What kind of injuries qualify for benefits?

Specific Traumatic Events: Work-related injuries most commonly involve a specific traumatic event (like lifting something heavy or tripping and falling) that occurs while the employee is working.

Cumulative Effect Injuries: Work-related injuries can also be caused by days, weeks, or even months of repetitive minute trauma such as typing or assembly work. The date of injury in such cases is the date of “ultimate breakdown,” meaning the first day the employee becomes disabled from working or the first day the employee seeks treatment of their condition. 

Occupational Diseases: Diseases, like asbestosis or silicosis, that arise out of exposures peculiar to employment can be compensable work-related conditions. Even ordinary diseases of life like influenza can be covered by workers’ compensation benefits if contracted while traveling out of the country on business.

Car Accidents: If an employee is injured in a car accident while working or running a special errand for an employer, workers’ compensation benefits are primary and no-fault benefits may also be payable. Accidents that occur while commuting to or back home from work are usually not covered by workers’ compensation, unless the employee is required to use her car to perform her duties at work.

Pre-existing Conditions: A work-related incident or activity need not be the sole cause of an injury. So long as a work-related incident or activity substantially aggravates, accelerates or combines with a pre-existing condition to result in disability, increased symptoms or need for treatment, workers’ compensation benefits are payable. Don’t let your employer or insurer convince you that benefits are not payable just because you had a similar injury or condition in the past.

What if the injury is the employee's fault?

Workers’ compensation is a no-fault system. Even if the injury is the result of the employee’s own negligence, benefits are usually payable. However, if the injury arises out of “horseplay,” specifically prohibited conduct, or intoxication, or if an employee intentionally injures herself, then benefits may not be payable.

What if the injury is the employer's fault?

It is not necessary to prove that an employer was somehow negligent and caused the injury. Moreover, even if the employer was negligent, the employee is not entitled to any damages over and above the benefits normally payable under the law.

Do I have to report my injury to my employer?

Unless an employer has actual knowledge of the occurrence of a work-related injury, employees are required to notify their employer that they suffered an injury while working and that they intend to claim workers’ compensation benefits. Notice should be given as soon as possible, preferably in writing. If notice is not given within 180 days of the injury, the employee’s claims may be forever barred. Employers cannot require that notice be given within a shorter period of time than that allowed by law.

How do I apply for workers' compensation benefits?

You do not have to file an application for workers’ compensation benefits. You only have to report your injury to your employer. Your employer is then obligated to report your injury to their insurer. The insurer will contact you; verify information concerning your injury and your prior medical history; and either accept liability for benefits or deny liability. If liability is denied, call me immediately.

Sometimes employers will refuse to report injuries to their insurers. If you are dealing with this situation, contact me immediately.

Can my employer legally punish me for filing a claim?

Employers are prohibited by law from discharging or threatening to discharge an employee for seeking workers’ compensation benefits, or in any manner intentionally obstructing an employee from seeking workers’ compensation benefits. You should never fail to report your injury and seek benefits out of fear of being fired or mistreated, or out of a desire to be a “good employee.”

What is the statute of limitations in Minnesota workers' compensation cases?

If primary liability for a claim is denied by the employer, the employee must file a claim petition within 3 years after the employer has made written report of the injury to the state. If no injury is reported to the state by the employer, the employee must file a claim petition within 6 years from the date of the injury.

What benefits are payable under Minnesota Worker's Compensation Law?

1.  Wage Loss Benefits:

Temporary total disability (TTD) is payable when the employee is totally off work due to limitations stemming from the injury, but is expected to return to work. TTD is payable at the rate of two-thirds of the employee’s average weekly wage on the date of injury subject to statutory minimums and maximums that depend upon the date of injury. TTD benefits must be paid at the same intervals as the employee’s wage was paid before their injury (i.e., if wages were paid weekly, TTD must be paid weekly). TTD is limited to a cumulative maximum of 130 weeks for injuries occurring on or after 10/1/08 (104 weeks for injuries occurring prior to 10/1/08). TTD stops if the employee returns to work; if the employee withdraws from the labor market (for example by moving from the Twin Cities where jobs are plentiful, to a small town where jobs are scarce); if the employee fails to make a reasonably diligent effort to look for appropriate work within their physical limitations; if the employee is released to return to work without limits; if the employee refuses an offer of work that is consistent with their plan of vocational rehabilitation, or that the employee can do within their limitations; or ninety days after the employee receives a written medical report indicating the employee has reached maximum medical improvement.

Temporary partial disability (TPD) is payable when the employee is working but at a reduced wage due to limitations stemming from the injury. TPD is payable at the rate of two-thirds of the difference between the employee’s average weekly wage on the date of injury and the employee’s post injury gross earnings, subject to the same maximum rate that applies to TTD benefits but with no minimum rate. TPD must be paid within ten days of when the insurer receives proof of the employee’s post-injury earnings. TPD is limited to a cumulative maximum of 225 weeks (four years and seventeen weeks) of benefits, or 450 weeks (eight years and thirty-four weeks) from the date of injury, whichever first occurs. TPD is only payable while the employee is working. TPD stops as soon as the employee begins making more than their average weekly wage on the date of injury; or if the employee is released to return to work without limits. TPD continues beyond ninety days after reaching maximum medical improvement.

Permanent total disability (PTD) is payable when the employee is permanently and totally disabled from working in any occupation that brings a steady income, and has permanent functional disability that satisfies the PPD threshold that applies to them based upon their age on the date of injury. PTD is payable at the same rate as TTD, subject to the same maximum rate but a higher minimum rate as TTD. Payments must be at the same intervals as the employee’s wage was paid before their injury (if wages were paid weekly, PTD must be paid weekly). PTD benefits stop at age 67, unless the employee is able to prove that they would not have retired at age 67 had the injury not occurred.

Average Weekly Wage (AWW): All benefits are based upon the employee’s average weekly wage as of the date of injury. AWW is generally calculated based upon the 26 weeks immediately prior to the date of injury.  Once AWW is determined, it controls the calculation of all wage loss benefits from the date of injury forward, no matter how long the wage loss continues. Raises or other income or benefit increases the employee would have received had the injury not occurred are not considered in determining wage loss under Minnesota workers’ compensation law.

Maximum Medical Improvement (MMI) 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, regardless of subjective complaints of pain. It is simply the point in time that everyone who suffers an injury reaches when their condition stops getting better. It does not necessarily mean complete recovery. If an employee continues to have symptoms after reaching MMI, they probably have suffered a permanent injury. Your treating doctor will generally determine when you have reached MMI.

2. Vocational Rehabilitation or Retraining Benefits:

If an injury prevents an employee from performing the essential functions of their pre-injury job, or any suitable job offered to them by the employer, they may be entitled to assistance in finding a new job, or even retraining for a new career. These services are provided by qualified rehabilitation consultants, or QRCs. The employee has the right to choose their QRC. If an employee requests an initial consultation with a QRC to determine if they are qualified for benefits, the insurer generally must pay for the consultation. The QRC will help coordinate or manage the provision of medical treatment, and will assist the employee in returning to employment which produces an economic status as close as possible to that the employee would have enjoyed had they not suffered their injury. Usually the plan for returning the employee to work is: return to work with the same employer in the pre-injury job; return to work with the same employer in a modified or lighter duty job; find a new job with a different employer; and if none of the above are possible, consider retraining the employee for a new career. Insurers must reimburse employees for all reasonable expenses necessarily incurred in looking for work, including mileage, postage, printing costs for resumes and cover letters, etc. Sometimes insurers will assign disability case managers (DCMs) to work with employees. They perform many of the same tasks as QRCs in terms of going to medical visits, talking to doctors, discussing return to work with the employee and the employer. However, DCMs are not the same as QRCs. They work for insurers, essentially as an extension of the claims adjuster, and their goal is to minimize treatment expenses by convincing the employee to stop treating, and reduce wage loss benefits by convincing the employee to return to work ASAP, even if the employee may not yet be ready to return to work safely. Employees are not required to work with DCMs.

3. Medical Expense Benefits:

Employers must pay all expenses related to treatment or supplies that are reasonably required to cure or relieve the effects of the employee’s work-related injury, including mileage or other out-of-pocket expenses you incur receiving treatment. This obligation continues for so long as the employee suffers from the effects of the injury and requires treatment, theoretically for life. There is no dollar limit. Insurers may try to limit treatment under the “treatment parameters.” The treatment parameters are rules intended to be applied as guidelines for determining what treatment is usually considered reasonable and necessary for different types of injuries. Insurers may try to impose the provisions of the parameters as absolute limits, and may try to convince you that you can’t receive treatment being recommended by your doctor. Don’t believe such a statement. For example, the insurer may tell you chiropractic treatment or physical therapy is limited to twelve weeks. That is false. You can receive chiropractic treatment or physical therapy for longer than twelve weeks. However, your doctor will need to explain why treatment beyond twelve weeks is necessary in your unique circumstances.

4. Permanent Partial Disability Benefits (PPD):

If an employee suffers an injury that results in permanent functional impairment that is ratable under the Permanent Partial Disability Guidelines, the employee will receive a sum of money to compensate for that permanent loss. Once you reach MMI, your doctor will address the issue of PPD. Your doctor will find the section of the Permanent Partial Disability Guidelines that most closely describes your injury. The Guideline will tell the doctor what percentage rating applies to your condition. There is a formula in the statute that then translates the percentage rating into a dollar amount. The formula is that you get $750 per percentage point if your rating is between 0-5 percent; $800 per percentage point if your rating is between 5-10 percent; $850 per percentage point if your rating is between 10-15 percent; and the dollar multiplier increases by $50 every five percentage point increment thereafter. For example, if your PPD rating is 3.5% you will receive $2,625.00; if your PPD rating is 7% you will receive $5,600.00; if your PPD rating is 12% you will receive $10,200.00. Once your PPD rating is established, these dollar amounts are not negotiable. You are not entitled to money for pain and suffering, or loss of enjoyment of life under Minnesota workers’ compensation law. The PPD benefit is the closest the system comes to compensating you for such damages.

5. Death/Dependency Benefits:

If an employee dies from a work-related injury, a variety of benefits become payable, including burial expenses and compensation to surviving dependents (spouse, children, and other persons financially dependent upon the deceased employee at time of death). Because dependency benefits can be quite complex depending upon the number and relationship of the surviving dependents, it would be best to call me immediately if you are confronting this situation.

Do I have the right to choose my treating doctor?

The general rule is that employees have the right to choose the type of doctor and the individual doctor from whom they wish to receive treatment. Employers cannot require employees to treat with the “company” doctor. The only exceptions to this occur when the employer elects to have a managed care plan, or when union collective bargaining agreements modify this right. The right to choose one’s treating doctor is extremely important. All employees should choose a doctor they trust and never allow the employer or its insurer dictate that choice.

What if my employer has a managed care plan?

Employers have the right to purchase insurance policies that include certified managed care plans. If this occurs, injured employees can be required to receive treatment from providers who participate in the plan, or from providers with whom the employee has a previous history of treatment. Employers must advise employees of the existence of the managed care plan at the time the employee reports their injury. If the employer fails to do so, and the employee begins treating with a provider of their choice before being told of the managed care plan, they have the right to continue treating with that provider even if the provider is not part of the plan and the employee has never treated with them before.

Is chiropractic treatment limited to 12 weeks?

Chiropractic treatment is not limited to 12 weeks as many employers or insurers will tell employees.  Chiropractic treatment may continue for so long as it is reasonably required to cure or relieve the effects of the employee’s work-related injury. Employees may continue receiving chiropractic treatment even after an employer or insurer says they will no longer pay, if the treatment continues to help the employee recover from the injury or continues to provide significant relief.

My insurer has scheduled an appointment for me to be examined by a doctor of their choice, called an "IME". What is this and do I really have to go?

You are required to submit to a physical examination by a doctor of your employer’s or its insurer’s choice. In fact, the insurer can obtain multiple adverse examinations so long as they are “reasonable.” Insurers prefer to call these “independent” medical examinations, or IMEs. In reality, there is nothing independent about them. These examinations are conducted by doctors hand-picked by the insurers, and in the vast majority of cases result in opinions that enable the insurer to stop paying benefits. They are truly adverse to your interests, not independent.

Unfortunately, you cannot refuse to attend an adverse examination. If you refuse to attend an adverse examination, your benefits can be suspended for that reason alone.

Your insurer can force you to travel up to 150 miles from your home to see their doctor. You are entitled to reimbursement for any mileage, parking and wage loss that you incur. If the examination is a long ways from your home, you may even be entitled to lodging and meals.

The insurer is required to provide you with a copy of the report once they receive it.

How do I sue the workers' compensation insurer if they refuse to pay my benefits?

The proper pleading to file depends upon what benefits are in dispute and the basis for the dispute. Because the benefit structure and the procedural process is so complicated in workers’ compensation cases, and because attorney fees are so reasonable, there really is no reason for you not to retain an attorney to represent you if your benefits are denied. Call me now for your free initial consultation.

How do attorney fees and costs work?

No attorney fees are payable unless and until benefits are successfully recovered. Then, the amount of the fees and who has to pay them depends upon the type of benefits recovered. If I recover wage loss benefits or permanent partial disability benefits payable to you, 25 percent of the first $4,000.00 recovered and 20 percent of any amount over $4,000.00 will be withheld and paid to me as a contingent fee. If I recover payment of medical expenses or vocational rehabilitation services, my attorney fee is 100% payable by the employer or the insurer. In addition, you may be entitled to an award called a subdivision 7 fee equal to 30 percent of my attorney fees in excess of $250.00.

Costs are different from attorney fees. Attorney fees pay me for my time and services. Costs relate to amounts I have to pay to others in order to represent you. For example, your doctors will charge to provide copies of your medical records and bills; if I need your doctor to prepare a report for trial, he or she will likely charge for their time preparing the report; if your deposition is taken, the court reporter will charge for their time. If I have to prepare exhibits for trial, I will charge a copy charge. I advance these costs for you as your case proceeds. If your case settles or if we go to trial and win, I can force the insurer to reimburse most of these costs. However, if we go to trial and lose, then there is no attorney fee but you are responsible to reimburse the costs.

The attorney fees and costs are very reasonable in workers’ compensation cases. There is no reason for you not to be represented by an attorney. The employer and its insurer certainly will be.