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:
|Acupuncture||Maximum of 2-3 times per week for 1-3 weeks, decreasing thereafter. Maximum treatment is 12 weeks and the treatment response must be achieved within 3-5 sessions. Minn. Rule 5221.6200, .6205, .6210, .6300, .6305|
|Adjustments||1-5 times per week for the first 1-2 weeks, decreasing thereafter. Maximum of 12 weeks with a treatment response within 3-5 treatments. Minn. Rule 5221.6200, .6205, .6210, .6300|
|Arthrodesis||Indicated if one of the following is found:|
1)unstable lumbar vertebral fracture; 2) for 2nd or 3rd surgery only, documented re-extrusion or re-displacement of lumbar inter-vertebral disc after successful disc surgery and new radiculopathy; 3) traumatic spinal deformity; 4) or intractable low back pain <3 months. Not indicated as first primary surgical procedure for new lumbosacral disc herniation with unilateral radiating leg pain. If first surgery, it has to be for pseudoarthrosis or spondylolisthesis. If lumbar athrodesis is performed to correct instability created during decompression, laminectomy or discectomy, approval is based on retrospective review. Minn. Rule 5221.6500, subp. 2C.
|Botox Injections||Not allowed for the treatment of any back conditions. Departure would need to be requested. Minn. Rule 5221.6200,.6205 and .6210.|
|Chronic Management||Applies to chronic management of all types of physical injuries. No further passive modalities or therapeutic injections are allowed, except as indicated in rules. No diagnostic test unless new symptoms or physical findings. Chronic management modalities include home-based exercise, health clubs, computerized exercise programs, work hardening, chronic pain management programs, and psychological counseling. Minn. Rule 5221.6600, subp. 2(A-F).|
|Chronic Pain Management Programs||Only indicated if patient is diagnosed as having chronic pain syndrome. This treatment may not exceed 20 8-hour days with a maximum of 4 weeks regardless of length of days prescribed. A maximum of 12 sessions is allowed for aftercare. Only one pain management program per injury. Insurers may not deny payment for a pain program that was previously authorized without giving 30 days’ notice of intent to apply the parameters to future treatment. Minn. Rule 5221.6600|
|CT Scan||CT scan is appropriate for low back if suspected (1) cauda equina, (2) neurologic deficit, or (3) when body lesion is suspected. CT scanning is not indicated in the first 8 weeks, except as provided above. After 8 weeks CT scanning is indicated if the patient continues with symptoms and objective physical findings.|
For other body parts, imaging cannot be used unless it is seriously being considered as the etiology of the condition, and should be used to develop a treatment plan.
Repeat imaging is indicated if: 1)diagnose a fracture or dislocation; 2)monitor therapy or treatment which is known to result in change in imaging findings 3) follow-up surgery; 4)diagnose change in patients condition marked by new physical findings; 5)evaluation of exacerbation 6) previous study was inadequate per an outside radiologist . Minn. Rule 5221.6100, subp. 2A.
|Decompression Surgery||Specific conditions must be satisfied. Must be a failure to improve within a minimum of 6 weeks after initial non-surgical care. There must also be some clinical findings to indicate surgery is reasonable. See Rule Minn. R. 5221.6500, 2(A) (low back) and 2(B)(cervical)|
|Desensitizing Procedures||Used for the treatment of RSD/CRPS, includes stroking, friction massage, stress loading and contrast baths. Time for response 3-5 treatments. Maximum of 12 weeks in a clinical setting, home use may be prescribed at any time. Minn. Rule 5221.6305, subp. 2B(2).|
|Discogram||Indicated when back pain is predominate complaint, failed to improve with nonsurgical treatment, other imaging has not established a diagnosis and fusion surgery is being considered or there has been a previous surgery and pseudoarthrosis, recurrent herniation, annular tear or internal disc disruption is suspected. Minn. Rule 5221.6100, subp. 2G(1-2).|
|Durable Medical Equipment||The following items are allowed under the treatment parameters: braces, corsets, cervical collars, splints, TENS units, traction devices and exercise equipment (in conjunction with a chronic management program). The following items are not allowed under the treatment parameters: whirlpools, Jacuzzis, hot tubs, special bath or shower attachments, beds, waterbeds, mattresses, chairs, recliners and lounges. Minn. R. 5221. 6200, subp. 8 (low back);.6205, subp. 8(neck);.6210, subp. 8 (thoracic) .6300, subp.8 (upper extremities);.6305, subp. 2 CRPS).|
|Electrical Muscle Stimulation||Treatment response of 2-4 sessions with optimum treatment frequency of 3-5 times per week, for the first 1-3 weeks, decreasing thereafter. Maximum treatment duration of 12 weeks, but only if given in combination with other therapies.Home use may be prescribed any time during the course of treatment for one month with evaluation for further use. Minn. R. 5221.6200,.6205, .6210,.6300,.6305|
|EMG||Not indicated for regional low back pain diagnosed in 5221.6200, subp. 1A(1). May be appropriate as diagnostic tool for radicular pain and cauda equina. However, not usually indicated in first 3 weeks after surgery. Minn. Rule 5221.6200, subp. 1D (low back), 5221.6205, subp. 1 D (neck), 5221.6210, subp. 1D (thoracic) and 5221.6300, subp. 1D (upper extremity). EMGs are only appropriate for nerve entrapment disorders and recurrent nerve entrapment after surgery. Minn. Rule 5221.6300, subp. 1D (upper extremity).|
|Epidural Injections||Time for treatment response within 1 week. Optimum treatment of once per week if positive response. If diminishing effectiveness, injections should be discontinued. Only one injection per visit. Maximum treatment of three injections. Minn. R. 5221.6200,subp.5 (low back) .6205 (Neck),.6210 (thoracic)|
|Exercise||Supervised exercise program indicated three times per week for 2 weeks, decreasing thereafter. Maximum duration of 12 weeks. Unsupervised Exercise up to three visits for instruction. See Health Club Minn. R. 5221.6200, .6205.,.6210,.6300,.6305,.6600|
|Facet Joint/Nerve Injections||Time for treatment response within 1 week. Optimum treatment of once per week to any one site if a positive response to first injections. If diminishing in effectiveness, injections should be discontinued. No more than three injections to different sites are reimbursable per visit. Maximum treatment of three injections to any one site indicated. Minn. R. 6200,.6205,.6210|
|FCE||Not indicated during initial non-surgical care. Indicated (after initial non-surgical care) if (1) permanent activity restrictions and capabilities must be identified or (2) there is a question about the ability to do a specific job. Only one FCA per injury. FCA is not indicated for upper extremity disorders during first 12 weeks of treatment, thereafter for same reasons as (1) and (2) above. Minn. R. .6200,.6205,.6210, and .6300|
|Health Club||Indicated when the patient is deconditioned and requires a structured environment to perform prescribed exercises. The program must have specific objective terms. Treatment period of 13 weeks with additional periods requiring authorization. Must have documentation of attendance and progression in activities. Allowed during chronic management of any injuries. Minn. R. 5221.6600, subp 2B|
|Injections||Can only be given in conjunction with active treatment modalities. See rule for specific types of injections and requirements. Minn. Rule 5221.6200, subp. 5A(1-5) (low back), 5221.6205, subp. 5A(1-4) (neck), 5221.6210, subp. 5A(1-4) (thoracic), 5221.6300, subp. 5A-C (upper extremity) and 5221.6305, subp. 2A (RSD/CRPS).|
|Manual or Mechanical Therapy||Treatment response of 3-5 treatments, 1-5 times per week for the first 1-2 weeks, decreasing thereafter. Maximum of 12 weeks indicated. Minn. Rule 5221.6200, subp. 3F&H (low back),5221.6205, subp. 3F&H (neck), 5221.6210, subp. 3F&H (thoracic) and 5221.6300, subp. 3H (upper extremity).|
|Massage||Time for treatment response is 3-5 treatments. Frequency of 1-5 times per week for the first 1-2 weeks, decreasing thereafter. Maximum treatment duration of 12 weeks. Minn. Rule 5221.6200, subp. 3H (low back), 5221.6205,subp. 3H (neck), 5221.6210, subp. 3H (thoracic) and 5221.6300, subp. 3H (upper extremity).|
|Medications||NSAID: indicated for symptomatic relief. Must begin with generic at lowest dosage.|
Opioid: indicated for symptomatic relief of acute and chronic pain that has been inadequately relieved by nonopioid medications. Must begin with generic and lowest dosage. Meperidine is not indicated. Transcutaneous opioids are only indicated in patients with disorder that prevents adequate oral dosing.
Muscle Relaxants: indicated for symptomatic relief of pain. Not allowed for more than 3 consecutive months. Benzodiazepines are not indicated. Minn. R. 5221.6015
|MRI||MRI is appropriate for (1) cauda equina, (2) neurologic deficit, (3) if previous spinal surgery has been performed, and (4) suspected discitis. Not indicated in the first 8 weeks unless noted above. MRI is indicated after 8 weeks if patient continues with symptoms and objective physical findings. Minn. R. 5221.6100, subp 2B.|
|Myelogram||Treatment parameters indicate that a myelogram can be substituted for a CT scan or MRI. Minn. R. 5221.6100, subp. 2C|
|Nerve Root Blocks and Median Nerve Injections||Time for treatment response within one week. Optimum treatment of 1 week if positive response. No more than three injections to different sites per visit. Maximum treatment of 2-3 injections to any one site depending on rule. If more is needed a “departure” needs to be requested. Minn. Rule 5221.6200, subp. 5A(4) (low back), 5221.6205, subp. 5A(3) (neck), 5221.6210, subp. 5A(3) (thoracic) and 5221.6300, subp. 5C (upper extremity). Indicated as therapeutic injection for radicular pain. Minn. Rule 5221.6200, subp. 12A. Minn. Rule 5221.6300, subp. 5C.|
|Prolotherapy||An injection used to treat chronic pain. This injection is not allowed for the treatment of any back conditions. Minn. Rule 5221.6200, subp. 5C (low back), 5221.6205, subp. 5C (neck) and 5221.6210, subp. 5C (thoracic).|
|Radiofrequency Denervation||Time for treatment response within 1 week. May repeat once for any site. Maximum of 2 injections to any 1 site. If more are necessary, a “departure” needs to be requested. Minn. Rule 5221.6200, subp. 5B (low back), 5221.6205, subp. 5B (neck), 5221.6210, subp. 5B (thoracic).|
|Repeat Imaging||Repeat imaging of same views with same modalities are not indicated except: to treat suspected fracture or dislocation; to monitor therapy; to follow-up on a surgical procedure; to work up a change in condition; to evaluate a new episode of injury or exacerbation; or if the study is technically inadequate. Minn. Rule|
5221.6100, subp. 1D.
|SI joint Injections||Time for treatment response within 1 week. Can repeat injection in 2 weeks after positive response. No more than two injections are reimbursable per visit. Maximum treatment of two injections to any one site. Minn. Rule 5221.6200, subp. 5A(2)and subp. 12A.|
|Stimulator/ Morphine Pumps and trials||Only indicated if: 1) treating physician determines a trial screening is necessary because intractable pain, not a candidate for another surgery; and no untreatable major psychological or psychiatric cormobidity. Physician must refer for psych evaluation; 2) a 2nd opinion from a provider outside treating physician and confirm no contraindications; 3) Provider must document at least 50 % improvement during trial for at least 3 days, compared with the pretrial pain level (stimulator) or 24 hours (Morphine pump). Minn. Rule 5221.6200, subp. 6C (I-2) (low back), 5221.6205, subp. 6C (1-2) (neck), 5221.6210, subp. 6C(1-2) (thoracic) and 5221.6305, subp. 3B (RSD/CRPS).|
|Sympathectomy||May only be performed on RSD/CRPS patients who had a sustained but incomplete improvement with sympathetic blocks by injection. Minn. Rule 5221.6305, subp. 3A.|
|Sympathetic Blocks||Time for treatment response within 30 minutes. Can repeat if positive response to first injection. If diminishing effectiveness, injections should be discontinued. No more than three injections to different sites per visit. Minn. Rule 5221.6305,|
subp. 2A(1) (RSD/CRPS).
|Traction||Time for treatment response is three treatments. Optimum treatment frequency of 2-3 times per week for the first 1 -3 weeks, decreasing thereafter. Maximum treatment duration of 12 weeks in a clinical setting, only if in conjunction with other therapies. Minn. Rule 5221.6200, subp. 3F (low back), 5221.6205, subp. 3F (neck) and 5221.6210, subp. 3F (thoracic).|
|Trigger Point Injections||Time for treatment response is 30 minutes. Optimum treatment once per week to any one site if positive response. If subsequent injections, show decreasing effectiveness then injections should be redirected or discontinued. No more than three injections per visit. Maximum treatment of four injections to any one site. May be indicated if low back pain is a component of radicular pain. Minn. Rule 5221.6200, subp. 5A(1)and subp. 12A (low back), 5221.6205, subp. 5A(1)(neck), 5221.6210, subp. 5A(1) (thoracic) and 5221.6300, subp. 5A (upper extremity).|
|Work Hardening||Indicated if the patient is disabled from usual work and requires reconditioning for specific job tasks and it cannot be performed on the job. Treatment period is six weeks and additional periods of treatment require prior notification. Minn. Rule 5221.6600, subp. 2D (chronic management).|
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.