Thursday, September 30, 2010

Medical Expense Benefits – MN Workers’ Compensation

One of the benefits available to injured workers under Minnesota workers’ compensation law is coverage for reasonable and necessary medical expenses. Reasonable and necessary medical expenses are fully covered under Minnesota Workers’ Compensation, meaning that you do not pay a premium, you do not have a deductible, and you do not pay co-pays for these benefits.

Minnesota Statute §176.135 provides coverage for a wide variety of medical benefits, including, but not limited to:
  • Medical treatment in an emergency room
  • Appointments with a medical doctor
  • Chiropractic treatment
  • Prescription medications
  • Over-the-counter medications
  • Podiatric treatment
  • Surgical treatment, hospitalization, and nursing services
  • Home nursing services
  • Crutches, walkers, and wheelchairs
  • Diagnostic tests, such as X-rays, MRI’s, and CT scans
  • Physical therapy and rehabilitation
  • Preventative rabies treatment
  • Dental treatment
  • ….and pretty much anything else necessary to cure and/or relieve the effects of your injury.
That being said, there are treatment parameters that apply to certain types of medical treatment. For example, chiropractic treatment is generally limited for neck, upper back, low back and upper extremity injuries for a period of up to 12 weeks, plus an additional 12 visits over the next 12 months if certain requirements are met, although there are several exceptions to this rule.

The chiropractic treatment parameters are one of the most contentious issues in Minnesota workers’ compensation medical dispute cases. We regularly represent injured workers who receive substantial benefit from chiropractic treatment, but then, once they’ve reached twelve weeks of treatment, the workers’ compensation insurer stops paying.

We often speak with injured workers who are hesitant to retain an attorney when their case involves a relatively small dispute over medical treatment. Maybe the insurer hasn’t reimbursed them for some prescriptions. Or maybe the insurer won’t pre-approve a follow up MRI. Or maybe the insurer is refusing to pay for additional chiropractic treatment or physical therapy.

Injured workers often wonder whether a Minnesota workers’ compensation lawyer will take their case if they just have a medical dispute. YES! Under Minnesota workers’ compensation law, if your case is limited to a dispute primarily involving medical issues, your workers’ compensation lawyer can petition the Office of Administrative Hearings to order the workers’ compensation insurer to pay your lawyer fees called Roraff fees, which are normally separate and above and beyond benefits payable directly to you.

We regularly represent injured Minnesota workers for claims involving primarily disputes over medical care. For example:
  • We tried and won a case where a workers’ compensation insurer refused to pay a $90.00 bill for a follow up visit with the employee’s spine surgeon. The employee had previously undergone two back surgeries, and had settled her case, closing out monetary benefits. The insurer refused to pay the bill because the employee was pregnant when she had her appointment, and they argued that it was her pregnancy, not her two prior back surgeries for herniated discs, that was causing her back pain.
  •  We represent an employee who settled his monetary benefits over 15 years ago. He has severe degenerative disc disease in his spine, and when he moved to Michigan, he couldn’t find a doctor who was willing to take on his challenging case. Each year, he returns to Minnesota for a follow up appointment with his surgeon, and each year, the insurer refuses to pay for his mileage and lodging, and each year, we file a claim on his behalf, and ultimately get the insurer to reimburse him.
  • We represented a woman who sustained a severe shoulder injury in the early 1990’s. Over the last several years, she began developing severe low back pain, which we believed was related to the bone graft which was harvested from her pelvis on two separate occasions. We ultimately procured a monetary settlement on her behalf, and recently secured pre-approval from the insurer to return for a consultation for her shoulder injury with the surgeon who performed her sixth and final shoulder surgery almost 15 years ago.
For a free, no-obligation consultation with one of our workers’ compensation lawyers, call Meuser & Associates at 877-746-5680 or click here to send us an email.
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