Minnesota Worker’s Comp Frequently Asked Questions (FAQ).

Minnesota Worker’s Comp can be a very complex process. Below is a list of frequently asked questions. Click on each question for respective answers:
 

What happens when I am injured on the job?
What is workers’ compensation?
How are workers’ compensation benefits paid?
What health care benefits are available?
What is a certified managed care plan?
What are independent medical examinations?
What monetary benefits are available?
What vocational rehab services are available?
What if I have problems with my claim?
Who has access to my private and state files?
What constitutes Worker’s Comp fraud?


What is workers’ compensation?

The workers’ compensation system provides benefits if you become injured or ill from your job. Workers’ compensation covers injuries or illnesses caused or made worse by work or the workplace. Workers’ compensation benefits are paid regardless of any fault of either the employer or employee.
Workers’ compensation pays for:
1. Medical care needed to treat the injury, as long as it is reasonable and necessary.
2. Wage-loss benefits for part of your income loss.
3. Benefits for permanent damage to a body function.
4. Benefits to your dependents if you die of a work injury.
5. Vocational rehabilitation services if you cannot return to your job or to the employer you had before your injury.

How are workers’ compensation benefits paid?

Benefits are paid by your employer’s insurance company or by your employer (if self-insured). Minnesota State law sets the benefit levels. Employers must display the Employee Rights and Responsibilities poster, which includes the name of their workers' compensation insurer. If you cannot find the poster at your workplace or if the insurer's name is not on it, ask your employer.

What happens when I am injured on the job?

Don’t wait. Report your injury to your supervisor as soon as possible. You may lose the right to workers' compensation benefits if you do not report the injury within timeframes set by law.

• Your employer must complete the First Report of Injury form.
  
• The employer has 10 days from its knowledge of a lost-time claim to report it to the employer's insurance company.
  
• If your disability lasts for more than three days, the insurer must file the First Report of Injury form with the Department of Labor and Industry.
  
• Your employer or its insurer must provide you with a copy of the First Report of Injury. A copy of the First Report of Injury in a lost-time claim must also be sent to your union, if you have one.
  
• If you were injured on or after Aug. 1, 2000, the employer must give you the Minnesota Workers' Compensation System Employee Information Sheet at the time you are given a copy of the First Report of Injury.
  
• After you have reported the injury, the insurer will investigate your claim, to verify that it was work-related.
  
• You should keep your employer informed of your medical condition and any work restrictions.
• You must notify the insurer of changes in your employment status and keep your employer and the insurer informed of your ability to work.
  
  If the insurer accepts your claim for benefits:
  
  
• The insurer must send you a copy of the Notice of Insurer’s Primary Liability Determination form stating your claim is accepted.
  
• The insurer must start paying wage-loss benefits within 14 days of the date your employer was informed about your work injury and lost wages. The insurer must pay benefits at the same intervals you were paid wages.
  Before 80 weeks of wage-loss benefits have been paid, the insurer must notify you of your right to request retraining.
  
• If you were injured between Oct. 1, 1995, and Sept. 30, 2000, you must file your request for retraining benefits before 104 weeks of wage-loss benefits have been paid to you.
  
• If you were injured on or after Oct. 1, 2000, you must file your request for retraining benefits before 156 weeks of wage-loss benefits have been paid to you.
  
• For injuries on or after Oct. 1, 2000, after you have been paid 52 weeks of temporary total disability benefits, the insurer must notify you in writing of the 104-week limitation on payment of this benefit.
  
  If the insurer denies your claim for benefits:
  
  
• The insurer must send you a copy of the Notice of Insurer’s Primary Liability Determination form stating denial of primary liability for your claim. The form must clearly explain the facts and reasons the insurer is using to deny your claim.
  
• If you disagree with the denial, you should seek the advice of an attorney.
  
• If you need help returning to work but your claim has been denied, call the department's Vocational Rehabilitation unit at (651) 284-5038 or 1-800-657-3749 and ask for a rehabilitation consultation.
  
  What health care benefits are available?

If your claim is accepted, payment will be made for the cost of all reasonable and necessary health care treatment related to your work injury.
Prescriptions and reimbursement for mileage to medical appointments are also payable.

• You may choose your own health care provider under most circumstances. Make sure your health care provider sends all bills and supporting information to the insurer. The supporting information must explain how the treatments and charges relate to your work injury.
  
• Your health care provider must notify the insurer before you have any surgery or hospitalizations, except in an emergency. You or the insurer may ask for a second opinion for any surgery that is not an emergency. The insurer must pay for the second opinion. You cannot be forced to have surgery if you do not want it.
  
  What is a certified managed care plan?

Some employers participate in a workers’ compensation certified managed care plan. A certified managed care plan is an organization that has been certified by the state to manage health care for injured workers. Your employer must tell you if you are covered by a certified managed care plan. Some employers or insurers have contracted with a managed care plan or network of doctors who are not certified by the department. You are not required to receive treatment from a doctor in a plan or network that is not certified.

If you are covered by a workers’ compensation certified managed care plan:

• Your employer must post a notice that shows how to get treatment using the managed care plan and provide the name and phone number of a contact person.
• You may ask the employer, the insurer or the certified managed care plan staff for a list of providers in the plan.
  
• A medical case-manager might be assigned to coordinate the delivery of health care for your injury.
  
• You must go to a provider in the certified managed care plan unless:
  
• You need emergency medical care
  
• You want to receive care from another health care provider who is able to treat your injury and has treated you at least twice in the last two years or who has a documented history of treating you
  Or
  
• You live or work too far from a health care provider in the plan. (There is a 30-mile limit in the seven-county Twin Cities area and a 50-mile limit in all other areas.)
  
  What are independent medical examinations?

The insurer may ask you to be examined by a health care provider of its choice. The examination is often called an independent medical examination (IME). The insurer may suspend your benefits if you refuse to be examined by that doctor. The insurer must reimburse you for mileage and other costs for attending the examination.

What monetary benefits are available?

• Disability is deemed to begin on the first calendar day or fraction of a calendar day that you are unable to work. By law, no wage-loss benefits are paid for the first three calendar days after the disability begins. If the disability continues, even if intermittently, for 10 calendar days or longer, the compensation is owed from the first day you were unable to work.
  
  Temporary total disability (TTD) benefits
  
  
• TTD benefits are paid if you are unable to work due to your work injury.
  
• TTD benefits are equal to two-thirds of your gross weekly wage at the time of injury (with maximum and minimum limits).
  The maximum and minimum amounts payable are determined by the law on the date of the injury.
  
• TTD benefits are paid for up to 104 weeks. They must be paid longer if you are in an approved retraining program.
  
  These benefits are paid at the same intervals as your wages were paid before the injury.
  
  TTD benefits generally end when:
  
  
• 104 weeks of TTD benefits have been paid and you are not in an approved retraining program.
  
• You have returned to appropriate work
  
• 90 days have passed since you were notified that you have reached maximum medical improvement;
  
• 90 days have passed since the completion of an approved retraining plan;
  
• You do not cooperate with an approved rehabilitation plan;
  
• You are able to work, but refuse gainful work within your physical restrictions.
  
• You are able to work with restrictions, but fail to diligently search for appropriate work;
  
• You are able to work, but withdraw from the labor market;
  
• Your health care provider releases you to work without any physical restrictions caused by the work injury; or
  
• You retire for reasons other than your injury.
  
• You have an obligation to inform the insurer if you return to any sort of work. The insurer may propose to discontinue your TTD benefits if you fail to diligently search for appropriate work within your physical restrictions.
  
  Temporary partial disability (TPD) benefits
  
  
• TPD benefits are paid if your work injury results in a lower weekly wage than you earned at the time of injury.
  
• Payment is two-thirds of the difference between your average gross weekly wage at the time of the injury and your current gross weekly earnings.
  
• The maximum amount payable is determined by the law that is in effect on the date of the injury.
  
• For injuries on or after Oct. 1, 1992, you cannot be paid more than 225 weeks ofTPD benefits or receive such benefits after 450 weeks beyond the date of injury, whichever comes first. However, if you are in an approved retraining program and are working at a wage loss during retraining, the TPD paid does not count against the 225- or 450-week limit.
  
  Procedure for discontinuing wage-replacement benefits
  
  
• Your employer or insurer must provide you with a written notice of its intention to suspend or discontinue benefits and file a copy of the notice with the department.
• The notice must indicate the proposed date of discontinuance and clearly indicate the reason, with all documentation of supporting facts attached.
  
• If you object to the proposed discontinuance, you may talk to the insurer, contact the DLI Customer Assistance unit, request a conference (this must be done within 12 days) or start an objection procedure.
  
  Permanent total disability (PTD) benefits
  
  If a work injury or illness prevents you from ever returning to a steady job and earning a living from work, you may be eligible for PTD benefits.
  You need a certain level of permanent disability, depending on your age and education, to be considered for PTD benefits.
  The PTD benefit amount is two-thirds of the gross weekly wage you were earning at the time you were injured.
  The amount of these benefits is determined by the law in effect on the date of injury.
  
  Permanent partial disability (PPD) benefits
  
  PPD benefits compensate for permanent loss-of-use of a body part.
  These benefits are paid after temporary total disability ends, approximately at the same rate and intervals.
  You may request the payment of PPD in a lump sum. The lump sum can be discounted to present value with up to a five percent discount factor.
  
  Death/dependency benefits
  
  The spouse, children and/or other dependents of a worker who dies because of a work-related accident or occupational illness are eligible for dependency benefits.
  Workers’ compensation insurance also pays burial expenses up to $15,000 for dates of injury on or after April 28, 2000.
  For injuries on or after April 28, 2000, payment is made to the estate, if the deceased has no dependents.
  
  Cost-of-living increases
  
  Cost-of-living increases for wage-loss benefits are determined by the law in effect on the date of injury. Workers with injuries occurring on or after Oct. 1, 1995, are eligible for annual cost-of-living increases starting four years after the injury date, with the maximum annual increase limited to two percent.
  
  What vocational rehabilitation services are available?

You may be eligible for vocational rehabilitation services if:

• You need help returning to work because of your injury; and
  
• Your employer is unable to offer you suitable gainful employment within your work restrictions.
  
• Vocational rehabilitation services are planned by you, the employer/insurer and a qualified rehabilitation consultant (QRC).
  These services are:
  
• Modifying job duties to fit abilities.
  
• Finding work with a different employer if yours does not have suitable work available; and
  
  Training for a new job.
  
  You may ask for vocational rehabilitation at any time. If you think vocational rehabilitation services will be helpful, write to the insurer to request a rehabilitation consultation with a QRC.
  
  Insurers must file a Disability Status Report with the department:
  
  
• When rehabilitation services are requested by you, your employer or the insurer;
  
• When it becomes known you will be unable to return to work for at least 13 weeks; or
  
• When 90 days have passed since your injury and you have not returned to work.
  
  On the Disability Status Report, the insurer must either refer you for a rehabilitation consultation or request that the department waive vocational rehabilitation services.
  
  A QRC conducts a vocational rehabilitation consultation to determine whether you are eligible for rehabilitation services. If you are eligible, the QRC will write a rehabilitation plan and coordinate rehabilitation services. The QRC will work with you, your employer and the insurer to plan the services you need to return to suitable gainful employment.
  
  If you disagree about your eligibility for rehabilitation services or if you disagree about the rehabilitation plan you may call Customer Assistance; if they cannot resolve your problem, they will instruct you on how to file a Rehabilitation Request form to seek assistance.

Choosing a qualified rehabilitation consultant.
You may choose your own QRC or the insurer may refer you to one for the rehabilitation consultation. If you do not choose the QRC for the consultation, you may select one to provide the services. You have up to 60 days after a rehabilitation plan is filed to request a different QRC. Under certain circumstances, you may be entitled to a different QRC after the 60-day period.

You may obtain a list of QRCs in your area by calling DLI Compliance Services at
(651) 284-5036.

Retraining

• Your rehabilitation plan may include retraining. Retraining is a formal course of study designed to return an injured worker to suitable gainful employment.
  
• For dates of injury from Oct. 1, 1995 through Sept. 30, 2000, you must file a request for retraining with the department before you receive 104 weeks of any combination of temporary total disability and temporary partial disability benefits.
  
• For dates of injury on or after Oct. 1, 2000, you must file a request for retraining with the department before 156 weeks of any combination of temporary total disability and temporary partial disability benefits are paid.
  
• Retraining benefits are limited to 156 weeks. Your QRC is responsible for preparing your retraining plan. It must be approved by the insurer and by the Department of Labor and Industry.
  
  What if I have problems with my claim?

Some workers’ compensation claims are paid without any problems. If you have questions or if you feel you are not receiving the correct benefits, follow these steps:

• Call the insurance claims adjuster. Write down the date, time and adjuster’s name for your records. Explain the problem and try to work it out. Many problems can be fixed with a telephone call.
  
• Discuss your problem with a Customer Assistance specialist at the Department of Labor and Industry. (Visit www.doli.state.mn.us/workcomp.html for helpful info, Customer Assistance names and phone numbers) If your problem has not been resolved, the Customer Assistance specialist can explain the dispute resolution process and provide information to help you decide the best way to resolve your problem. If your medical benefits are provided through a certified managed care plan, you must first use the managed care plan’s dispute-resolution process to resolve disagreements about medical care. The managed care plan must respond to you within 30 days after you notify them, in writing, of a problem. Some unions and employers, especially in the construction industry, have specific procedures that must be followed when resolving disputes. Contact your union representative for further information.
  
• Contact an attorney.
  
  Records privacy and state files

Besides state agency staff, the contents of your workers’ compensation file can be examined only by:

• You (the employee)
  
• Your employer at the time of injury
  
• Your employer’s insurer
  
• An agent of the employer or insurer
  
• The dependents of an employee who has died
  
• Anyone else with written permission from the employee or dependents
  
  Fraud

Any person who, with intent to defraud, receives workers’ compensation benefits to which the person is not entitled by knowingly misrepresenting, misstating, or failing to disclose any material fact is guilty of theft and shall be sentenced pursuant to section 609.52, subdivision 3.

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