It is a common misconception among employees that a Workers’ Compensation insurance claim starts with the insurance company right away when they get injured. There is a lot more to it than just getting hurt at work and telling your supervisor, manager or boss. You should, of course, tell your supervisor, manager or boss, but you should also follow up with them to make sure that they fill out a First Report of Injury or get their Workers’ Compensation insurance information. A Workers’ Compensation claim doesn’t begin with the Workers’ Compensation insurance company until the insurance company receives notice of a claim.

If your employer is unwilling to notify the Workers’ Compensation insurance company, then you, as the injured worker, are able to do so. However, it is wise to get an attorney involved to communicate with the insurance company on your behalf. Otherwise, you run the risk of disclosing too much information to the insurance company right away, when you think you’re just telling them how you got hurt. An attorney can discuss the claim with the insurance company and get them the information that they need to proceed with the claim.

If your employer has already provided the insurance company with a First Report of Injury and the insurance company tries to contact you to get a statement on the incident, it is also wise to get an attorney at that point rather than making the statement on your own, for the same reasons listed above.

There may be certain phrases or nuances that you would use to describe the incident that can actually hurt your claim. Recent case-law relies heavily on how an incident occurred in order to determine whether or not you may be entitled to benefits under the Workers’ Compensation laws.

Once your case is opened, and the insurance company has conducted a preliminary investigation, consisting of requesting and reviewing medical records and statements from the employer and possible witnesses, they will determine whether they are going to accept or deny your claim. A form will be filled out by the insurance company called a Notice of Primary Liability Determination, in which the insurance company states whether they are accepting or denying the claim.

There are three boxes on this form. The first box says accepted and benefits will be paid, the second says accepted but wage loss will not be paid and has a box to provide an explanation, and the third box indicates your Workers’ Compensation claim is denied and includes a box to provide an explanation.

If your claim is accepted, that means that the insurance company has admitted liability to some extent for your injury and they will pay the claim to a certain extent. If box three is checked, and you believe that your injury is work-related and is being wrongfully denied, then you have to hire an attorney to file a claim petition with the State of Minnesota Department of Labor and Injury on your behalf.

Those with admitted injuries oftentimes believe that that means that all of their bills, lost time and expenses will be paid for. Unfortunately, this is not the case. Insurance companies will frequently admit claims initially, and then when they have a reason to discontinue benefits or deny payment of treatment, they will do so.

In those cases, the injured worker will need to get an attorney to petition this denial. If box two of the Notice of Primary Liability Determination is checked, that means that they will not be paying wage loss. If you have actual missed time from work of more than three days, then your attorney will have to file a claim petition.

If the insurance company has been paying you wage loss benefits, and then suddenly you receive a Notice of Intention to Discontinue letter, and you disagree with their reason for cutting you off, then your attorney will need to call and request a conference on the discontinuance of your benefits. If the insurance company accepted liability, but won’t approve medical or rehabilitation services, then your attorney will have to file for an administrative conference with the Department of Labor and Industry.

Once your attorney has had to request assistance from the State of Minnesota on your case, your claim is then considered to be in litigation. If you have an administrative conference, your claim will get set on the calendar within a matter of weeks if it is about wage loss benefits, or possibly a few months if it is over a medical or rehabilitation issue. If the employee prevails at the conference and there is no appeal, then the employer and insurer are expected to provide the previously denied benefits. If the employer and insurer appeal and ask for a formal hearing, then the claim proceeds.

Once the claim is in litigation, we enter into the discovery phase of the claim. A deposition may be scheduled. A deposition is similar to giving a statement to the insurance company, except that there is a court reporter present, your attorney and the attorney for the employer and its insurance company. Your attorney can explain in detail what your specific deposition will be about, but usually the employer and insurer’s attorney will ask questions about how the injury happened and if you’ve had any similar injuries in the past.

The attorney for the employer and insurer will also usually seek to set up an Independent Medical Examination with a doctor of their choosing, who has the right to examine you under the State of Minnesota’s Workers’ Compensation laws. The reason why the employer and insurer will ask for this is to get an opinion from their own doctor about whether the treatment or requested benefits are actually reasonable, necessary and related to your Workers’ Compensation claim.

After discovery has been completed, the matter proceeds to a settlement conference or discussion of possible settlement of the case. Your attorney will explain to you what a reasonable Workers’ Compensation settlement amount would be to ask for as an initial demand, and then explain the subsequent offers and counter offers from there, as well as what amount of money is reasonable to accept. If the parties are able to settle, then a stipulation for settlement is drafted within the weeks following the settlement, outstanding medical bills are dealt with, and then the parties sign, the judge issues an award letter, and then payment is received.

If the matter is not able to be settled, then the claim proceeds to a Workers’ Compensation hearing. If you go to a hearing, the injured worker is required to be at court and personally appear before the judge. It is possible to proceed to hearing without an attorney, but that is not recommended, as the injured worker/employee will be required to testify as to their injury and why they should be entitled to the benefits they are claiming.

With an attorney present, the attorney can “direct” the employee, or ask the employee a list of questions to explain their position to the judge in the most efficient way possible. Your attorney can also make opening and/or closing arguments to the court on your behalf and question the witnesses for the employer/insurer. Once a hearing is done, the judge has two months to issue a written decision on the case. If neither party appeals, the claim is done. The benefits will have to be paid within two weeks, unless benefits were denied or one of the party’s files an appeal.

If either party decides to file an appeal, then the claim goes to the Workers’ Compensation Court of Appeals. The parties will have to submit written briefs and may have to make oral argument in front of the Court of Appeals. The Court of Appeals has 90 days to make a decision once the case has been assigned. Then, when the written decision is received, the parties can again choose to appeal or not appeal to the Supreme Court of the State of Minnesota. However, most claims do not make it this far.

We can help you throughout any step of the Workers’ Compensation claims process, regardless of the size of your case. Every Workers’ Compensation insurance claim is unique, and we want to help you get all of the benefits you need to pay your medical bills, support your family, and get back to work.