Simple Suggestions to Avoid Problems with Minnesota Workers’ Compensation Medical Coverage after a Settlement

In my 35 years practicing Minnesota workers’ compensation, my experience has been that most work comp cases in which attorneys become involved are eventually settled. I am referring to cases where some dispute has arisen or an injured worker feels the need to hire a lawyer to protect his or her interests. There are many claims, perhaps the majority, which involve minor injuries, minimal lost time from work, minimal medical care and no attorneys.

Cases that are settled typically involve a payment to the employee of a lump sum of money representing disputed past or potential future benefits in order to avoid the uncertainties of trial. Where possible, we always try to negotiate settlement terms which leave future medical claims open for the injury. For example, a claim involving a low back injury might settle for a lump sum payment and the insurance company would remain responsible for future medical care relating to the low back injury. (For more information about work comp settlements in Minnesota, please review our previous blog posts: What is a fair work comp settlement in Minnesota?  When do you get a work comp settlement in Minnesota?

This is where things can get complicated. Once the case has settled, the insurance company still has the right to challenge future medical bills related to the work injury. This means that the employee always has the burden of proving that medical care or treatment is reasonable, necessary and related to the original work injury.

Avoiding Hassles Over Future Medical Bills

If you find yourself in a situation where you have settled a work comp claim and future medical coverage remains open under the terms of the settlement, there are a few things you can do to make your life easier and avoid future hassles with the insurance company.

1. Periodically visit your physician to document ongoing problems.  If you have a permanent injury or any type of ongoing symptoms relating to the work injury, it’s a good idea to periodically schedule an appointment to meet with your physician about your condition. This is a good idea because you can have your condition monitored for any new or additional tests or treatment which might improve your quality of life. It’s also a good idea because it creates an ongoing medical record of your problems so the work comp insurance company is aware that you are continuing to receive medical treatment.

If you stop treating for a couple of years and the work comp insurance company suddenly receives a medical bill, they will want to know why there was a lapse in treatment, what prompted you to return to your physician and whether you have had some new injury or accident which might make some other medical provider responsible.

2. Make sure any physician you visit is aware that your condition is work related.  Doctors are very busy and may not always know or remember that you are being seen for a work injury. It can be very helpful if you remind your doctor of your work injury and ongoing treatment history so that some reference to the work injury shows up in the office notes. This is another way to ensure that the work comp insurance company remains aware of your ongoing difficulties.

3. Make sure the billing department at the hospital or clinic knows that you are being seen for a work comp claim.  If you don’t mention that your visit is for work comp, it is very likely that your health insurance will be billed instead of work comp. A medical provider will probably just keep sending bills to your health insurance unless you instruct them otherwise. If this happens more than a couple of times, you will again disappear from the work comp insurance company’s records and your health insurance will be paying medical bills that should be paid by work comp.

4. Get and keep the work comp billing details.  After a settlement, you should ask your attorney for all of the relevant contact information for the work comp insurance company. This would include the name of your employer, the name of the work comp insurance company, the date of injury and a claim number. This information should be presented to the medical billing department every time you have a medical appointment or receive care and treatment for the work injury.

5. Contact your attorney right away if there is a problem.  If, for some reason, the work comp insurer denies or ignores a bill for treatment related to your work injury, contact your lawyer right away. The longer you wait, the more difficult it may be to relate the treatment to the work injury or to persuade the work comp insurance company that they should be paying the bill. Remember, your lawyer is unable to help you unless you notify him or her about the problem.

Conclusion

Following these simple tips can help make it easier to avoid problems with the work comp insurance company after your settlement. Remember, this only applies to claims where future medical coverage remains open under the terms of your settlement.

If you have been injured on the job and have questions about your claim or the Minnesota work comp system, please don’t hesitate to give us a call. You can contact us, anytime, with questions about your case or to arrange an absolutely free consultation. It won’t cost you anything and we will always give you our honest assessment about whether you need a lawyer to represent you. If you have questions about how much it costs to hire a lawyer for a Minnesota workers’ compensation case, you can check out this previous post.

Keep in mind, you are dealing with an insurance company which handles hundreds or thousands of claims every day. They have experienced claims adjusters and attorneys managing their files. Even if you don’t need a lawyer at the moment, a little information about the work comp system can make a big difference for you in your dealings with the insurance company. At Bradt Law Offices, we have been providing assistance to injured workers all across northern Minnesota and the Iron Range for more than 35 years.

As always, thank you for visiting our blog and please spread the word that we are a good source of work comp information and assistance for workers injured in northern Minnesota and anywhere on the Iron Range