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Workers' compensation -- Claim process



Frequently asked questions

Disclaimer:  The information on these Web pages provides a general overview of the Minnesota workers' compensation system for educational purposes only. It is not a complete description of workers' compensation law or of the topics discussed and should not be construed as offering or providing legal advice. Those with questions about workers' compensation law are encouraged to contact the Department of Labor and Industry for more information or a lawyer for legal advice.

1. What happens when I get injured at my job?


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Tell your employer immediately. Be sure to report your injury to your supervisor. If you need to seek emergency medical attention do that first, but then contact your employer as soon as possible. Your employer will complete a First Report of Injury (FROI) form, so be sure to give your employer accurate and complete information about how your were hurt and about any injuries you sustained.

 

2. What types of injuries are covered by workers' compensation?


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A work-related injury can be any condition that is caused, aggravated or accelerated by employment activities. This includes traumatic injuries, gradual injuries or occupational diseases.

 

3. Does my employer have to carry workers' compensation insurance?


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Minnesota Statutes 176.181, subd. 2, requires every employer to provide workers' compensation insurance for their employees, either through a policy with a licensed insurance company or through self-insurance approved through the Minnesota Department of Commerce. There are some exceptions, which can be found in Minnesota Statutes 176.041.

  • Employers are generally defined as those who hire others to perform services.

  • Employees are generally defined as people performing services for another for hire, including minors and workers who are not citizens. Some volunteers are considered employees for purposes of workers' compensation. See Minnesota Statutes 176.011, subd. 9.

 

4. What benefits might I be entitled to if my claim is accepted?


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Some benefits you might receive include wage-loss benefits, compensation for loss of use of a part of the body, medical benefits, vocational rehabilitation and retraining. Click on the links in the flow chart to learn more about each benefit type.

 

5. What medical treatment is covered by workers' compensation?


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The Minnesota workers' compensation statutes entitle an employee to reasonable and necessary medical treatment or supplies to cure or relieve the effect of the work injury. The employer is required to furnish medical treatment as described by Minnesota Statutes 176.135, subd. 1, including psychological, chiropractic, podiatric, surgical and hospital treatment.

 

6. Can I treat with my own physician?


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Employees may choose their health care provider for treatment of a work-related injury. An employer may require an employee to see a designated health care provider for treatment only in the following circumstances.

  • An employer may require an employee to receive treatment and supplies from a managed care plan certified under Minnesota Statutes 176.1351 except as otherwise provided by that law and corresponding laws (Minnesota Rules Chapter 5218).

  • An employer that is part of a collective bargaining agreement, recognized and on file with the department, may include a provision specifying a list of health care providers that may be the exclusive providers of medical and related treatment and independent medical examinations (Minnesota Statutes 176.1812).

  • An employer may require an employee to obtain outpatient prescription and nonprescription medications from a pharmacy or network of pharmacies as long as it is within 15 miles of the employee's residence (Minnesota Statutes 176.135, Subd. 1(g)).

 

7. What is an independent medical examination (IME) and do I have to attend?


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An independent medical examination (IME) is an evaluation performed by a doctor selected by the employer or insurer who is not involved in the employee's care. The purpose of the IME is to provide an opinion about a variety of medical and job-related issues. The workers' compensation insurance carrier or self-insured employer has a legal right to request an IME with a doctor it selects, at reasonable times and places. Under most circumstances, the examination must be within 150 miles of the employee's residence. The insurer must pay for the exam and must reimburse the employee for reasonable mileage and other costs of attending the examination.

Failure to attend the examination could result in an interruption of benefits to the injured worker.

 

8. How does my workers' compensation claim affect the Family Medical Leave Act (FMLA), sick time, vacation time, paid time off (PTO), etc.?


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The work or nonwork status of the injury or disability has no bearing upon the employer's obligations under the Family Medical Leave Act (FMLA). The employee's eligibility for the protections of FMLA is governed entirely by whether the employee's injury or medical condition brings the employee within the coverage of FMLA. If the employee qualifies for FMLA leave, the employer will not be able to terminate the employee for absenteeism or take any other actions prohibited by FMLA until the employee's entitlement to FMLA leave has been exhausted.

Sick leave, vacation leave or paid time off (PTO) cannot be used to pay workers' compensation benefits. However, accrual of these benefits may be affected by being off of work due to an injury.

 

9. What happens if I am unable to return to the work I did before I was injured?


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You may be eligible for wage-loss benefits as discussed in question four. You may also be eligible for vocational rehabilitation services, at no cost to you, to help you return to work.

Services may include vocational counseling, transferable skills analysis, job-seeking skills, job placement and formal retraining.

 

10. Where can I find Minnesota laws and statutes regarding workers' compensation?


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Minnesota Statutes Chapter 176 contains the Minnesota Workers' Compensation Act, which allows employees to receive compensation for injuries or occupational diseases that arise out of or in the course of employment.

Various Minnesota Rules, some of which are found in Chapters 5220, 5221 and 5223, also relate to Minnesota workers' compensation.

 

11. What do I do if my workers' compensation claim or wage-loss/monetary benefits are denied?


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If the insurer has denied primary liability for your claimed injury (has never paid any benefits):  Call the insurance claims adjuster. Write down the date, time and adjuster's name for your records. Explain the problem and try to work it out. Many problems can be fixed with a telephone call.

If a conversation with the claims adjuster does not resolve the matter, you may discuss your problem with a Alternative Dispute Resolution specialist at the Department of Labor and Industry (DLI). The Alternative Dispute Resolution specialist will try to help resolve your problems.

If your problem has not been resolved, the Alternative Dispute Resolution specialist can explain the dispute-resolution process and provide information to help you decide the best way to resolve your problem.

DLI offers mediation services for resolving disputes about workers' compensation claims. Mediation is a free, informal process where trained, experienced workers' compensation mediators offer the parties a quick, cost-effective means by which any issue -- simple or complex -- can be resolved to the satisfaction of all concerned parties. A mediator can be reached at (651) 284-5032 or 1-800-342-5354.

You may also appeal the denial and request a hearing by filing an Employee's Claim Petition form. It may be wise to consult with an experienced workers' compensation lawyer to decide whether to file an Employee's Claim Petition form on your own behalf or whether you should have a lawyer assist you.

If you are a member of a union or part of the construction industry, note:  Some unions and employers, especially in the construction industry, have specific procedures that must be followed when resolving disputes. Contact your union representative for further information.

 

12. What if my wage-loss benefits have been discontinued or stopped?


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The insurer may discontinue wage-loss benefits under certain circumstances. See An employee's guide to the Minnesota workers' compensation system (see page 8 of the PDF) for a list of reasons the insurer may discontinue wage-loss benefits.

Before the insurer can discontinue your wage-loss benefits, the insurer must send you a Notice of Intention to Discontinue Benefits (NOID) form. If you disagree with the discontinuance, you must contact the Office of Administrative Hearings (OAH) to request a conference. The deadline to request a conference is described on the NOID form. OAH can be contacted at (651) 361-7912.

If your benefits have stopped and you have not received an NOID form, call the insurance company to ask if the benefit check was issued and confirm the address it was sent to. However, if the insurer has discontinued your wage-loss benefits without properly notifying you by filing an NOID, and you disagree with the discontinuance, you must request a conference by contacting OAH within 40 days of the date the insurer should have sent the NOID form. Again, OAH can be contacted at (651) 361-7912.

 

13. What if my checks are late?


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If you are concerned about a pattern of lateness in the payment of benefits, you may want to consider requesting your file be reviewed by a member of the Compliance, Records and Training unit for possible penalty assessment. The penalty review process is not designed to assist in matters where your benefit payments have stopped. If payment of your benefits has stopped, see question 12 above.

Penalties for late payments of ongoing temporary total disability or temporary partial disability benefits are available if there is proof that more than three benefit payments were issued more than three business-days late. Proof of late payment would be a copy of your compensation check stubs and, in the case of temporary partial disability benefits, documentation of the date on which wage-loss documentation was sent to the insurer. Penalties assessed against the insurance company are payable to the Assigned Risk Safety Account in the department and also payable to the employee. The penalty amounts are determined by the length of delay and amount of benefits delayed. The penalties payable to the employee range from 6 to 30 percent of the amount delayed, the percent is determinied by the length of the delay.

You may submit your request for penalty review, with late-payment documentation to:

  • Minnesota Department of Labor and Industry
    Workers' Compensation Division
    Compliance, Records and Training
    443 Lafayette Road N.
    St. Paul, MN  55155-4315

 

14. What if my medical benefits are denied or not paid? How do I solve a disagreement about medical care?


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If the insurer has admitted liability for your claimed injury (has paid some benefits):  call the insurance company to discuss the issue with the adjuster or claims representative. Ask whether the bill has been paid. If you can't resolve the issue, you can request assistance from the Department of Labor and Industry (DLI) regarding the issue by filing a Medical Request form. A conference may be scheduled at DLI or the Office of Administrative Hearings (OAH) about the issue.

If the insurer has denied primary liability for your claimed injury (has never paid any benefits):  you cannot file a Medical Request form. You must request a hearing by filing the Employee's Claim Petition form.

It may be wise to consult with an experienced workers' compensation lawyer to decide whether to file these forms (Medical Request or Employee's Claim Petition) on your own behalf or whether you should have a lawyer assist you.

You may also contact the Alternative Dispute Resolution unit to speak with one of the mediators prior to filing a Medical Request or an Employee's Claim Petition form. A mediator may be able to offer suggestions or work with you and the insurer to resolve the disputed issue(s). A mediator can be reached at (651) 284-5032 or
1-800-342-5354.

If you are informed your medical benefits are provided through a certified managed care plan:  you must first use the managed care plan's dispute-resolution process to resolve disagreements about medical care. The managed care plan must respond to you within 30 days after you notify it, in writing, of a problem.

 

15. What if my rehabilitation benefits are denied? How do I solve a disagreement about my vocational rehabilitation plan?


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If the insurer has admitted liability for your claimed injury (has paid some benefits):  call the insurance company to discuss the issue with the adjuster or claims representative. If you can't resolve the issue, you can request assistance from the Department of Labor and Industry (DLI) regarding the issue by filing a Rehabilitation Request form. A conference may be scheduled at DLI about the issue.

If the insurer has denied primary liability for your claimed injury (has never paid any benefits):  you cannot file the Rehabilitation Request form. You must request a hearing by filing the Employee's Claim Petition form.

It may be wise to consult with an experienced workers' compensation lawyer to decide whether to file one of these forms (Rehabilitation Request or Employee's Claim Petition) on your own behalf or whether you should have a lawyer assist you.

You may also contact the Alternative Dispute Resolution unit to speak with a mediator prior to filing one of these forms. A mediator may be able to offer suggestions or work with you and the insurer to resolve the disputed issue(s). A mediator can be reached at (651) 284-5032 or 1-800-342-5354.

If the insurer has denied primary liability or has denied that your need for rehabilitation assistance is related to your injury:  you can contact the Vocational Rehabilitation unit (VRU) that is part of the Workers' Compensation Division. VRU provides vocational rehabilitation services to injured workers whose claims have been denied by the employer/insurer. A VRU qualified rehabilitation consultant (QRC) will contact you to determine if you qualify for services. Although all injured workers are eligible for services through VRU, the unit primarily serves claims where liability is denied by the insurer.

 

16. I think someone is committing workers' compensation fraud, what should I do?


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Any person who, with intent to defraud, receives workers' compensation benefits to which the person is not entitled by knowingly misrepresenting, misstating or failing to disclose any material fact is guilty of theft and shall be sentenced pursuant to Minnesota Statutes 609.52, Subd. 3.

Contact the Minnesota Department of Commerce's Fraud Prevention unit about possible workers' compensation fraud at 1-888-372-8366.

To report an employer conducting business without workers' compensation coverage, complete the form at http://workplace.doli.state.mn.us/isu/uninsured.


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