 176.101, subd. 8, that states for injuries occurring after 10/1/00, an employee who receives any other service-based government retirement pension is presumed retired from the labor market. The term “service-based government retirement pension” does not include disability-based government pensions. These presumptions are rebuttable by a preponderance of the evidence. Benefit amount The amount of PTD benefits is based upon the number of hours normally worked in the employment. Employee’s weekly PTD benefit is paid at the rate of 2/3rds of the average weekly wage, subject to maximums (currently $750.00 per week) and minimums (currently $504.00 per week). This benefit amount is reduced by government disability or old age and survivor benefits. Temporary Partial Disability (TPD) Temporary partial disability benefits are intended to supplement the income that an injured employee can earn in a partially disabled condition. TPD compensation is paid while the employee is employed at a wage loss. Duration of benefits. For injuries on or after 10/1/92, benefits are limited to a maximum of 225 weeks of TPD payments and no benefits are payable more than 450 weeks after the date of injury. Minn. Stat. § 176.102, subd. 2(b). Benefit amount. TPD benefits are paid based upon 2/3rds of the difference between the employee’s average weekly wage at the time of injury (DOI) and the employee’s post-injury earnings. Permanent Partial Disability (PPD) Permanent partial disability benefits represent payment of monetary benefits for functional loss of use or impairment of function of body parts permanent in nature. The permanency must be causally related to the personal injury and must be based on objective medical evidence. PPD Schedules Determinations of impairment for the purposes of calculating PPD awards must be based upon the Minnesota Workers’ Compensation PPD Schedules. These schedules are set forth in Minn. R. 5223.0300-5223.0650 (7/1/93 to the present). Non-scheduled injuries If an injury for which there is objective medical evidence is not rated by the PPD Schedules, the unrated injury must be assigned and compensated for at the rating for the most similar condition that is rated. Minn. Stat. § 176.105(1)(c). Calculation of payment PPD is paid for the proportion that the loss of function of the disabled part bears to the whole body, multiplied by the dollar amount aligned with that percentage. The schedule of impairment rating percent and dollar amount of benefit is set forth by statute and was recently updated on 10/1/00. Method and timing of payment For injuries between 10/1/95 and 9/30/00, PPD is payable upon cessation of TTD benefits. The compensation is payable in installments at the same intervals and in the same amount as the employee’s TTD rate on the date of injury. Effective 10/1/00, the statute specifically allows employees the option to take payment of PPD in a lump sum.	Medical Benefits Medical Treatment Rehabilitation Wage Loss Recovery Temporary Total Disability (TTD) TTD Duration of benefit Maximum medical improvement TTD Benefit amount Permanent Total Disability (PTD) PTD Duration of benefits PTD Benefit amount Temporary Partial Disability (TPD) Permanent Partial Disability (PPD) PPD Schedules Non-scheduled injuries Calculation of payment Method and timing of payment Carter J. Bergen, P.A Suite 270, Parkwood Place 7650 Currell Boulevard Woodbury, Minnesota 55125 Phone 651.714.5530 Fax 651.714.8864 info@carterbergenlaw.com