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.

DON’T IGNORE MEDICAL DISPUTES WITH THE WORKERS’ COMPENSATION INSURANCE COMPANY!

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.

Chiropractic Treatment and Minnesota Workers' Compensation Passive Treatment Parameters

For some injured workers, chiropractic care and treatment can be very helpful in relieving low back or neck pain and stiffness resulting from a work injury, including disc injuries, sprains and strains, and degenerative conditions.

The Minnesota Workers’ Compensation Rules set forth treatment parameters for passive care, including chiropractic treatment. These parameters are essentially guidelines for determining how much chiropractic treatment is reasonable and necessary to cure or relieve the effects of the work injury. Generally, the parameters permit 12 weeks of passive care or treatment to cure or relieve the effects of a work-related injury.

Twelve additional treatments over the course of a year may be permitted if (1) the employee is released to work or is permanently totally disabled and the additional passive treatment results in progressive improvement in, or maintenance of, the functional status achieved during the initial twelve weeks of passive care, (2) the passive treatment cannot be given on a regularly scheduled basis, (3) the doctor must document a plan to encourage the employee’s independence from and decreased reliance on ongoing treatment, (4) the employee must undergo active treatment modalities during this period in addition to the passive care, (5) the additional twelve weeks of passive care must not delay surgical intervention or an evaluation for chronic pain, and (6) the passive care is not to treat chronic pain syndrome.

A departure from the passive treatment parameters for work related neck or back injuries may also be appropriate if (1) there is a documented medical complication of the condition, (2) if the prior treatment did not meet the accepted standards of practice, (3) where the treatment is necessary to assist the employee in the initial return to work where the employee’s work activities place stress on the body part affected by the work injury, or (4) where there is an incapacitating exacerbation of the employee’s condition.

The Rules also permit a departure where the treatment meets two of the following three criteria, which must be documented in the medical records: (1) the employee’s subjective complaints of pain are progressively improving as evidenced by documentation in the medical record of decreased distribution, frequency or intensity of symptoms, (2) the employee’s objective clinical findings are progressively improving, as evidenced by documentation in the medical records of resolution or objectively measured improvement in physical signs of injury, or (3) the employee’s functional status, especially vocational activity, is objectively improving as evidenced by documentation in the medical record, or successive reports of workability, of less restrictive limitations on activity.

Finally, even if the prescribed treatment does not fall into one of these exceptions to the parameters, the Minnesota Workers’ Compensation Court of Appeals, as confirmed by the Minnesota Supreme Court, held that a departure is warranted “in those rare cases in which departure is necessary to attain proper treatment.”

After you undergo an initial twelve weeks of chiropractic treatment, the workers’ compensation insurer may indicate that they will not approve additional treatments. What they don’t tell you, however, is that there are literally dozens of exceptions to the treatment parameters. Your situation may fall within one of these exceptions. We have successfully argued on behalf of many, many of our clients that departure from the treatment parameters was appropriate, and that additional chiropractic care and treatment was compensable.

If you were injured on the job, and chiropractic treatment helps relieve your pain, but the workers’ compensation insurance company is denying payment for your chiropractic treatment, give us a call at 877-746-5680 or click here to email us to schedule a free consultation.

Visit our workers' compensation website at MeuserLaw.com!