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The Life Cycle of a Workers’ Compensation Claim

Topics

PERA

Workers' Compensation

Personal Injury

work_comp_clientThe workers’ compensation system in Minnesota is an administrative process and, therefore, is different than a civil lawsuit. As a result, clients aren’t as familiar with the work comp process and what to expect during the duration of the time in the Minnesota work comp system.
First, an injured employee will report the work-related injury to his or her employer. The employer then must file a First Report of Injury. This First Report of Injury or “FROI” does not mean the employer and its insurance company will accept liability for the injury and begin making wage loss benefit payments or pay for your medical bills. This document shows that they were aware of the injury and that you believe your injury is causally related to your work activities. The FROI helps to demonstrate that the employer was placed on notice and aware of its potential liability. Employers—not employees—are responsible for completing the FROI and filing with the Minnesota Department of Labor and Industry.

Second, the work comp insurance carrier will decided whether or not to accept liability for the employee’s injury. The insurance company may collect medical records, conduct a recorded statement, and reach out to your employer or supervisor. It is best to have an attorney working on your behalf in the earliest stages. The insurance company is looking for reasons to deny your claim. If the insurance company accepts liability and pays everything they are required to pay, then the attorney will not take any fees. The insurance carrier will issue a Notice of Primary Liability Determination, a form that either accepts your claim or, if it denies your claim, will list a reason for the denial.

If your claim is denied, then an employee should file a Claim Petition. The claim petition begins the contested litigation process. The claim petition will list the date and nature of your injury, the benefits to which you believe you are entitled, and sends out notice to any potential intervenors—or entities that paid for benefits that work comp should have covered had they accepted your claim. The claim petition will also include a medical report or record from your doctor that causally relates your injury to your job activities. The claim petition is served on the State of Minnesota as well as the employer and insurer.

Next, the discovery process begins. This stage is the information gathering portion. The employer/insurer will file an answer to the claim petition, which asserts why you are not entitled to work comp benefits and asserts any affirmative defenses to your claim. Both parties will gather medical records, witness statements, and bills. Attorneys will share information back and forth between the parties. Likely, the attorney for the employer/insurer will take your deposition, a formal recorded statement. You also may be sent to an independent medical exam by the insurance company. The insurance company pays this doctor for a report regarding the nature and extent of your injuries and whether they are work-related.

Then, the more formal negotiation process will begin. Your attorney will prepare a settlement demand which will detail the monetary extent of your claim and the amount it will take for you to settle your case rather than proceed to a formal hearing in front of a workers’ compensation judge. Your case will be scheduled for a settlement conference at the Office of Administrative Hearings. The attorneys for each side will meet with a judge and work to determine whether the case will be able to be settled. Clients are available by phone to either accept or reject any settlement offers.

If the parties are unable to reach a settlement, then the matter will be scheduled for a pretrial conference and set for a formal hearing. The hearing will last approximately one half day and both parities will have an opportunity to present their side to the workers’ compensation judge. You will testify and your medical bills, reports, and records will be entered into evidence. The workers’ compensation judge will then issue a written opinion regarding the nature and extent of your injuries and if he or she finds them to be work-related also the employer/insurer’s extent of liability and may order them to pay past and ongoing benefits.

If you believe you have sustained a workers’ compensation injury contact the attorneys at 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.


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