How to Handle a Disputed Workers’ Comp Claim

Workers’ compensation helps people hurt on the job get medical care and lost wages, and in Minnesota, this system covers most employees for injuries that happen at work, regardless of who is at fault. Although the system is supposed to run smoothly, disputes can rise when insurers deny claims or an employer says that the injury didn’t happen at all or didn’t happen at work. A Minneapolis workers’ compensation attorney should be one of your first calls to protect your rights in these situations and fight back against attempts to deny the compensation you are owed.

What Happens When a Claim Is Denied?

Insurers must send you a notice explaining why they deny a claim, and some of the more common reasons for a denial include doubts about whether the injury was really related to work or about the nature and extent of your injuries. The form that you will be sent is called the Notice of Insurer’s Primary Liability Determination, and you should review it carefully with your lawyer to see what the exact issue is.

If the denial covers everything, then no benefits start. Other times, medical care gets approved, but wage payments do not. The important thing to remember is that you have the right to challenge this denial, and there are several ways to resolve these disputes without having to go to court. That said, court may be the only option in the end. That’s why it’s best to talk to a lawyer as soon as you can. Your lawyer will do their best to keep you out of court if at all possible and get it resolved quickly.

First Steps After a Denial

Talk to Your Minneapolis Workers’ Compensation Attorney

It’s important to act fast as soon as you get that denial notice. Not only do you want to get the ball rolling, but you don’t want to have to wait any longer than necessary to get the compensation you need. So make your first call to a lawyer to talk through what to do next.

Contact the Insurance Adjuster

You and your lawyer will call the insurance adjuster pretty early on to ask questions about their decision. Your lawyer can take the lead on this and will note down who they spoke with and when it happened. Sometimes, this talk will fix things, and when there’s a lawyer on the phone, you might be surprised how many insurance companies become easier to work with.

Contact the Minnesota Department of Labor and Industry (DLI)

There are various options when you connect with the DLI. They may also contact the insurance company on your behalf, and if you file a Medical Request or Rehabilitation Request form, then someone at the DLI will review the issue. They can contact your employer and insurance company, and once they do, they’ll issue a decision. You can continue to appeal this decision if you believe it’s wrong, however.

Investigating the Accident and Getting More Evidence

Depending on the nature of your situation, one thing that your lawyer may do is initiate a more in-depth investigation into what happened and try to get more evidence to challenge the denial. This might include anything from more comprehensive medical records to new witness statements or video footage showing what really happened or even negligence by your employer.

Your lawyer will file all the required forms, like a Claim Petition, which is how you’ll kickstart more formal proceedings if negotiations fail. This petition goes to the Office of Administrative Hearings (OAH).

Medical Evidence and the IME

Obviously, medical evidence is just about the most important type you have, as you’ll need to show exactly how you’ve been injured and how it’s related to your job. For example, if your employer is claiming that your back pain comes from an old football injury rather than from your job with them lifting boxes, your lawyer will need to be able to put together comprehensive medical evidence that shows how and when the back pain started.

Your employers’ insurance may request something called an IME, or Independent Medical Examination. With an IME, the insurance company gets to choose a doctor to evaluate you and give a report. The IME may dispute your own doctor’s findings or corroborate them, and your lawyer will fight back hard if the IME returns a very different diagnosis than that of your own doctor.

Formal Hearing at the Office of Administrative Hearings

If your lawyer petitions for this hearing, an administrative law judge will review all the evidence, listen to witnesses, and decide if your claim qualifies for benefits. Your attorney will present your case, cross-examine the insurer’s witnesses, and argue why the denial was wrong.

If the judge rules against you, Minnesota law allows you to make an appeal, but your lawyer will need to file a notice with the Workers’ Compensation Court of Appeals within 30 days. This court will then review the judge’s decision for legal errors, but it will not reconsider the case based on new evidence. If the appeal fails, you can escalate to the Minnesota Supreme Court, though bear in mind that they take only a very few cases.

Settlement Negotiations

At any point in this process, you may enter into settlement negotiations with your employer’s insurer. The farther the case escalates, the more likely your insurer is to at least offer a settlement to avoid the expense and difficulty of a hearing. Your attorney will guide you through this process and make sure that all the evidence is clearly presented. Bear in mind that insurers are skilled negotiators and know how to get their way. It’s important to work with the lawyer for many reasons, not least of which is having a skilled negotiator on your side.

Temporary Benefits During Disputes

As you can imagine, these disputes can stretch on for a while, and you still need income! The first thing to try is for Temporary Total Disability (TTD) benefits, which will pay two-thirds of your average weekly wage, subject to state maximums, if you’re unable to work at all. If the insurer denies TTD because they claim you can still work light-duty jobs, your lawyer can help you decide, along with advice from your doctor, over whether to fight this.

Retaliation or Employer Pushback

Retaliation is illegal, but, unfortunately, it does still happen. Some employers push back whenever an employee makes a workers’ comp claim. Retaliation can be as blatant as firing someone, but it can also be more subtle. It can involve giving you undesirable working hours, refusing to consider you for a promotion, or creating a hostile work environment. If your employer retaliates in any way, this is a separate issue from your workers’ compensation claim and violates both state and federal law. We can help you file a separate claim against your employer in the situation.

Bear in mind, too, that your employer might also try to pressure you to return to work before you’re ready. If your doctor says you shouldn’t be doing any heavy lifting after a workplace fall, for instance, but your boss insists you resume full duties, your lawyer can intervene.

If your workers’ compensation claim is being denied, don’t deal with the frustration and red tape on your own. Contact us at the Atkinson Gerber Law Office in Minneapolis or St. Paul today for experienced legal help.