Minnesota Workers’ Compensation Claim Denied? What Happens Next

If your Minnesota workers’ compensation claim has been denied, it does not necessarily mean the case is over.

A denial means the employer or workers’ compensation insurer is taking the position that it is not responsible for some or all of the benefits you are claiming.

The insurer may deny the claim from the beginning, or it may accept part of the claim while disputing another issue.

For example, the insurer may accept that a work injury occurred but deny:

  • wage-loss benefits;
  • surgery;
  • additional medical treatment;
  • permanent disability;
  • a later period of disability; or
  • whether your current condition is still related to the work injury.

Understanding what exactly has been denied and why is the first step toward deciding what to do next.

What Does It Mean When Workers’ Compensation Denies Primary Liability?

A denial of primary liability means the employer or insurer is denying legal responsibility for the claimed work injury.

In other words, the insurer is saying that the employee does not have a compensable workers’ compensation claim, at least as alleged.

That may be very different from a case where the insurer accepts the injury but disputes a particular benefit.

Primary-liability denials often involve issues such as:

  • whether an injury happened at work;
  • whether work caused the medical condition;
  • whether proper notice was given;
  • whether the worker was an employee;
  • whether the condition is actually work-related;
  • whether the injury was temporary;
  • whether a later period of disability is still related to the original work injury; or
  • whether a pre-existing condition rather than work caused the current problems.

The reason for the denial matters because it determines what evidence will be important.

Why Are Minnesota Workers’ Compensation Claims Denied?

There are many possible reasons.

Common denial arguments include:

  • The injury did not occur at work.
  • The employee did not provide timely notice.
  • The medical condition is unrelated to work.
  • The condition is degenerative or pre-existing.
  • There is not enough medical support for causation.
  • The employee was an independent contractor rather than an employee.
  • The work injury was temporary and has resolved.
  • Current disability is caused by something else.
  • The employee is able to work.
  • The medical treatment is not reasonable or necessary.
  • The employee’s wage loss is not caused by the work injury.

A denial letter may use broad or technical language.

Do not assume the insurer’s stated reason is legally correct simply because it appears in writing.

What Should I Do When I Receive a Denial?

Read the denial carefully.

Look for:

  • the date of the denial;
  • what benefits are being denied;
  • the reason given;
  • whether the insurer is denying the entire claim or only part of it;
  • what medical evidence the insurer relies on;
  • whether an IME report is involved; and
  • whether the insurer disputes notice, causation, disability, or treatment.

Keep the denial letter.

It may become important evidence later.

You should also gather:

  • medical records;
  • work restrictions;
  • accident reports;
  • witness information;
  • wage records;
  • job descriptions;
  • correspondence with the insurer;
  • QRC records, if applicable; and
  • any medical opinions addressing work causation.

Can I Still Get Benefits After My Claim Is Denied?

Potentially, yes.

A denial is the insurer’s legal position. It is not the same thing as a final judicial decision.

If the employee challenges the denial and proves entitlement to benefits, a compensation judge may order the employer and insurer to pay benefits.

Those benefits may include:

  • temporary total disability;
  • temporary partial disability;
  • permanent partial disability;
  • permanent total disability;
  • medical treatment;
  • surgery;
  • vocational rehabilitation;
  • retraining; and
  • other workers’ compensation benefits.

Whether the claim succeeds depends on the evidence and the legal issues involved.

How Do I Challenge a Denied Minnesota Workers’ Compensation Claim?

When primary liability is denied, an injured employee may need to file an Employee’s Claim Petition.

The Claim Petition begins formal workers’ compensation litigation.

The petition identifies the benefits being claimed and the basis for the employee’s position.

Depending on the case, it may seek:

  • wage-loss benefits;
  • payment of medical treatment;
  • surgery;
  • permanent partial disability;
  • rehabilitation benefits;
  • permanent total disability; or
  • other compensation.

The employer and insurer then have an opportunity to respond.

What Happens After a Claim Petition Is Filed?

Workers’ compensation litigation can involve several stages.

These may include:

  • filing of an Answer;
  • exchange of medical records;
  • discovery;
  • depositions;
  • an independent medical examination;
  • medical reports;
  • vocational evidence;
  • settlement discussions;
  • mediation; and
  • ultimately a hearing before a compensation judge if the case does not resolve.

Not every case goes through every step.

Some cases settle relatively early.

Others require significant discovery and a formal hearing.

How Important Is Medical Causation?

Medical causation is often one of the most important issues in a denied claim.

The key question may be whether the work injury is a substantial contributing cause of the employee’s medical condition, disability, or need for treatment.

For example, an insurer may argue that the employee’s back symptoms are caused by age-related degeneration rather than work.

The treating physician may believe the work injury substantially aggravated the underlying condition.

A useful medical opinion should usually explain:

  • the diagnosis;
  • the work incident or work activity involved;
  • the employee’s prior medical history;
  • objective medical findings;
  • why the work injury contributed to the condition; and
  • why the physician disagrees with competing medical opinions, if applicable.

A conclusory statement is often less persuasive than a detailed opinion with a clear factual and medical foundation.

What If I Had a Pre-existing Condition?

A pre-existing condition does not automatically defeat a workers’ compensation claim.

Many employees have prior arthritis, degeneration, old injuries, or previous treatment.

The relevant question is often whether the work injury aggravated, accelerated, or substantially contributed to the condition causing disability or the need for treatment.

For example:

  • an employee may have had prior back degeneration but worked full duty until a work injury;
  • an employee may have had shoulder arthritis but no disabling symptoms before a work incident;
  • an employee may have had an old knee injury but experienced a significant worsening after work activity.

The existence of prior problems is relevant, but it does not necessarily end the analysis.

What If the Insurance Company Says I Did Not Give Notice?

Minnesota workers’ compensation law contains notice requirements.

The facts can matter greatly, including:

  • when the injury occurred;
  • when the employee realized it was work-related;
  • when the employer learned about it;
  • who was told;
  • what was said;
  • whether the employer already had actual knowledge; and
  • whether the delay prejudiced the employer or insurer.

Notice disputes can be fact-intensive.

Do not assume a claim is lost simply because the insurer says notice was late.

What If My Injury Developed Gradually?

Not every compensable work injury results from one dramatic accident.

Minnesota workers’ compensation law recognizes certain cumulative-trauma injuries, often called Gillette injuries.

These claims may arise from repetitive work activity over time.

Examples can include:

  • repetitive shoulder use;
  • cumulative back stress;
  • repetitive hand or wrist activity;
  • lifting over months or years;
  • repeated bending or twisting; or
  • other cumulative physical stress.

Because there may be no single accident date, these claims can involve complicated questions about medical causation, date of injury, notice, and which employer or insurer is responsible.

What If the Insurer Says My Work Injury Was Only Temporary?

This is another common defense.

An insurer may accept that a work injury occurred but argue that it caused only a temporary aggravation that later resolved.

The insurer may then claim that any ongoing symptoms result from an underlying condition rather than the work injury.

These cases often involve competing medical opinions.

Important evidence may include:

  • symptoms before and after the work injury;
  • treatment history;
  • objective findings;
  • work restrictions;
  • imaging;
  • improvement or worsening over time; and
  • physician opinions concerning whether the work injury remains a substantial contributing cause.

What If the Insurance Company Sent Me to an IME?

An independent medical examination often plays a major role in a denied claim.

The IME physician may be asked whether:

  • a work injury occurred;
  • the injury caused the current condition;
  • the injury was temporary;
  • treatment is reasonable and necessary;
  • surgery is appropriate;
  • restrictions are necessary;
  • the employee has reached MMI; or
  • permanent disability exists.

An unfavorable IME report may strengthen the insurer’s denial.

But the IME report does not automatically decide the case.

The treating physician may disagree, and a compensation judge may ultimately determine which medical opinion is more persuasive.

Can I Get Medical Treatment While the Claim Is Denied?

A denial can create practical problems with obtaining medical care.

Some providers may bill health insurance while the workers’ compensation dispute is pending.

Others may delay treatment until responsibility is resolved.

If another health insurer pays medical expenses that are later determined to be the responsibility of workers’ compensation, reimbursement issues may arise.

Treatment decisions should be discussed with your medical providers, health insurer, and attorney when appropriate.

Do not assume that a workers’ compensation denial necessarily means you must stop treating.

What If the Insurer Accepts the Injury but Denies Surgery or Other Treatment?

That is different from a full denial of primary liability.

If the insurer accepts the underlying injury but disputes whether a particular treatment is reasonable, necessary, or causally related, the dispute may proceed through a Medical Request or other medical-dispute procedure.

If the insurer denies the entire claim, a Claim Petition is generally the more appropriate route.

Identifying the exact nature of the denial is therefore important.

What If I Am Not Working Because of the Injury?

If the work injury prevents you from working, you may have a claim for temporary total disability, depending on the circumstances.

If you return to work but earn less because of the injury, you may have a claim for temporary partial disability.

In a denied claim, the insurer may dispute not only causation but also whether the wage loss is actually related to the work injury.

Important evidence may include:

  • work restrictions;
  • physician reports;
  • job-search records;
  • wage records;
  • rehabilitation evidence;
  • QRC reports;
  • employment history; and
  • testimony concerning why the employee is not earning pre-injury wages.

What If I Was Fired After My Work Injury?

Termination of employment does not automatically end a workers’ compensation claim.

The effect of a termination can depend on many factors, including:

  • why the employment ended;
  • whether the employee had restrictions;
  • whether suitable work remained available;
  • whether the employee conducted a diligent job search;
  • whether the termination involved misconduct;
  • the employee’s earning capacity; and
  • the medical and vocational evidence.

A termination may complicate wage-loss issues, but it does not necessarily eliminate workers’ compensation rights.

How Long Does a Denied Workers’ Compensation Case Take?

There is no single timetable.

The length of a case may depend on:

  • how complicated the medical issues are;
  • whether an IME is required;
  • how quickly records are obtained;
  • whether depositions are necessary;
  • whether the parties pursue mediation;
  • the number of disputed benefits;
  • court scheduling; and
  • whether the case settles before hearing.

Some disputes resolve relatively quickly.

Complex claims can take much longer.

Can a Denied Claim Settle?

Yes.

Denied workers’ compensation claims frequently settle.

A settlement may reflect both:

  • the potential value of the benefits being claimed; and
  • the risk that either side could lose at hearing.

For example, an employee may have substantial potential wage-loss and medical exposure, but the insurer may have a strong causation defense.

That litigation risk can affect settlement value.

Likewise, strong treating-doctor support and persuasive vocational evidence may increase the insurer’s potential exposure.

Settlement value should therefore be evaluated in light of both the benefits at stake and the strength of the evidence.

Should I Hire a Minnesota Workers’ Compensation Attorney If My Claim Is Denied?

A denied claim is one of the situations where legal representation can be particularly important.

An attorney can help determine:

  • exactly what the insurer is denying;
  • whether a Claim Petition should be filed;
  • what medical evidence is needed;
  • whether your treating physician should provide a causation opinion;
  • how to respond to an IME;
  • what wage-loss benefits may be claimed;
  • whether rehabilitation or retraining is appropriate;
  • whether settlement is reasonable; and
  • how to prepare the case for hearing if necessary.

The denial letter may be only the beginning of the dispute.

Minnesota Workers’ Compensation Attorneys for Denied Claims

Lemmon & Tanasychuk, LLC represents injured workers throughout Minnesota.

We represent employees—not employers or insurance companies—in Minnesota workers’ compensation matters involving:

  • denied claims;
  • denied primary liability;
  • wage-loss disputes;
  • medical causation;
  • pre-existing conditions;
  • independent medical examinations;
  • denied surgery and medical treatment;
  • permanent disability;
  • rehabilitation and retraining; and
  • workers’ compensation settlements.

If your Minnesota workers’ compensation claim has been denied, we can review the denial, medical evidence, and circumstances of your injury and help you understand what options may be available.

Contact Lemmon & Tanasychuk, LLC for a free consultation.

This article provides general information about Minnesota workers’ compensation law and is not legal advice. Workers’ compensation rights depend on the facts of each case, and applicable statutes, rules, and procedures can change.