Medical Benefits | Minnesota Workers Compensation

The employer and insurer are responsible for payment of causally related and “reasonable and necessary” Minnesota workers comp medical treatment, which will aid in curing or relieving the effects of your work injury. Covered Minnesota workers comp medical treatments may include hospitalization, surgery, physical therapy, occupational therapy, chiropractic services, injection therapy, chronic pain management and many other forms of medical care. The right to receive these benefits may be impacted by the Minnesota Workers’ Compensation Treatment Parameters depending on various factors including whether the injury is admitted or denied.

Choosing a Physician

The injured worker generally possesses the right to choose the treating doctor after a work injury.  It has long been the law that Minnesota employees are given great latitude both in choosing and changing physicians.  This choice can be limited if the employer participates in a certified managed care plan.  If that is the case, the employee will be required to pick a physician from the list provided by the plan – unless a documented history of treatment before the injury with that doctor can be demonstrated.  Absent a certified plan, however, the employee has the right to choose the doctor who treats the injury.

How to choose my doctor after a work injury?

Find the right work comp doctor for you. If you have questions, call Minnesota Workers Compensation Attorney Jerry Sisk at Law Office of Thomas Mottaz today for a FREE consultation.

Injured workers should understand, that accepting a doctor suggested by the employer can result in that doctor becoming the treating physician.  Minnesota law indicates that a doctor who treats an employee two times for an injury becomes the “primary healthcare provider”.  The law further allows an employee to change this primary healthcare provider one time within the first 60 days after treatment begins – without first obtaining permission from the employer or insurer.  After 60 days, however, a change of primary physician must be approved by the employer or the workers’ compensation insurer – or if need be, the workers’ compensation court system.

As a general rule, the court has given great latitude in choosing and changing physicians. Reasons that have been allowed have included:

• Loss of confidence in a doctor’s ability to effectively treat the injured worker;
• Lack of improvement in the employee’s condition; and
• A breakdown in communication with the physician.

A compensation judge shall not approve a request to change primary providers, where:

• a significant reason underlying the request is an attempt to block reasonable treatment or to avoid acting on the provider’s opinion concerning the employee’s ability to return to work.
• the change is to develop litigation strategy rather than to pursue appropriate diagnosis and treatment;
• the provider lacks the expertise to treat the employee for the injury;
• the travel distance to obtain treatment is an unnecessary expense and the same care is available at a more reasonable location;
• at the time of the employee’s request, no further treatment is needed; or
• or another reason, the request is not in the best interest of the employee and the employer.

Limits to Allowed Medical Treatment

Under Minnesota work comp there are limits to certain types of treatment including the duration and frequency. These limits are based on the Minnesota Treatment Parameters. The purpose of the rules is to establish guidelines for reasonable treatment of employees with compensable injuries and to facilitate communication between the healthcare provider and the insurer.

The following are some types of treatment for work-related injuries:

What if the Treatment is not Allowed?

The MN Supreme Court has recognized that the treatment parameters cannot anticipate every circumstance and held a compensation judge may depart from the rules in those rare instances in which departure is necessary to obtain proper treatment. A health care provider must provide prior notification of the departure to work comp insurer. It should be noted that the treatment parameters only apply if the injury has been admitted by the insurer.  However, the courts may look to the treatment parameters as a guideline.

MN Work Comp Law allows treatment to be done if not covered by the parameters where two of the following three criteria are met, as documented in the medical records:

• 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;
• The employee‘s objective clinical findings are progressively improving, as evidenced by documentation in the medical record of resolution or objectively measured improvement in physical signs of injury; and
• The employee‘s functional status, especially vocational activity, is objectively improving as evidenced by documentation in the medical record, or successive reports of work ability, of less restrictive limitations on activity.

Also, the treatment has to be reasonable and necessary in order to be paid. Certain factors are considered in determining if the treatment is reasonableness and necessary. These factors include:

• • Documentation of the treatment itself and of the details of a reasonable treatment plan;
  • Whether the frequency and duration of the treatment is warranted, in light of the potential for psychological dependency;
  • The degree and duration of the relief itself that is obtained from the treatment;
  • The relationship of the treatment to the goal of returning the employee to suitable employment and non-work activities;
  • Appropriate referral to medical providers in the event of continuing problems, in light of the possibility that the chiropractic treatment itself may be causing the problem; and
  • The cost of the treatment in light of the relief provided and the results obtained.

As noted, there are limits to the treatment that may be allowed under workers’ compensation.  It is best to consult an attorney in cases where your medical treatment has been denied. Although you have been denied treatment, you still may be able to have your medical bills paid for.

Can I get paid for my Mileage to the doctor?

You can get Medical Mileage for trips to the doctor. See Medical Mileage

Let Jerry Help You

Since 2008, Jerry Sisk has been protecting injured workers rights in Minnesota workers compensation matters.  Jerry’s experienced and knowledgeable staff can answer all of your legal questions, and provide you assistance to get through this process.

If you believe you are entitled to workers compensation benefits, please call Minnesota workers compensation attorney Jerry Sisk at 855-354-2667. Consultations are free and help is available 24 hours day/7 days a week. We look forward to fighting on your behalf and getting you the money you deserve.