The Adjuster Refuses to Pay My Benefits. Am I Eligible for Penalties?

In rare circumstances employers and insurers may be subject to monetary penalties for violating the Minnesota Workers’ Compensation Act. Penalties serve as a deterrent to employers and insurers from flagrant disregard of the rules. Some penalties are payable to the State of Minnesota and some are payable to the employee.

1. Frivolous Liability Denial

When an adjuster for an insurance company denies an injured worker’s claim, the adjuster must demonstrate a good-faith effort to investigate the claim. The adjuster may also not use clearly inaccurate statements of fact or applicable law under the Minnesota Workers’ Compensation Act. If a judge finds that an adjuster has violated Minnesota Statute §176.221, subdivision 1 and 176.225, subdivision 1, then the judge may issue a penalty against the insurance company payable to the State and the employee. An employee may be entitled to 30% of the amount of the delayed benefits.

At Meuser Law Office, P.A. we have recently brought a claim for penalties for the failure of an insurer and public employer to pay temporary total disability benefits and temporary partial disability benefits after the law enforcement officer separated from the date of injury employer in order to receive PERA Duty Disability benefits. The insurer and employer admitted liability for the injury and is in agreement with the Independent Medical Examiner and treating physician’s restrictions for the employee. The employer and insurer refuses to pay despite the definitive case law on this issue under Boutto v. U.S. Steel Corp. (July 18, 2007 WC06-288).

2. Non-specific Denial of Liability

Similar to penalties for frivolous denial of liability, under Minnesota Statute 176.84 insurers must issue specific and clear reasons that the adjuster is denying the injury. The penalty for a non-specific denial of liability is $500 each violation.

3. Late Payments of Benefits

Insurers and employers are also required to make timely payment of benefits under Minnesota Statute § 176.221, subdivision 1. An employee’s first temporary total disability payment must be issued the 14th day after the first day of an employee’s disability or the date the employer received notice, whichever is later. The employee may be awarded 25% of the delayed benefits.

4. Obstructing an Employee’s Minnesota Work Comp Benefits

Under Minnesota Statute §176.82, subdivision 1, an insurer or an employer who fires or threatens to fire an employee for making a claim for workers’ compensation benefits is liable for civil damages in addition to workers’ compensation benefits owed. This violation also includes costs and reasonable attorney fees in addition to punitive damages three times the amount of any compensation benefits to which an employee is owed.

This violation may be difficult to prove but if an employee is able to offer concrete evidence, for example text messages, letter, or a saved voicemail with the employer threatening to fire the employee for filing a work comp claim, may be persuasive.

5. Refusing to Offer Continued Employment

Under Minnesota Statute §176.82, subdivision 2, an employer who has work available with the employee’s physical restrictions must offer continued employment. If an employer does not have reasonable cause to continue to offer suitable employment is liable for one year of the employee’s wages in a civil lawsuit. Employers with less than 15 full-time employees are exempt from this statute.

6. Failure to Ensure

An uninsured employer may also be fined by the Department of Labor and Industry for failure to insure employees for workers’ compensation injuries, regardless if any employee has been injured. An employer may be required to pay a penalty up to $1,000 per employee per week for the time period the employee was not insured.

7. Failure to Pay Settlement Award

After the parties agree to a settlement and the settlement is set forth in the stipulation for settlement, a workers’ compensation judge must review and then issue an award on stipulation, which is a court-order dictating what the employer and insurer must pay. The employer and insurer must issue payment within 14 days of the award or be subject to fines.

If you believe you may be entitled to penalties under the Minnesota Workers’ Compensation Act or have a workers’ compensation claim, contact the knowledgeable attorneys at Meuser Law Office, P.A. for a free no-obligation case evaluation. Call us today at 877-746-5680.

by Mary Beth
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Independent Psychological Evaluations

When do I have to submit to an IPE?

An independent psychological evaluation (IPE) may be required for mental disability claims. Under the Workers’ Compensation Act, only certain mental disorders are compensable. Post-traumatic stress disorder (PTSD) is defined by Minn. Stat. 176.11, subd. 15 as the condition described in the most recently published addition of the DSM-V. See article entitled Cumulative Post-Traumatic Stress Disorder and Police Officers for a full description. PTSD is not compensable if it is the result of a disciplinary action, such as a work evaluation, job transfer, layoff, demotion, etc.

All other mental health conditions must be related to a physical injury to be compensable. For example, if a workers’ compensation claimant injuries his back at work and develops depression due to his pain, the depression would be a compensable injury. This is what is referred to as a physical-mental injury.

What is an IPE?

Your date of injury employer and its insurance company may ask that you submit to an IPE. This involves meeting with a psychologist selected by the insurer. Typically, the IPE evaluator is given a foundation letter by the insurance company’s attorney, which explains the employer-insurer’s legal position and summarizes the pertinent portions of your case, including the medical records, diagnoses, and job duties. If the IPE arises out of a PTSD claim, the insurer’s attorney provides a summary of your Criteria A Events. As such, the IPE evaluator knows the employer-insured’s position prior to the evaluation, and the IPE evaluator will search for ways to support their position during the course of the evaluation. Be honest and truthful with the evaluator—but, also remember, the IPE evaluator is not your friend.

During the evaluation, the IPE evaluator will typically have you undergo a series of psychometric testing, including the MMPI-2 and MMPI-2-RF. The evaluator will also ask that you submit to an interview, which can last anywhere from 45 minutes to 2 hours. Depending on the claim, this may be a structured interview using the CAPS-5 or the PTSD Checklist. Again, it is important that you are open and honest with the evaluator—but, it is also important that you are not simply agreeing with the evaluator’s questions.

What is an IPE Report?

Following the evaluation, the IPE evaluator will issue a report. In this report the evaluator will determine: 1) whether you have a mental health diagnosis (e.g., PTSD, anxiety, depression, adjustment disorder, etc.); 2) whether this diagnosis is related to specific incidents and/or your work duties; 3) your functional capacity (i.e., work restrictions); 4) whether your treatment to-date has been reasonable and necessary; and 5) future treatment recommendations, if any.

The opinions of the IPE evaluator are typically at odds with the opinions and recommendations of your treating physician(s). It is important that you continue to follow the treatment recommendations of your treating physician, even if they are not supported by the IPE evaluator. Your treating physician and the IPE evaluator have very different goals in making their recommendations. With the IPE evaluator, no therapeutic relationship is being established and they are not providing treatment. The IPE evaluator’s sole purpose is to determine whether or not you are eligible for disability benefits. Conversely, your treating physician is making recommendations in an effort to improve your mental health.

Can I object to an IPE?

Technically, you can object to an independent psychological evaluation, however, if a mental health disability is the subject of your claim, a judge will compel you to attend the IPE. As such, as a general rule, we advise our clients to voluntarily attend the IPE. Prior to attending the appointment, we make sure that our client knows what to expect so the process is a little easier.

If the insurer requests a second IPE, we would likely object and force the insurer to file a motion to compel your attendance at the second IPE. A judge may ultimately order the second IME—this decision is typically dependent upon the opinions of the first IME evaluator and how much time has elapsed since the first IPE. Either way, because an independent psychological evaluation is invasive and uncomfortable, we will try to avoid a second IPE whenever possible.

If you are scheduled for an IPE and are not currently represented by a Minnesota workers’ compensation attorney, it is imperative that you speak to a lawyer regarding your options and next steps. Employer-insurers will attempt to use the independent psychological evaluation report to deny primary liability on your claim, cut off your workers’ compensation benefits, or assert defenses to your claims. Contact Meuser Law Office, P.A. for a free, no-obligation workers’ compensation legal consultation to discuss your rights. Call us today at 1-877-746-5680.

by Ashley Biermann
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What Should I Expect From My Work Comp Lawyer?

At Meuser Law Office, P.A. we pride ourselves in the work we do and the commitment we make to our clients. We are one of the few workers’compensation law firms in the state of Minnesota that also handles PERA and MSRS disability claims. Our attorneys are experienced in these areas of law and have successfully represented thousands of clients, including State Patrol, police officers and firefighters throughout the state for both workers’ compensation and PERA/MSRS disability claims.

When choosing an attorney to represent you, you should expect a free consultation. Work comp attorneys in the state of Minnesota are paid on a contingency fee basis, which means you will not be charged unless the attorney recovers benefits or monies on your behalf. All work comp attorneys are paid the same in the state of Minnesota pursuant to statute. Typically, you will meet in-person with an attorney before you make a hiring decision. Good attorneys spend an hour with potential clients in-person gathering information about the client’s potential case, explaining the law and providing recommendations for your case. If you are meeting only with a paralegal instead of an attorney, you should consider this a red flag and request to meet with a lawyer. Sometimes it’s not possible to meet face-to-face due to distance or work schedules so in that case, it’s appropriate to schedule a telephone consultation with the attorney.

Once the attorney has been hired, there are some basic things you should expect from your attorney going forward, such as:     

• Client should expect an honest assessment and valuation of the case. It doesn’t help you if your attorney doesn’t tell you both the good and the bad parts of your case. All cases have “warts.”
• Return phone calls and emails in a reasonable amount of time. At times it may be best to schedule a telephone call with your attorney for a status update through an office paralegal.
• All communication to the insurance company’s adjuster and/or insurer’s attorney should go through your attorney’s office. Your attorney is the main point of contact for your case.

As the case gets underway, the client should expect to receive copies of work done on his or her behalf by their attorney, including correspondence to opposing counsel, claim petitions, and any paperwork sent to the court. Various phases of the case, including independent medical examination (IME), settlement conferences, formal hearings, and depositions will happen throughout the work comp case. The client can expect to be notified of these litigation events in advance and should know what to expect at each step of the way so there is no confusion. Other examples of what a client should expect from an attorney may be:

• Prior to a mediation or settlement conference his or her attorney will create a demand letter that will outline the monetary claim for benefits. This demand letter must be approved by the client before being sent to the attorney for the insurer and employer.
• If a client will be consulting with a qualified rehabilitation consultant (QRC) during their case, when appropriate, your attorney should choose and recommend a QRC, send job logs to help track your job search, and mileage logs for reimbursement.
• Your attorney should never settle your case without your permission. You will be involved in the negotiation process and likewise you will not try to settle your case on your own without your lawyer. Your lawyer will give his or her recommendation but to settle or not to settle is your decision alone. 

Clients should expect that attorneys limit their practice to one or two areas of law. An attorney who deals with criminal law, including DUI cases and restraining orders, is not going to be up to date on the complex workers’ compensation and personal injury areas of law. You want an attorney that is experienced in this particular type of law. Even though all workers’ compensation attorneys are paid the same in the State of Minnesota, all work comp attorneys are not equal. Why choose an inexperienced or less knowledge attorney when you can choose a team of experienced attorneys who practice exclusively in the area of work comp and personal injury for the same amount of money. If clients want to change attorneys at any time of their case, he or she is not charged extra for a change of attorney.

At the very least a client should expect a team of knowledgeable attorneys who will work together on your case and bounce ideas off each other. This type of approach will benefit the client the most. Don’t wait to get an attorney involved if you have a Minnesota workers’ compensation claim. The process can be complex and you want to be sure you receive the full benefits you are entitled. Contact Meuser Law Office, P.A. for a free no-obligation consultation and claim evaluation. At Meuser Law Office, P.A. we keep our clients informed of the process as well as what to expect each step of the way. Call us today at 1-877-746-5680.

by Mary Beth
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Permanent Partial Disability (PPD) Benefits 101

What is permanent partial disability (PPD)?

Permanent partial disability benefit, or PPD, is a benefit in the Minnesota workers’ compensation system used to compensate an injured worker for the permanent impairment or the loss of use or function of a body part due to a work injury.

Who determines PPD?

Your treating physician or the independent medical examiner for the insurance company will issue a PPD rating under the Minnesota Workers’ Compensation Act.

When is PPD determined?

Once an injured worker reaches “maximum medical improvement” or MMI as deemed by his or her treating physician, the physician will issue a PPD rating. MMI is the point at which the injured worker’s condition is not expected to dramatically improve or decline. MMI is generally determined when the injured worker has reached a plateau in his or her medical treatment.

Insurance companies or your attorney may send your treating a physician a “healthcare provider report” or HCPR. The healthcare provider will then issue a rating as applicable to your condition under the statute.

An insurer may also send you to an independent medical exam or IME. The IME doctor may then issue a PPD rating in his or her IME report. Or your attorney may ask your doctor to issue a rating when he or she sends your health care provider a narrative request wherein he or she may opine more extensively as to the nature and extent of your condition.

How are PPD ratings determined?

PPD ratings are determined based on the health care provider’s rating in addition to the date of injury.

For injuries before 1984, PPD ratings were issued to each body part and then multiplied by a specific number of weeks and the injured worker’s weekly compensation rate. If a worker injured more than one body part, the amount owed was increased by 15%. Insurers generally paid this benefit in a lump sum.

For injuries after 1984, PPD ratings are assigned as a percent of a disability to the body as a whole. The rules that govern the rating are referred to as the PPD schedule. The total percentage rating is multiplied by a specific dollar amount to determine the monetary benefits payable. Physicians refer to the PPD schedule under Minnesota Rules Parts 5223.0300 - 5223.0650 for injuries after July 1, 1993.

When is PPD paid?

PPD may be paid in a lump sum or may be paid out as a weekly benefit. If PPD is paid out in a lump sum the amount owed is reduced slightly by a present value calculation. PPD may be paid concurrently with temporary partial disability benefits and permanent total disability benefits but not with temporary total disability (TTD) benefits. Frequently, it is in the employee’s best interest to wait on pursuing a PPD rating until the employee has exhausted his or her temporary total disability benefits. An employee’s TTD benefits cease 90 days after being deemed to have reached MMI or maximum medical improvement and by definition if a physician issues a PPD rating the employee is determined to have reached MMI.

Why are PPD benefits so low?

Permanent partial disability is not meant to replace pain and suffering damages. PPD benefits are tied to the legislature’s interpretation of how an injured worker’s permanent impairment will affect his or her future ability to work. For example, if an employee completely loses his or her ability to taste or smell, under Minnesota Rules 5223.0360, Subpart 3 A and B, he or she is only entitled to a 1% rating or under the current schedule or $750 (.01 (x) $75,000).

Moreover, PPD benefits have not been adjusted for inflation in years, unlike many other work comp benefits in the State of Minnesota.

If you have questions about a PPD rating or believe that you have been underpaid by the insurance company, contact the knowledgeable attorneys at Meuser Law Office, P.A. right away. Don’t wait to get an attorney involved if you have a Minnesota workers’ compensation claim. The process can be complex and you want to be sure you receive the full benefits you are entitled. Contact Meuser Law Office, P.A. for a free no-obligation consultation and claim evaluation. At Meuser Law Office, P.A. we keep our clients informed of the process as well as what to expect each step of the way. Call us today at 1-877-746-5680.

by Mary Beth
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MN PERA Duty Disability Application Tips – Be Cautious of Misinformation

At Meuser Law Office, P.A. we represent more police officers, firefighters, and other first responders injured in the line of duty than any other law firm in the State of Minnesota. The attorneys at Meuser Law Office, P.A. have more experience representing public servants in their claims for PERA Duty Disability benefits than any other attorney in the State of Minnesota.

When finding an attorney to assist you in your pursuit for benefits it is very important to know how many PERA claims he or she has pursued. Frighteningly, we have seen a solo practitioner advertise for PERA Duty Disability applications “helps and tips” on a website that lists incorrect information. Misinformation can seriously harm your claim. Your claim for Duty Disability or regular disability benefits in conjunction with Healthcare Continuation benefits can be worth over a half a million dollars. The amounts of money at stake with each claim are too high to jeopardize by retaining counsel who doesn’t know what he or she is doing. He or she may not know how the PERA disability benefits are coordinated with workers’ compensation benefits in Minnesota and this inexperience or ignorance will hurt your claim.

First and foremost, please do NOT “get your employer on board.” This is truly terrible legal advice! In almost all PERA disability cases it is best NOT to let your employer know that you are applying for PERA Duty Disability or regular disability benefits until after you have submitted your application. The employer may know that a disability pension is inevitable in your case but letting them know too early could jeopardize work comp benefits and your Healthcare Continuation benefits. The entity could send you for an Independent Medical Exam (IME) which is almost always adverse and could become discoverable by PERA and affect your claim negatively. A sophisticated public entity, such as the City of Minneapolis or the City of St. Paul who frequently deals with PERA claims will also know that they may be on the hook for Healthcare Continuation benefits if your application is approved and therefore be responsible for very significant sums of money.

Moreover, it is NOT your employer’s responsibility to submit all First Reports of Injuries (FROIs) to the Public Employees Retirement Association (PERA). Nor is it your employer’s responsibility to submit a job description. A job description can be requested from Human Resources or experienced PERA attorneys generally already have your job description on file. PERA does contact your employer once your application has passed the first stages and will request a “unit certification form” from the employer. PERA should contact the employer, not you.

Additionally, you need TWO not just ONE doctor to sign off on your application for PERA Duty Disability benefits. The requisite PERA form is quite complex and PERA has strict rules on what they will and will not accept on the form. It’s best to talk to an attorney first before you discuss this benefit with your doctor. Your doctor might not understand that you are not asking for total complete disability benefits but rather a disability benefit that allows you to work outside of law enforcement and or the fire service.

It is vital that attorneys coordinate work comp claims, PERA Duty Disability claims, and Healthcare Continuations claims. Sometimes employers try to force workers into signing employment law releases as part of his or her work comp agreement. You may be unknowingly waiving your ability to receive Healthcare Continuation benefits.

When deciding to apply for PERA Duty Disability benefits or Healthcare Continuation benefits, do your research. Go online. Ask your coworkers for recommendations. At Meuser Law Office, P.A. we are confident that if you ask around your station or department you’ll find coworkers who have used our services and we come highly recommended. Meuser Law Office, P.A. is one of the few workers’ compensation law firms in the state of Minnesota that also handles PERA and MSRS disability claims. We’ve successfully represented hundreds of State Patrol, police officers and firefighters throughout the state for both workers’ compensation and PERS/MSRS disability claims. Sitting down with us for a consultation to learn more about your potential claims is a lot like financial planning. We can explain what rights you have and make recommendations to you in terms of how to best protect your rights to those benefits. The knowledgeable attorneys at Meuser Law Office, P.A. can help make the process easier to navigate. Contact us today for a free, no-obligation consultation by calling 1-877-746-5680.

by Mary Beth
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Do You Need a Functional Capacity Evaluation (FCE)?

Sometimes undergoing a Functional Capacity Evaluation (FCE) can help your Minnesota workers’ compensation case if there is a dispute over the extent of your physical restrictions. Oftentimes the restrictions issued by your treating physician will differ from those issued by the insurance company’s doctor after undergoing an Independent Medical Exam (IME). An FCE can provide clarity and objectively show that an injured worker has physical restrictions. Sometimes a treating physician will refer an injured worker for a FCE and the insurance company will deny the testing.

A Functional Capacity Evaluation is a series of objective tests used to determine an injured workers’ functional limitations. After the evaluation is completed, an injured worker’s treating physician will examine the results of the FCE and then issue permanent restrictions.

The testing can take anywhere from a few hours to a few days. Testing also generally involves an interview to determine why types of conditions you have both work and non-work related, types of treatment you’ve undergone, type and intensity of symptoms, and how your symptoms impact your daily living activities. Testing includes performing simulated work tasks such as lifting, pushing and pulling, squatting, overhead activities, and other relevant physical activities.

While injured workers are not expected to continue to perform activities that cause him or her pain, the goal is to determine the maximum abilities that he or she is able to perform. So it is important to tell the tester when the activity causes the employee pain and it’s critical not to exaggerate symptoms during testing. The people who administer FCEs are experts and will be able to tell if the injured worker is exaggerating any symptoms. It will hurt your Minnesota workers’ compensation claim if the tester documents that the employee is exaggerating his or her symptoms.

A FCE report will then be created after the employee completes the testing. An FCE report typically lists limitations on weight lifting, bending, twisting, pushing, pulling, kneeling, overhead work, sitting or standing for prolonged periods. The FCE report is often extensive and can provide valuable evidence in a workers’ compensation hearing.

Typically, a Functional Capacity Evaluation takes place after an injured worker reaches Maximum Medical Improvement, also referred to as MMI. A treating physician will determine that an injured employee is at MMI when he or she has reached a plateau in treatment or he or she is as good as he or she is going to get and no new treatment is anticipation or recommended.

Qualified Rehabilitation Consultants (QRCs) may use the results from the Functional Capacity Evaluation to determine suitability of light duty or employment with a new employer. A QRC may then use these permanent restrictions to come up with a plan to get the employee back to work and may even use them to propose a retraining plan, if the restrictions are preventing the employee from re-entering the workforce in a position that pays similar to his or her pre-injury wage.

After receiving the results of a FCE the employer may determine that it cannot accommodate an employee’s permanent restrictions and then may terminate the employee. Separating from a date of injury employer is not always a bad thing and it’s important to consult with an attorney to help with this process. The results from a Functional Capacity Evaluation can help to leverage a workers’ compensation settlement as well. In cases with employees who have PERA or MSRS Duty Disability claims it can provide valuable evidence that the date of injury employer can no longer accommodate the police officer, firefighter, deputy sheriff, corrections officer, or state trooper’s permanent restrictions.

Don’t wait to get an attorney involved if you have a Minnesota workers’ compensation claim. The process can be complex and you want to be sure you receive the full benefits you are entitled. Contact Meuser Law Office, P.A. for a free no-obligation consultation and extensive claim evaluation. At Meuser Law Office, P.A. we keep our clients informed of the process as well as what to expect each step of the way. Call us today at 1-877-746-5680.

by Mary Beth
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Do I Need a Work Comp Attorney If I’m Being Paid?

If you have sustained an injury, either in the line of duty or while on the job, it is in your best interest to hire an attorney experienced in Minnesota workers’ compensation and PERA/MSRS law to represent you. Sometimes injured workers are reluctant to hire an attorney if they are currently receiving ongoing workers’ compensation benefits and the work comp insurance company has paid all their medical bills. Typically, it’s not if there will be a dispute with the insurance company, it’s when there will be a dispute, and you will want an attorney representing you, familiar with your case, and prepared to handle any disputes right away.

If the work comp insurance carrier is paying all the benefits to which you are owed, then no fees are charged. All workers’ compensation attorneys are paid the same in the State of Minnesota: 20% of wage loss benefits recovered after a dispute. These fees are paid directly to your attorney from the insurance carrier so you do not have to worry about writing a check. You also do not have to pay any money up front or any kind of retainer.

If there is a dispute over medical care and treatment, then the attorney will charge the insurance company on an hourly basis for the work done for procuring the employee’s medical care. These fees are called Roraff fees and are separate and distinct and do not come out of money owed to the injured worker.

Why do I Need an Attorney?

(1) It’s helpful to have an attorney handling your case because you can consult him or her with your questions and concerns, and trust that you are getting accurate information from someone with your best interest in mind. An attorney will answer you questions in a timely fashion and ensure that your interests are put above the interest of the insurance company.

(2) Work comp attorneys in the State of Minnesota work on a contingency basis, therefore, you can call and ask your attorney questions or even meet with your attorney without worrying that you will be billed for every minute you spending talking with them.

(3) The adjuster assigned to your case will be speaking and consulting with their own attorneys, looking for ways to save the insurer and employer money.

(4) Attorneys can help you avoid a dispute before one arises. For example, your attorney may advise you not to turn down a light duty position. If you turn down the light duty position, then the adjuster from the insurance company may use this as a reason to cut off your Temporary Total Disability (TTD) benefits.

(5) An attorney can help you choose your own Qualified Rehabilitation Consultant or “QRC.” An injured worker may choose his or her own but the insurance adjuster will not inform you of that option.

(6) The adjuster can take a recorded statement, which is like a deposition but less formal. Having an attorney present for this can help ensure the adjuster is asking the appropriate questions.

(7) Even if the insurance company is paying ongoing workers’ compensation benefits and medical benefits the adjuster may still send you to an Independent Medical Exam or an “IME.” This doctor is not independent and does not have your best interests in mind. The purpose of this examination is to give the insurance company a reason to discontinue your benefits. An attorney will prepare a summary of your medical records and specific questions to your treating doctor so that the doctor can combat the IME’s report with a narrative report.

(8) If you wait until you retain an attorney when the insurance company does cut off your benefits, it will take more time for your attorney to become familiar with your case and request medical records as well as records form the Department of Labor and Industry, which may delay the time in which your wage loss benefits are reinstated.

Meuser Law Office, P.A. is one of the few workers’ compensation law firms in the state of Minnesota that also handles PERA and MSRS disability claims. We’ve successfully represented hundreds of State Patrol, police officers and firefighters throughout the state for both workers’ compensation and PERA/MSRS disability claims. Sitting down with us for a consultation to learn more about your potential claims is a lot like financial planning. We can explain what rights you have and make recommendations to you in terms of how to best protect your rights to those benefits. The knowledgeable attorneys at Meuser Law Office, P.A. can help make the process easier to navigate. Contact us today for a free, no-obligation consultation by calling 1-877-746-5680.

by Mary Beth
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Why Has My Work Comp PTSD Claim Been Denied?

Since October 1, 2013, workers who have developed PTSD, or post-traumatic stress disorder, as a result of exposure to traumatic events while in the course and scope of their employment are entitled to workers’ compensation benefits in the state of Minnesota. Many of our clients with PTSD are police officers, State Troopers, corrections officers, deputy sheriffs, 911 dispatchers, and firefighters.

Despite that an employee may have been diagnosed with post-traumatic stress disorder by a licensed psychiatrist or psychologist and the treating physician determined that the employee developed PTSD as a result of traumatic work-related exposure or exposures, most work comp insurance companies will deny PTSD claims.

If a work comp insurance company denies your PTSD claim you should immediately consult with an attorney to bring a claim petition on your behalf.

Top Reasons Work Comp Insurance Companies Deny PTSD Claims

1.  The date of the injury is before October 1, 2013

Many adjusters are not familiar with the new law and the correct application of the law. If a police officer, firefighter, corrections officer, or 911 dispatcher witnessed or experienced a specific traumatic event before October 1, 2013, insurance companies typically deny primary liability of the claim. Even if the traumatic event did take place before October 1, 2013, the applicable date of injury used to determine compensable claims is the date the employee became disabled as a result of the condition.

2.  Inadequate medical support

While the employee’s doctor may find that the work activities caused the employee to develop PTSD, the work comp insurance carrier may find that they do not agree with the treating physician. At some point they may send you to an Independent Medical Exam or “IME” these exams are certainly not independent as the doctors are paid by the work comp insurer and likely will find that the employee does not have PTSD nor has he or she developed PTSD as a result of work-related exposures.

3.  The type of traumatic event was one that the employee was expected to be exposed as a part of regular job duties

This reason for denial has no basis in law nor does it make any sense. But, I’ve seen work comp adjusters use this reason as a basis for denial of primary liability. It’s irrelevant that as a part of the employee’s job duties he or she was exposed to horrifying, shocking, or disturbing events or that as a part of his or her job duties, it’s not unconceivable that he or she might be attacked or fear for his or her life.

4.  Non-compensable mental injury without physical injury

Despite that the law change as of October 1, 2013, and work comp in Minnesota no longer requires that the employee also experience an accompanying physical injury, many adjusters still deny on this basis.

5.  The employee did not physically witness the disturbing event

Under the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the qualifying diagnosis for PTSD has changed and allows for individuals who experience the disturbing events, although physically removed from the situation, to be diagnosed with PTSD. The DSM-V is the standard that doctors use to diagnose conditions. Therefore under the DSM-V, a 911 dispatcher may still be entitled to workers’ compensation benefits if he or she develops PTSD. But, adjusters will still deny claims for this reason.

If the work comp insurance company has denied your PTSD claim, their denial does not mean that you are not entitled wage loss benefits, rehabilitation, retraining, or medical benefits under the Minnesota Workers’ Compensation Act as a result of your disability.

At Meuser Law Office, P.A. we have successfully obtained benefits on behalf of employees who have developed post-traumatic stress Disorder both before and after the law changed on October 1, 2013. Our attorneys have represented many police officers, firefighters, corrections officers, and State Troopers with PTSD and successfully recovered benefits on their behalf. If you have developed PTSD as a result of your job duties contact our office today for a free, no-obligation consultation.

by Mary Beth
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What Should I Do If I am a Minnesota State Trooper and I am Injured in the Line of Duty?

For State Troopers who have suffered an on-duty injury, there are specific initial steps that need to be followed for purposes of complying with the Minnesota workers’ compensation rules:

1. Immediately call 911 and/or seek emergency medical care for any serious or life threatening illness or injuries.
2. Report your injury to your supervisor. There are several forms that your employer must provide to you, including the Workers’ Compensation Information and Privacy Statement, which you must sign and return, and the Employee Statement Regarding Injury/Illness/Incident, which you must complete and return. Your supervisor will also provide you with a packet of information called the Workers’ Compensation Employee Information Packet, which contains several informational documents.
3. Your supervisor must then complete an Incident/Injury/Illness Data Form, and submit it to the workers’ compensation claims administrator.
4. Seek medical care. Minnesota State Troopers are covered under a managed care program administered by Corvel. You can seek initial care through a Corvel-network medical provider for your initial medical evaluation, or you can seek care with a provider with whom you have treated twice in the last two years. In other words, you can seek initial medical care with a family physician or other medical practitioner with whom you have previously treated. The managed care program administered by Corvel has specific rules about when a change in treating physicians can take place, and when medical care can be sought outside the network.
5. Procure a workability report from your physician and provide it to your supervisor. If your doctor takes you off work, or places restrictions on your work activities, provide a copy of the workability report to your supervisor.
6. If your injury is serious – i.e., is expected to result in more than a few days off work, is expected to result in a surgery, or may result in long-term limitations, consider contacting an experienced workers’ compensation attorney for a free no-obligation consultation.

Even if it doesn’t seem like a serious injury at the time, report it! All too often we meet with State Troopers who had injuries that they failed to report because the injuries didn’t seem serious at the time. Failure to report an injury can preclude you from claiming it at a later date if it turns out to be more serious than you realized at the time.

If you have questions about how to report your injury, the attorneys at Meuser Law Office, P.A. can assist you with the process.

Helpful Hints for Your Workers’ Compensation Claim:

1. If you miss time off from work as a result of your injury, you may be eligible for the assistance of a Qualified Rehabilitation Consultant (QRC). You have the right to choose your own QRC, and it’s imperative that you exercise the right to select your own! If the State assigns you a QRC, you are allowed to change QRC’s as a matter of right within 60 days. Beyond that point, it becomes much harder – if not impossible to change QRCs.
2. Workers’ compensation wage loss benefits are payable when you’re completely off work as the result of a work-related injury, or if you’re experiencing a reduction in your earnings as a result of your injury. The State may pay out IOD and/or sick or vacation time to cover the difference between your workers’ compensation benefit and your normal salary.
3. If your workers’ compensation claim is denied by Risk Administration, contact a workers’ compensation attorney. It is extremely unlikely that you will be able to get them to reverse their decision without filing a formal claim.
4. If you receive notice of being scheduled for an “Independent Medical Examination,” (IME), it’s time to speak with an attorney. Generally, you are required to attend an IME. Being scheduled for an IME is a huge red flag warning that workers’ comp is looking for a way to cut off your benefits.
5. Keep track of all mileage and out of pocket expenses associated with your medical care. These expenses are generally 100% reimbursable under Minnesota workers’ compensation laws.
6. If you have suffered an in-the-line-of-duty injury that prevents you from returning to full duty as a State Trooper, you may eligible for MSRS State Patrol Plan Duty Disability Benefits. There are extremely complex rules that apply to the coordination of workers’ compensation benefits and MSRS Duty Disability and/or retirement benefits. Before you file for State Patrol Plan Duty Disability Benefits or Retirement Benefits, consult with an experienced attorney to ensure you are maximizing your benefits.
7. If your injury was sustained as the result of a motor vehicle collision, in addition to your workers’ compensation claim and MSRS disability benefits, you may be able to sue the at-fault driver for additional damages, including unreimbursed wage loss, medical expenses, and intangible losses such as pain and suffering and loss of enjoyment of life.

In cases involving serious injuries, it’s advisable to speak with an attorney experienced with the nuances of Minnesota workers’ compensation and PERA/MSRS law as soon as possible to ensure that you are following the necessary steps to protect your rights. Meuser Law Office, P.A. is one of the few workers’ compensation law firms in the state of Minnesota that also handles PERA and MSRS disability claims. We’ve successfully represented hundreds of State Patrol, police officers and firefighters throughout the state for both workers’ compensation and PERA/MSRS disability claims. Sitting down with us for a consultation to learn more about your potential claims is a lot like financial planning. We can explain what rights you have and make recommendations to you in terms of how to best protect your rights to those benefits. The knowledgeable attorneys at Meuser Law Office, P.A. can help make the process easier to navigate. Contact us today for a free, no-obligation consultation by calling 1-877-746-5680.

by Jen Yackley
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Independent Medical Exams in PTSD Workers’ Compensation Claims

When injured employees bring a Minnesota worker’s compensation claim, insurers and employers have a right to send the employee to an independent medical exam (IME). Doctors paid by the insurance company perform the exam and therefore are not independent and very rarely find the employee is injured. If on the rare occasion the doctor finds the employee is injured, the IME report typically states the injury is not a result of his or her employment. During the IME the doctor performs a brief examination, but the vast majority of the written report is based on a review of the employee’s medical records. Independent medical exams are particularly troublesome in post-traumatic stress disorder (PTSD) cases for a few reasons, such as:

Independent medical exams conducted on police officers, firefighters, corrections officers, deputy sheriffs, and 911 dispatchers in Minnesota workers’ compensation cases are extremely subjective. Unlike other work comp cases, injured workers can point to objective findings on an MRI or CT scan. Mental illness has subjective components.

In order for a medical provider to diagnose a person with PTSD, the person must meet the criteria set forth by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Clinicians may choose to administer a few different tests in order to support his or her diagnosis, including the MMPI-2 (Minnesota Multiphasic Personality Inventory), CAPS-5 (Clinician Administered Posttraumatic Stress Disorder Scale for DSM-5), PCL-5 (PTSD Checklist for DSM-5), or MCMI-III (Millon Clinical Multiaxial Inventory).

These tests rely heavily on self-reporting and therefore, make it easy for the IME doctor to claim that the injured worker is malingering, over-reporting, or making up symptoms. Experienced clinicians who regularly treat people with post-traumatic stress disorder can differentiate between fake and real symptoms, but IME doctors motivated by money from the insurance company are not inclined to diagnose injured workers with PTSD.

Additionally, more often than not PTSD occurs with a number of other mental health conditions. People who suffer from PTSD may also suffer from an anxiety disorder or depression and may abuse alcohol as well. IME doctors may purposefully attribute all the injured worker’s symptoms to other disorders, which in most cases are not compensable under the Minnesota Workers’ Compensation Act.

IMEs also may re-traumatize injured workers with PTSD. The injured worker is forced to report and relive traumatic events under the microscope during an adversarial process, people looking to discredit and to minimize their experiences.

Unfortunately, the nature of post-traumatic stress disorder lends itself to many of the excuses that employers and insurers use to deny PTSD claims. An even sadder reality is that almost all the employers of our clients with PTSD, police officers, sheriff deputies, and corrections officers are public employees. Our cities and counties are more comfortable granting benefits to public servants with physical injuries that they can see, not the mental scars left behind from being forced to shoot someone in the line of duty, seeing children die in grisly car accidents, being shot at by strangers, or seeing the aftermath of domestic violence. We need to do better by the people who keep the public safe and in the process suffer a very real, debilitating injury.

At Meuser Law Office, P.A. we have successfully represented many injured workers with PTSD, including police officers, firefighters, correction officers, deputy sheriffs, and 911 dispatchers. We have successfully obtained settlements and benefits on behalf of our clients despite negative IME reports. It’s very important to choose a team of lawyers with extensive experience in this complicated area of law if you or someone you love suffers from PTSD as a result of his or her employment. Contact us today at Meuser Law Office, P.A. for a free no-obligation consultation by calling 1-877-746-5680.

by Mary Beth
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