Work Comp. is Denying My Surgery, What Do I Do?: MN Workers' Compensation

We often get calls from folks who have Minnesota work-related injuries who find themselves in a difficult spot when the workers’ compensation insurance company refuses to authorize a proposed surgery or other recommended treatment. 

 A workers’ compensation insurance company frequently refuses to authorize surgeries and other medical treatment either on the basis that the proposed surgery or treatment is not reasonable or necessary, that the proposed treatment or surgery is outside the Minnesota permanent treatment parameters, or that the underlying injury is not a substantial contributing factor to your need for surgery or other medical treatment. Often times, the workers’ compensation insurer will base its denial on the findings of an Independent Medical Exam. Unless the proposed surgery is done on an emergency basis, the workers’ compensation insurer does have the right to require you to attend an Independent Medical Examination before agreeing to the proposed treatment.

No matter what the reason for the denial, don't have to simply accept it if the workers' compensation insurance company disputes your entitlement to medical care!

The rules and hoop-jumping that can go along with getting pre-approval for surgical treatment in a Minnesota workers’ compensation case can, unfortunately, substantially delay your medical care.

Where medical care is disputed in a Minnesota workers’ compensation case, particularly in disputes over pre-authorization for surgery or other treatment, there are procedures that allow many of these disputes to be heard on an expedited, or “fast-track” basis. In some cases, the injured worker can file a Request for Certification of Dispute, and a Medical Request, and the issue will be heard at the Department of Labor and Industry at an Administrative Conference. Other cases are initiated by filing a Claim Petition, and the issue is heard by a judge at the Office of Administrative Hearings.

Unfortunately, disputes over medical care are very common in Minnesota workers’ compensation cases. In fact, it’s not unusual to have multiple disputes over medical care during the course of an injured worker’s claim. When an insurance company starts disputing medical care on a workers’ compensation case, it’s usually only a matter of time before they start disputing other benefits, if they haven’t already been denied.

For a free, no-obligation case evaluation to learn more about your options when the workers’ compensation insurance company is disputing your medical care, call Meuser & Associate at 877-746-5680 or click here to send us an email. 

Will I Have to Undergo an Independent Medical Examination (IME) for My MN Workers’ Compensation Injury?

In our practice, I’d estimate at least 2/3 of my Minnesota workers’ compensation clients are required to undergo an “Independent” Medical Examination (IME) at least once during the duration of their claim. IME’s on disputed claims are almost inevitable.

We refer to so-called “Independent” Medical Examinations (IME) as adverse exams. They are not independent. The doctor you see will not offer treatment recommendations or advice. The doctor is hired by and paid for by the workers’ compensation insurance company.

The purpose of an IME is to provide an “independent” and “expert” opinion report regarding the nature and cause of your injuries for the insurance company. As you might imagine, very, very few of these reports are favorable to the Employee. Generally speaking, the IME doctor will opine that you weren’t hurt, that your injuries were pre-existing or unrelated to your work, that if you did have an injury, you’re completely healed, that your medical care has been unreasonable or unnecessary, that you’re not disabled, or that you’re simply faking it all together. The workers’ compensation insurance company then uses this so-called “expert” opinion as a basis to deny your claim.

Unfortunately, you are generally required to attend if the workers’ compensation insurance company decides to send you to one.

I ran across an interesting report from the MN Dept. of Labor and Industry analyzing what types of workers’ compensation claims involved an Independent Medical Examination. Claims that were closed in 2001 were included in the analysis, and a total of 1,197 of claims were reviewed to determine whether an IME had been performed and filed with the Department of Labor and Industry. Not all IME’s that are conducted are filed with DOLI, so some claims with no IME on file may have still had one conducted. Some claims fell into multiple categories. Not surprisingly, the analysis shows that claims where there was a dispute, or where the Employee’s disability lasted for an extended period were very likely to involve an IME.

• IME’s were filed on 9% of all claims involving indemnity benefits.
• IME’s were filed on 16% cases where claimants received temporary total disability (TTD) benefits for more than four weeks.
• IME’s were filed on 28% cases where a vocational rehabilitation plan was filed.
• IME’s were filed on 31% cases involving a primary denial of liability as well as a claim for indemnity benefits.
• IME’s were filed on 37% cases where a Rehabilitation Request for Assistance was filed.
• IME’s were filed on 56% cases where a Medical Request for Assistance was filed.
• IME’s were filed on 52% cases involving an Administrative Hearing Request, dealing with objections to discontinuances of wage loss benefits.
• IME’s were filed on 54% cases where a Stipulation for Settlement was filed.
• IME’s were filed on 63% cases where a Claim Petition was filed.
• IME’s were filed on 84% cases where a formal Objection to Discontinuance or Petition to Discontinue was filed.

If you’ve been scheduled for an Independent Medical Examination (IME) by your workers’ compensation insurance company, now is the time to speak with a workers’ compensation lawyer. It means that the workers’ compensation insurance company is going to try to stop your workers’ compensation benefits, and they’re seeking a so-called “expert” opinion to justify their reason for stopping your benefits.

For a free, no-obligation consultation with one of our Minnesota workers’ compensation lawyers, call us at 877-746-5680, or click here to send us an email.

Maximum Medical Improvement (MMI) and MN Work Comp: A Double-Edged Sword

If you’re an injured worker in Minnesota, at some point in time, you will probably be sent a letter from the workers’ compensation insurance company notifying you that you’ve reached Maximum Medical Improvement (MMI). On the upside, Maximum Medical Improvement often means you may qualify for Permanent Partial Disability (PPD) benefits. On the downside, it means the insurer can stop paying you temporary total disability benefits (TTD) even if you are not fully recovered or back to work.

Maximum Medical Improvement (MMI) is an important concept in Minnesota workers’ compensation law. It is 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, irrespective and regardless of subjective complaints of pain.” In plain language, it essentially means that from an objective perspective, your condition has improved as much as it is going to. It doesn’t mean that you’re healed. It doesn’t mean that you’re not entitled to additional medical care. It doesn’t mean that your case is over. And it doesn’t mean that you’re no longer suffering from the effects of your injury.

What it does mean, however, is that the workers’ compensation insurance company will stop you temporary total disability (TTD) benefits 90 days after sending you notice of reaching Maximum Medical Improvement (MMI), regardless of whether you’ve fully recovered from your injuries, and regardless of whether you’ve found a new job.

Often, the insurance company secures an MMI determination by sending you to attend an Independent Medical Examination (IME).

This is one of the hardest concepts for my clients to deal with. If you lost your job because of your injury, and you have yet to find a new job, if you have reached Maximum Medical Improvement (MMI), the insurance company will discontinue temporary total disability benefits.

The upside is that if you’ve reached Maximum Medical Improvement (MMI), it is appropriate for your doctor to make a determination as to any permanent impairment you’ve sustained, which may entitle you to Permanent Partial Disability (PPD) benefits.

The other good news is that if you believe that you have not in fact reached Maximum Medical Improvement (MMI), in many circumstances, we can dispute that determination. For example, if the MMI determination was issued by an IME doctor, and your doctor disagrees, you may not actually be at Maximum Medical Improvement. Or, if your doctor has recommended additional diagnostic testing, surgery, or other treatment, you may not have reached Maximum Medical Improvement yet.

Workers’ compensation insurance companies often seek a pre-mature determination of Maximum Medical Improvement (MMI) to try to limit their potential liability for ongoing temporary total disability (TTD) benefits.

If you’ve sustained a Minnesota work-related injury, the workers’ compensation insurance company will almost invariably try to discontinue your benefits prematurely. Unfortunately, injured workers are a liability in the eyes of the insurance company, and they will often go to surprising means to keep their costs as low as possible, regardless of what is right or fair.

For a free, no-obligation consultation to learn more about your workers’ compensation rights, call us at 877-746-5680, or click here to send us an email to speak with one of our Minnesota workers’ compensation lawyers.

Visit us at MeuserLaw.com!

Work Comp. Independent Medical Examination (IME)

If you've sustained an injury at work, and your employer or the insurance company has scheduled you for an Independent Medical Examination (IME), there are a few things you should know.

First, you are generally required to attend this examination. To find out if you have to go, contact your attorney. If you don't have an attorney, give us a call at 877-746-5680 for a free consultation.

If your employer and their insurance company are requesting that you attend an Independent Medical Examination (IME), generally, it means that they are looking for a basis to discontinue some or all of your workers' compensation benefits.

You should also be aware that the doctor who conducts the "Independent" Medical Examination (IME) is paid by the insurance company. While in theory, doctors conducting IME's are supposed to be objective, in reality, the opinion issued by the IME doctor is generally not favorable to the injured worker.

Unlike when you visit your regular doctor, no doctor-patient relationship is created when you are examined by the IME doctor. Therefore, nothing you tell the doctor is privileged or confidential. You should also be aware that the doctor will not provide any treatment for your injury, nor will they recommend treatment or refer you for additional medical care or treatment.
The only purpose of an Independent Medical Examination (IME) is to get an expert opinion regarding the cause, nature, and extent of your injuries.

You should be aware that a scheduled IME can generally only be canceled for emergencies. You should also plan on being there about 20 minutes before the exam is scheduled to begin. If you are late, or if you miss the exam, the insurance company may try to charge you for the missed appointment.

Typically, the doctor will ask you regarding your past medical history, and will generally conduct a physical examination. Just be honest about your medical history, and be honest about your current injuries and symptoms. It is a good idea to make note of the type of examination the doctor conducts. Did he have you touch your toes? Did he touch your back? Did he rotate your shoulder? Did he lift your legs up? How long did he spend examining you?

After your examination, the doctor will issue an opinion. You and your attorney should be provided with a copy of this opinion.

What the doctor says in his or her opinion can have a serious impact on your right to benefits. For example, the doctor may conclude that your injury is not related to your work, which gives the insurance company a basis to deny both wage loss benefits and medical benefits. The doctor may also determine that you have reached Maximum Medical Improvement (MMI), which means that the doctor believes that no further significant recovery from or lasting improvement to your injury can be reasonably anticipated, regardless of your subjective complaints. Your entitlement to Total Temporary Disability (TTD) benefits ceases 90 days after you are served with notice of Maximum Medical Improvement (MMI). Finally, the doctor may conclude that medical treatment you have received in the past was not reasonable or necessary, which gives the insurance company a basis to refuse to pay for your medical bills.

While you shouldn't get upset if the IME report is not favorable to you, it is important that you contact an attorney if you do not already have one. Your attorney can challenge the doctor's opinion by a variety of means, including obtaining a report from one of your treating physicians. While an IME opinion can provide an insurance company with a basis to deny your workers' compensation benefits, there are many ways to challenge their denial.

If you've been scheduled for an IME, often the insurance company is looking for a basis to deny your work comp benefits. If you do not already have an attorney, you should contact one as soon as possible. Call Meuser & Associates at 877-746-5680 to schedule a free consultation. Click here to send us an e-mail. We can help you get the benefits you are entitled to, and we can help you keep the benefits you are currently receiving.

Visit our workers' compensation website at MeuserLaw.com!