Monday, March 9, 2009

Getting Medical Treatment When Your Workers' Compensation Claim Has Been Denied

One of the major problems with the Minnesota workers’ compensation system is how long it can take to resolve disputes over primary liability. When an insurer denies primary liability for a work-related injury, they will not pay any wage loss benefits, permanency benefits, rehabilitation benefits, and most problematic, medical expenses.

When a workers’ compensation insurer denies primary liability, meaning they do not believe they are responsible for paying for the injury, generally, a Claim Petition must be filed. It can take several months, or longer in some cases, for an employee’s Claim Petition to move through the workers’ compensation system. During that time period, the insurance company is not paying benefits. Workers’ compensation insurers deny primary liability for a variety of reasons, including, but definitely not limited to:
  • The injury was not caused by the employee’s work activities
  • The injury did not arise out the course and scope of an employee’s work activities
  • The injury was caused by something other than work
  • The employee had pre-existing injuries that are causing the current problem
  • The employee did not sustain any injury at all
  • The claimant was not an employee at the time of the injury
While there are certain rules an insurance company must follow when denying primary liability, in reality, they can deny a claim because it’s Tuesday, and they deny all claims on Tuesdays.

While a claim is pending, one of the major issues we see is the fact that it is difficult, if not impossible, for an employee with no health insurance to receive medical treatment if his or her claim is denied. If the workers’ compensation insurer is denying primary liability, an employee may submit the medical expenses through private insurance, MinnCare, or medical assistance. If bills related to a work-injury are submitted through private insurance, that insurance company has what’s known as a subrogation interest in the pending workers’ compensation claim. What this means is that the health insurance company has a right to seek reimbursement for the charges it covered from the workers’ compensation insurance company.

If that injured worker does not have private insurance or medical assistance, finding a health care provider that will provide services without some form of insurance can be extremely difficult. There are some health care providers who will agree to treat an injured worker without insurance until the claim is resolved. Your workers’ compensation lawyer can give you some ideas as to how to get the treatment you need while your claim is pending.

If you’ve been injured on the job and the workers’ compensation insurance company is denying primary liability, and you’re having trouble getting the medical treatment you need, call us at 877-746-5680 or click here to send us an email to schedule a free consultation.

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