Workers' compensation -- Rehabilitation provider

A:  The rules require that the intern shall sign their name with the intern designation. As such, "QRC intern" should be written after your name (Minnesota Rules 5220.1400, Subp. 3a).

B:  Also, Minnesota Rules 5220.1803, Subp. 5 states, "the rehabilitation provider number assigned by the commissioner shall be on all reports submitted by the rehabilitation provider."

Example using A and B:  Valerie Bieser, QRC intern #313

The terms "client," "employee" and "injured worker" are used interchangeably throughout Minnesota 5220 rehabilitation rules. The department has no particular preference about the use of these terms by rehabilitation providers.

Minnesota Rules 5220.1802 refers to "required progress records" in some places and to "required rehabilitation reports" in other places.

According to Minn. Rules 5220.0100, Subp. 30, "required progress record" means a record maintained by the rehabilitation provider that documents the rehabilitation provider's services and the employee's rehabilitation progress. The record shall include all case notes and written reports, whether or not they are submitted to the commissioner, and all correspondence received or prepared by the rehabilitation provider about an employee's rehabilitation.

According to Minn. Rules 5220.0100, Subp. 31, "required rehabilitation report" means the rehabilitation consultation report, the plan progress report and any other report that must be submitted to the commissioner whenever a rehabilitation plan is initiated, proposed to be amended, suspended or closed, or when a change of assigned qualified rehabilitation consultant occurs on a case.

The instruction section of R-forms need not be forwarded to the department.

The department does not provide a specific billing guideline for the completion of any R-form.

If a party does not sign an R-2 or R-3, Minnesota Rules 5220.0410 and 5220.0510 specify what options are available to that person. The QRC would be encouraged to contact the party to see if there is an objection and if it can be resolved. If not, the objecting party must file a Rehabilitation Request for Assistance form with DLI within 15 days of receipt of the proposed plan.

The definition of a "qualified employee" anticipated that the QRC consider the treating physician's opinion of the employee's work ability in conjunction with the provision of rehabilitation services. An IME physician is not a primary health care provider as defined in Minnesota Rules 5221.0430, Subp. 1. The health care provider directs and coordinates medical care for the employee; the IME physician is not a health care provider and provides no medical care on behalf of the employee.

Because an independent medical examination is part of claims adjustment, a QRC should not use the IME report recommendations to develop or implement the rehabilitation plan (Minnesota Rules 5220.1801, Subp. 8B).

If the insurer wants the IME report recommendations used to develop or implement the rehabilitation plan, the insurer may file a Rehabilitation Request form with the department. If ordered by a mediator/arbitrator or compensation judge, the QRC must then follow the IME physical restrictions.

If you don't see your question answered here or want more information for rehabilitation providers, send an email message to DLI's Workers' Compensation Division or call (651) 284-5005, toll-free at
1-800-342-5354.

Employees usually call the adjuster to ask for a consultation with a qualified rehabilitation consultant (QRC); most adjusters accommodate an oral request. However, as shown below, the rules anticipate the request will be in writing. A written request documents the date the request was made in the event of a dispute. No particular form is required.

Minnesota Rules 5220.0110, Subp. 6. Employee request for consultation. The employee may request a rehabilitation consultation by giving written notice to the insurer requesting a rehabilitation consultation. Notification of the request shall be filed with the commissioner.

Minnesota Rules 5220.0130, Subp. 3(C) requires a narrative report to be attached to the RCR form explaining why the employee has or has not been found to be a qualified employee. There is no set length. However, the qualified rehabilitation consultant (QRC) needs to explain their rationale so the parties will understand how the decision was arrived at.

The rules do not provide for extensions beyond the 14 calendar-days within which the consultation report must be "received" by the department.

If you don't see your question answered here or want more information for rehabilitation providers, send an email message to DLI's Workers' Compensation Division or call (651) 284-5005, toll-free at
1-800-342-5354.

In this situation, it is recommended the qualified rehabilitation consultant (QRC) review the new medical reports/records. If the QRC determines the injured worker is no longer a "qualified employee," the QRC should then submit an amended Rehabilitation Consultation Report form, with narrative report, stating the employee is not a qualified employee and, therefore, not eligible to receive rehabilitation services. Should any of the parties disagree with the QRC's amended assessment, they may contact the QRC to discuss their concerns and/or file a Rehabilitation Request for Assistance form with the department.

In this situation, it is recommended the qualified rehabilitation consultant (QRC) review the new medical reports/records. If the QRC determines the injured worker is no longer a "qualified employee," the QRC should then submit an amended Rehabilitation Consultation Report form, with narrative report, stating the employee is not a qualified employee and, therefore, not eligible to receive rehabilitation services. Should any of the parties disagree with the QRC's amended assessment, they may contact the QRC to discuss their concerns and/or file a Rehabilitation Request for Assistance form with the department.

When the R-2 form is filed, Minnesota Rules 5220.1803, Subp. 5, requires an initial evaluation narrative report about the employee that includes the following information in summary fashion:  medical status, vocational history, educational history, social history, relevant economic factors, transferable skills, employment barriers and recommendations. Narrative information on the R-2 form itself does not satisfy this requirement.

Minnesota Rules 5220.0410, subp. 5, states in part:  "The assigned qualified rehabilitation consultant shall file the rehabilitation plan with the commissioner within 45 days of the first
in-person contact between the qualified rehabilitation consultant and the employee or within
15 days of circulation to the parties, whichever is earlier."

Therefore, qualified rehabilitation consultants (QRCs) should not file the R-2 form with the division at the same time it is circulated to the parties. Under Minnesota Rules 5220.0410, subp 5, the QRC must file the R-2 (or R-3) form at the following times, whichever occurs first:

• when the parties have all signed it;

• 15 days after circulation to the parties (or 15 days after recirculation if one of the parties proposed a change within the first 15 days); or

• 45 days after the first in-person contact with the employee.

If the QRC does not have all of the signatures at the applicable 15- or 45-day filing deadline, the QRC must file the copy with the signature(s) that have been obtained along with a letter or other evidence of the date the plan was sent to each party as required by Minnesota Rules 5220.0410, subp. 6.

About online filing
When preparing the R-2 form online, the QRC should prepare the R-2 for circulation to the parties and then take the following steps:

1. click "Previous" (not "finished");

2. click "Save";

3. click "Print" (to print the document for circulation to the parties; and

4. when the earliest of the three filing events has occurred (all parties have signed it, 15 days after circulation or 45 days after the first in-person meeting) go back into the online R-2 form, complete the questions related to signatures and then click "finished." Clicking "finished" sends the document to DLI electronically. Do not click "finished" until one of the three filing events listed above has occurred.

-- DLI is revising the online R-2 form to make this process clearer. --

Remember to retain the original document with signatures in the event of a dispute about effective date.

Minnesota Rules 5220.0410, Subp. 6, requires the R-2 form to be filed with the department with evidence (i.e. copy of letter sent to the party, who didn't sign the R-form) of the date the plan was sent to each party. The plan will be deemed approved when received by the department.

If you don't see your question answered here or want more information for rehabilitation providers, send an email message to DLI's Workers' Compensation Division or call (651) 284-5005, toll-free at
1-800-342-5354.

A second page may be attached so that each of the individual services to be provided can be clearly identified. At the top of the page, list the employee's name, worker identification (WID) number or Social Security number (SSN), and date of injury. Provide complete information about each additional service category, plan completion date, cost information, etc., using the same format as on the R-3 form.

The system was designed to add more lines when needed. Go to "Add link," which then allows additional services needed for the plan to be recorded.

Yes. Minnesota Rules 5220.1802, Subp. 4, requires a placement vendor to submit progress reports and cost information directly to the qualified rehabilitation consultant (QRC) with copies to the employee, insurer and attorneys, and to the date-of-injury employer upon the employer's request. Due to this, the QRC should be able to report the current job placement costs easily.

Yes. Minnesota Rules 5220.0710, Subp. 2, and 5220.0510, Subp. 3a, require the new qualified rehabilitation consultant (QRC) to promptly file an R-3 form with the department indicating the QRC change.

Yes. If the previous plan has expired, the qualified rehabilitation consultant (QRC) must complete a new R-3 form and provide identifying information, proposed amendment, rationale for the amendment, itemization of each rehabilitation service -- including registered rehabilitation vendor names, projected completion dates, costs, etc.

Minnesota Rules 5220.0450, Subp. 3, states the Plan Progress Report form is not required to be completed if the R-3 plan amendment contains the information in subpart 2, items A through E, and is filed within 15 days before or 15 days after six months have passed from the date the rehabilitation plan was filed. On the R-3 form, questions 20 through 23 need to be answered.

Examples of barriers to successful completion of the rehabilitation plan

1. The employee continues to experience nonhealing of the lumbar fusion, beyond the doctor's original projection.

2. The pre-injury employer reported there will not be a job for the employee to return to so she will need to find a new job.

3. The treating physician, Dr. Smith, provided a diagnosis of severe depression.

4. The unemployment rate in the 50-mile radius of the employee's home is averaging 10.5 percent. In conjunction with this, there are very few medium to large employers in the area with any job openings.

Examples of measures to be taken to overcome barriers

1. The doctor has recommended the use of a bone stimulator two times a day for the next six weeks. Additionally, supplements have been prescribed to help with bone growth. If there is no improvement after six weeks, the physician indicated a bone density scan may be required.

2. Approximately one month before the employee is released to work with limitations, job-seeking skills will be initiated so there will not be a delay in job-search activities.

3. The employee is receiving medication management from psychiatrist Dr. Jones and psychological treatment from psychologist Ms. Bieser for depression.

4. The placement specialist will be instructed to actively discuss on-the-job training with prospective employers to enhance the employee's employment opportunities.

If the injury is healing in a predictable fashion and the employer and employee are cooperating in the return-to-work effort, there may be no barriers to report.

Typed information is preferable, with a type size of 11. However, there is nothing in the rules that requires information to be typed. If handwriting is used, it must be legible, per Minnesota Rules 5220.1802, Subp. 1.

If you don't see your question answered here or want more information for rehabilitation providers, send an email message to DLI's Workers' Compensation Division or call (651) 284-5005, toll-free at
1-800-342-5354.

There is no obligation for an employee to accept vocational rehabilitation assistance. However, under some circumstances, refusing rehabilitation services could adversely affect an employee's entitlement to other workers' compensation benefits. The QRC should suggest the employee consult with their attorney and/or contact the Department of Labor and Industry about such consequences.

A QRC may only close the case if the employee, employee's attorney and the insurer agree, using the category of agreement of the parties. See Minnesota Rules 5220.0510, Subp. 7 C, Closure report by assigned qualified rehabilitation consultant.

If you have the word of the employee, and/or the employee's attorney, and insurer that an award on stipulation or a mediation award has been issued that closes out entitlement to future rehabilitation benefits, you may close a rehabilitation case and check box B (Award on stipulation/mediation) in item 21 on the R-8 form. You do not have to have a copy of the stipulation in your possession.

Note:  Document the source, who reported the award and the reason for closure of the rehabilitation plan in the R-8 summary of rehabilitation services report (Minnesota Rules 5220.0510, Subp. 7F(4)).

Yes. Minnesota Rules 5220.0510, Subp. 7F(4) requires the QRC to provide a summary of the rehabilitation services provided and rehabilitation costs by all rehabilitation providers.

If a settlement plan has occurred, but an award has not yet been issued, the QRC may close the rehabilitation plan with the consent of the employee, the employee's attorney and the insurer. The QRC would check box "d" (Employee and insurer have agreed to close the plan) in item 21 on the R-8 form.

If the employee and/or the employee's attorney do not agree to closure, an R-8 form cannot be filed.

Note:  Document the source, who reported the settlement and the reason for the closure of the rehabilitation plan in the R-8 summary of rehabilitation services report; Minnesota Rules 5220.0510, Subp. 7F(4).

If you don't see your question answered here or want more information for rehabilitation providers, send an email message to DLI's Workers' Compensation Division or call (651) 284-5005, toll-free at
1-800-342-5354.

Examples of barriers to successful completion of the rehabilitation plan

1. The employee continues to experience nonhealing of the lumbar fusion, beyond the doctor's original projection.

2. The pre-injury employer reported there will not be a job for the employee to return to so she will need to find a new job.

3. The treating physician, Dr. Smith, provided a diagnosis of severe depression.

4. The unemployment rate in the 50-mile radius of the employee's home is averaging 10.5 percent. In conjunction with this, there are very few medium to large employers in the area with job openings.

Examples of measures to be taken to overcome barriers

1. The doctor has recommended the use of a bone stimulator two times a day for the next six weeks. Additionally, supplements have been prescribed to help with bone growth. If there is no improvement after six weeks, the physician indicated a bone density scan may be required.

2. Approximately one month before the employee is released to work with limitations, job-seeking skills will be initiated so there will not be a delay in job-search activities.

3. The employee is receiving medication management from psychiatrist Dr. Jones and psychological treatment from psychologist Ms. Bieser for depression.

4. The placement services will be instructed to actively discuss on-the-job training with prospective employers to enhance the employee's employment opportunities.

If the injury is healing in a predictable fashion and the employer and employee are cooperating in the return-to-work effort, there may be no barriers to report.

If you don't see your question answered here or want more information for rehabilitation providers, send an email message to DLI's Workers' Compensation Division or call (651) 284-5005, toll-free at
1-800-342-5354.

Yes. An employee may decline any and all vocational rehabilitation services. However, declining vocational services may be to the employee's disadvantage. A qualified rehabilitation consultant (QRC) should explain the services in detail to the employee, answer any questions the employee has about the services, provide the employee with the phone number to the DLI Alternative Dispute Resolution unit, and encourage the employee to discuss the situation with one of the mediators, to completely understand how declining such services may impact the employee's workers' compensation claim. If the employee is represented by an attorney, the employee certainly should discuss the situation with the attorney before making the final decision about declining available services.

If the employee (or the insurer) disagrees with any major part of the rehabilitation plan, any party or the QRC may file a Rehabilitation Request form and, if necessary, DLI or the Office of Administrative Hearings (OAH) will then decide the issue.

Yes. At this point, the qualified rehabilitation consultant (QRC) would propose an R-3 rehabilitation plan amendment to reflect a change in the vocational plan. The services listed in number 18 would include job-seeking-skills training, job placement services, etc.

The term "full duty" is not found in the workers' compensation statutes or rules. As such, use of the term is confusing and should never be relied upon.

The qualified rehabilitation consultant (QRC) should follow up with the physician to determine what exactly the doctor meant by the phrase "full duty." For instance, was the employee released back to his sedentary job, but would have had physical limitations if working at a different job? Or was the employee released to work for any job without any physical restrictions?

Following this, the QRC should determine if the employee still meets the definition of being a "qualified employee" (Minnesota Rules 5220.0100, Subp. 22). If the answer is yes, then the employee should be provided ongoing rehabilitation services to facilitate a return to suitable gainful employment (Minnesota Rules 5220.0100, Subp. 34).

The definition of a "qualified employee" anticipates that the QRC consider the treating physician's opinion of the employee's work ability in conjunction with the provision of rehabilitation services. An IME physician is not a primary health care provider as defined in Minnesota Rules 5221.0430, Subp. 1. The health care provider directs and coordinates medical care for the employee; the IME physician is not a health care provider and provides no medical care on behalf of the employee.

Because an independent medical examination is part of claims adjustment, a QRC should not use the IME report recommendations to develop or implement the rehabilitation plan (Minnesota Rules 5220.1801, Subp. 8B).

If the insurer wants the IME report recommendations used to develop or implement the rehabilitation plan, the insurer may file a Rehabilitation Request form with the department. If ordered by a mediator/arbitrator or compensation judge, the QRC must then follow the IME physical restrictions.

See Minnesota Rules 5220.1250 Roles of registered rehabilitation providers. Job placement vendors further need to be mindful of the following rules.

Rule definitions

• Minnesota Rules 5220.0100 Definitions

• Subp. 22, Qualified employee

• Subp. 25, Registered rehabilitation vendor

• Subp. 27, Rehabilitation plan

• Subp. 34, Suitable gainful employment

Vendor services (if within the rehabilitation plan)

• Minnesota Rules 5220.0100 Definitions

• Subp. 16, Job development

• Subp. 18, Job placement

• Subp. 19, Job seeking skills training

• Subp. 21, On-the-job training

Communications

• Minnesota Rules 5220.1802 Communications

• Subp. 4, Registered rehabilitation vendor reporting

Prohibited conduct

• Minnesota Rules 5220.1801 Professional conduct

• Subp. 8 A and B 1-8, Separate roles and functions

• Subp. 9 A, Prohibited conduct

• Subp. 9 E, Prohibited conduct

• Subp. 9 K 1-4, Prohibited conduct

• Subp. 9 N, Prohibited conduct

• Minnesota Rules 5220.1802 Communications

• Subp. 5, Data privacy

• Minnesota Rules 5220.1805 Business practices

• Subp. E, Business practices

The rehabilitation provider should continue to objectively state what is actually happening with the case. If concerns develop about the employee's fulfillment of agreed upon activities, it is suggested the vendor, QRC and employee discuss the rehabilitation plan, the goals established and each of the parties agreed upon efforts to facilitate the employee's return to suitable gainful employment. Also at this time, there may be value in determining if there should be a formal change in the plan to reflect new directions.

If the employee continues to disagree with the direction of the plan or has questions about his or her rehabilitation plan the employee should be encouraged to contact their attorney (if retained) or the department's hotline at 1-800-342-5354. If this does not resolve the situation, the employee, QRC or another party can file a rehabilitation request form for assistance from the department.

If you don't see your question answered here or want more information for rehabilitation providers, send an email message to DLI's Workers' Compensation Division or call (651) 284-5005, toll-free at
1-800-342-5354.

The Poole factors are found in the case of Poole v. Farmstead Foods, Inc., 42 W.C.D. 970, 978 (WCCA 1989). In that case, the Workers' Compensation Court of Appeals identified factors to be considered in determining whether retraining is appropriate. The factors include:

1. the reasonableness of retraining as compared to returning to work with the employer or other job placement activities;

2. the likelihood the employee has the ability and interest to succeed in a formal course of study in a school;

3. whether retraining is likely to result in reasonably attainable employment; and

4. whether retraining is likely to produce an economic status as close as possible to that which the employee would have enjoyed without disability.

No, see Minnesota Rules 5220.0750, Subp. 5, Retraining plan approval

If you don't see your question answered here or want more information for rehabilitation providers, send an email message to DLI's Workers' Compensation Division or call (651) 284-5005, toll-free at
1-800-342-5354.

The QRC is expected to be available in-person or by telephone for rehabilitation conferences addressing eligibility and rehabilitation plan disputes. Attendance in person is preferred.

If an attorney or adjuster wants a rehabilitation provider to attend a hearing of any type and is willing to pay the provider's hourly fee, the provider should plan to attend. If the parties see no reason for a rehabilitation provider to attend, there is probably no reason to do so. If possible, a rehabilitation provider should be available by phone during the time, in case an issue arises for which the provider would have valuable input.