Anatomy of a Workers’ Compensation Claim: Part III

Anatomy of a Workers’ Compensation Claim: Part III

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  • Available benefits.

One of the questions I believe many people have about workers compensation claims relates to the benefits available to them. Specifically…what are they? There are a wide variety of potential benefits but the two biggest, and likely the most sought after and needed, are medical expenses and wage loss.

Medical Expenses. Medical expenses are available to anyone who sustains an injury in the course and scope of their employment. (Please refer to the earlier “Anatomy” blogs to determine how to file an initial claim.) Those benefits includes chiropractic care (although there are some limits on that treatment), physical therapy, doctor visits, diagnostic studies, medications and out of pocket expenses for mileage, prescriptions, parking costs and the like. As a general rule you can pick your own facility where you

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would like to have treatment. Some employers are, however, part of a “preferred provider network” or often in the construction trades the “exclusive provider network” that functions in the “Union Construction Workers Compensation Program.” If you are in a union be sure to check with your employer to determine if they are part of that system. The rules, jurisdiction and procedures are all different than a regular Minnesota workers compensation claim. If you are not in a union, however, do not let an employer tell you where you MUST treat medically. IF you have a prior treatment history with a doctor or chiropractor you ARE allowed to make that doctor your primary physician following

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a work related injury.

There are many rules and parameters that affect an insurer’s responsibility to pay your medical bills. I think it is worth consulting an attorney to address some of the complex idiosyncrasies and nuances of the medical treatment parameters in the Minnesota workers compensation system. Please refer to the last blog to learn how to file a claim to get medical expenses paid when an insurer denies payment. As a general rule, if you are treating with an approved doctor and that doctor makes a treatment recommendation, the insurer will pay for it. The treatment must be three things in order to be payable: reasonable (which means the cost must be usual and customary); necessary (which means the treatment is required to diagnose, treat or cure your injury or condition) and causally related (which means the work injury or condition must be a “substantial” factor in bringing about the need for the treatment). If there is a dispute about payment of a bill your doctor will need to address these issues. Again, it makes sense to consult a lawyer if there is a dispute so your doctor can issue the necessary opinions and have the proper foundation to issue those opinions.

Wage Loss. Wage loss is available to an injured worker if he/she misses more than 3 consecutive days of work following an injury. If you miss the first three days but return on day four and miss no more work, you will not be entitled to wage loss. If you continue to miss time after the fourth day but less than 10 days, then you will receive the wage loss for days four through nine. If you miss ten consecutive days or more then you will be eligible for wage loss dating back to your injury date or first lost day from work.

Wage loss is paid at two thirds (2/3) of your pre-injury wage. The means of calculating the average weekly wage (AWW) and the litigation surrounding the issue could be the subject of an entire article or seminar. It

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is complicated and it is another situation in which it makes sense to consult an attorney to make sure that the insurer has properly calculated your wage (AWW).

Workers compensation wage loss benefits have many limits imposed the by the statute. For example, total wage loss or temporary total disability (TTD) is payable for a maximum of 130 weeks. Irrespective of your condition or disability at week 131, if you have received 130

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weeks of TTD, you are no longer entitled to TTD. There is at least one exception to this rule. For example, in the case of a retraining plan you can extend beyond the 130 weeks. I tried to get a case to the Minnesota Supreme Court to change that in the context of multiple injuries but the case settled before the Court decided whether or not they wanted to hear it.

Partial wage loss or temporary partial disability (TPD) is payable if your injury causes you to have limitations that reduce your hours, your wage or force you to get another job that pays you less than you earned before

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your injury. This is part of what makes the AWW so important. These benefits are capped at a maximum of 225 weeks BUT those benefits MUST be paid within 450 weeks of your injury date.

  • Unavailable Benefits.

One question I am repeatedly asked is: what is the value of pain and suffering or loss of enjoyment of life? People want to know if they can expect compensation for the fact that they will live with their pain and injury for a lifetime.

Pain and suffering. In the context of a workers compensation claim, however, that pain is not compensated at all. That does not diminish its significance in an injured worker’s life, but the statute does not allow for a specific claim the way you could in car crash or dog attack claim. The reason for it is a trade off in the legislature when they drafted the Minnesota Workers Compensation Statute. In exchange for covering everyone who sustained work –related injuries and not penalizing people who were injured through their own fault, the legislature eliminated claims for pain and suffering. The legislature did set up a permanent partial disability schedule (PPD) for injured workers who sustain permanent injuries. PPD is, however, a long and complex subject that will be the subject of a future blog, but it is imperative for people to know that you cannot recover for pain and suffering in a workers compensation claim.

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expansive nature of the Minnesota Workers Compensation statute and the benefits available under it seem limitless. The difficulty is not only their number but in the complexity with which they are paid or distributed and the rules that govern that distribution. It makes sense to at least consult a trusted and experienced lawyer to address your questions to ensure that you are receiving all the benefits to which you are entitled. These consultations are free and I think worth the time you spend making that call.

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