In our Minnesota workers’ compensation law practice, we regularly see even the most legitimate workers’ compensation claims being denied by workers’ compensation insurance companies.
If primary liability is denied on your Minnesota workers’ compensation claim, you should strongly consider consulting with a lawyer who is experienced in Minnesota work comp law.
What is Primary Liability in Worker’s Compensation?
In Minnesota workers’ compensation law, primary liability refers to the insurer’s responsibility to provide benefits for a work-related injury or illness.
When primary liability is accepted, the insurer acknowledges that the employee’s injury is connected to their job and covered under workers’ compensation.
However, insurers can also deny primary liability, which means they reject responsibility for the claim.
When that happens, the injured employee will not receive benefits unless they successfully challenge the decision with the help of a workers’ compensation attorney.
What is a Notice of Primary Liability Determination?
When the workers’ compensation insurer makes decision whether they are accepting or denying a work comp claim, they will send a Notice of Primary Liability Determination.
In cases where primary liability is denied, a statement explaining “a specific reason for the denial, which must be in language easily readable and understandable…and a clear statement of the facts forming the basis for the denial” will be included.
That statement explains the reason, legitimate or not, that the insurer denied primary liability.
Read Our Step-by-Step Guide to Report a Work-Related Injury
Reasons for Denial of Primary Liability
When the workers’ compensation insurer decides whether they are accepting or denying a work comp claim, they will send a Notice of Primary Liability Determination.
In cases where primary liability is denied, a statement explaining “a specific reason for the denial, which must be in language easily readable and understandable…and a clear statement of the facts forming the basis for the denial” will be included.
That statement explains the reason, legitimate or not, that the insurer denied primary liability.
Here are some of the main reasons for denial and what they mean for you.
Disputes Over Work-Relatedness
One of the most frequent reasons for a denied claim is a dispute over whether your injury or illness is genuinely connected to your job. Insurers may argue that the injury didn’t happen during work hours or claim that your duties weren’t the cause. This reason is very common in health conditions that develop over time, such as carpal tunnel syndrome.
Pre-Existing Conditions
Another reason for denial involves pre-existing conditions.
If you have a medical condition that existed before your injury, the insurer might claim that your current health issue is not directly related to your work but is a result of the pre-existing condition.
Minnesota law does provide coverage for work-related aggravations of pre-existing conditions, but proving this connection may require strong medical evidence.
Inadequate Medical Evidence
When the insurer reviews your workers’ compensation claim, they’ll contact you and your doctor to gather medical evidence about the injury.
They’ll likely contact you to ask about your injury, including how it occurred, the treatment you’ve received so far, any current physical limitations, and when your next medical appointment is scheduled. These details help them understand the timeline and scope of your condition.
The insurer will then ask for the treatment records directly from your healthcare provider to review your diagnosis, treatment history, and how your condition impacts your ability to work.
Some examples of what they may ask for are return-to-work forms or workability assessments to see if your injury restricts you from performing certain job tasks.
Additional Reasons
If there’s a reason to deny a claim, the insurer will find it.
- Lack of timely reporting
- That the injured worker’s condition is “idiopathic” – or of unknown cause
- That the injured worker is not an “employee” within the meaning of the work comp law
- That the employee is an “independent contractor” and not covered under the Minnesota Workers’ Compensation Act
- That the injured workers’ condition is due to a “superseding, intervening cause” – or some sort of incident or condition that occurred after the alleged work injury
What Should I Do if I Get a Denial of Primary Liability Letter?
If you received a denial of primary liability letter, don’t panic.
Here’s a step-by-step guide on how to respond and improve your chances of successfully appealing the denial.
Contact a Workers’ Comp Attorney
Reach out to the attorneys at Meuser Law to help you initiate the appeals process and guide you through the necessary steps to fight the denial.
Workers’ compensation claims are often complex, and having experienced legal representation can make all the difference in overturning a denial.
Review the Denial Letter Carefully
Read over the Denial of Primary Liability letter closely to understand the specific reasons for the insurer’s decision. Understanding the reason behind the decision can help you and your attorney create a targeted strategy to win your appeal.
Based on the reason for denial, you’ll want to start strengthening your claim with new evidence. With your attorney’s guidance, you might consider the following types of evidence:
- Updated, detailed statements from your doctor that clearly link the injury to work duties
- A second medical opinion to add weight to your case
- Statements from coworkers who witnessed the incident or can attest to the physical demands of your job
- Expert testimony from vocational or medical experts
Talk to Your Worker’s Comp Attorney About Alternative Dispute Resolutions
Before escalating to a formal hearing, the Minnesota Judicial Branch lays out several options for alternative dispute resolution (ADR).
Instead of having an entire court process, both sides will try to negotiate with the shared goal of reaching an agreement. Your attorney will represent you during these discussions, advocating for the best possible outcome.
Request a Formal Hearing (If Needed)
If the initial denial cannot be resolved through informal discussions, you can request a formal hearing through Minnesota’s workers’ compensation system. This is a legal proceeding where you and the insurer present evidence before a workers’ compensation judge.
At the hearing, your attorney will present your case, including medical records, witness statements, and any other relevant documentation, to argue for the reinstatement of your claim.
Await the Outcome Following the Appeal
After going through the appeals process, there are several possible outcomes:
- Acceptance of Primary Liability: The insurer may agree to accept primary liability after further review of your evidence, allowing you to receive full benefits.
- Settlement: In some cases, a negotiated settlement can provide a resolution without going to a formal hearing.
- Denial Upheld: If the denial is upheld at a formal hearing, further legal options may be available, such as appealing to a higher court.
Regardless of the outcome, having an attorney by your side is critical to ensuring you do everything possible to fight for your benefits. If you’ve received a denial of primary liability letter, contact Meuser Law today to discuss your next steps.
