What You Need to Know
Date: October 2019
The Minnesota Workers’ Compensation law was first adopted in 1913. Workers were concerned about improving their working conditions and ensuring compensation for injuries sustained while working. Employers were equally concerned about the possibility of a large jury award to an injured employee. In response to these concerns, labor and management joined together to reform how employees were compensated for injuries in the workplace.
Today’s system provides payments to employees who suffer work-related injuries or diseases. It represents a compromise between the interests of the employer and those of the employee. The law provides the exclusive remedy for work-releated injuries and limits the amount of compensation. In exchange, liability is imposed regardless of fault, assumption of the risk or if the injury was the responsibility of fellow employees.
This resource provides guidance on the workers’ compensation claim handling process and some of the most common terms used in managing a work-related injury or illness.
The First Report of Injury (FROI)
The first step in effective claims management is proper notice. In the world of workers’ compensation, everything is measured in calendar days. Penalties are assessed for late reporting. If a member is unsure whether to file a First Report of Injury on a questionable claim, he or she should call MCIT for advice. Members should not delay in reporting a claim because it seems questionable. Filing the First Report of Injury does not admit liability; it only means a claim has been made by the employee.
Employers have a legal obligation to report work-related injuries. State law requires that an employer report a serious injury or death to the Department of Labor and Industry (DLI) within 48 hours of the occurrence. MCIT must also be notified immediately in such a case. Any other work injury where the employee is off of work for three calendar days must be reported to MCIT by law within 10 days of the occurrence.
MCIT requests receipt of the report within three days to conduct a diligent investigation. MCIT has 14 calendar days from the date the member is notified of the injury to make a determination of liability and issue payment or deny the claim. These timelines are even more critical if the claim is questionable, as the Department of Labor and Industry requires that denials include supporting documentation and adequate reasoning. Penalties are assessed for frivolous denials.
The First Report of Injury should be completed by the employer. Key information includes:
- Social Security number—required for identification purposes
- date of injury—if unknown, a best estimate, first date of treatment, etc.
- employee address—required for MCIT to send Employee Information Sheet mandated by the state
- how the injury occurred and which body part(s) is injured—be specific
- date member received notice— this includes the direct supervisor
- lost time information— if none, may note “N/A” in the blanks
- medical treatment information—if name of facility is unknown, indicate “pending”
- date the form is completed
If a member is unsure about anything on the FROI, he or she should contact MCIT immediately and not delay reporting. The form can be supplemented later. If any key information is missing, MCIT will follow up with the member for that information.
Minnesota law imposes a penalty of up to $500 for each delayed report. If MCIT does not commence payments within the 14-day period, an additional penalty of up to 125 percent of any late payment can be assessed. This can result in payment of more than twice the benefits that were initially due.
Penalty payments affect an entity’s loss experience, as well as contributions for the next three years.
The Notice of Primary Liability Determination (NOPLD)
By the 14th day after the work-related injury, a determination is made by the MCIT claims staff about whether to accept or deny the claim. MCIT’s obligation is to determine if the injury occurred in the course and scope of employment and notify the Department of Labor and Industry of the determination by filing the Notice of Primary Liability Determination. This form also incorporates the amount of wage loss benefits that will be paid.
When a worker is injured at work and misses more than three days of work due to the injury, wage loss benefits are paid pursuant to the Workers’ Compensation Act. The first three days are generally covered by the employer’s sick leave or paid time off policy. Once the time off reaches the 10th day after the injury, workers’ compensation wage loss benefits are paid to the employee back to the first day of lost time. The wage loss benefit payable under the Workers’ Compensation Act is 66.67 percent (two-thirds) of the injured worker’s average weekly wage at the time of the injury. Wage loss benefits are not taxable as personal income.
Wage Loss Benefits
Wage loss benefits continue until the injured worker is able to return to gainful employment or is found unable to return to any employment. Employees may be eligible for the following.
- Temporary total disability (TTD): An employee who is completely off work due to physician orders or restrictions that a member cannot accommodate can receive TTD for up to 130 weeks.
- Temporary partial disability (TPD): An employee who returns to work earning a lower weekly wage than was earned at the time of injury will have the difference made up by TPD benefits. For injuries sustained after Oct. 1, 2018, an employee cannot be paid more than 275 weeks of TPD benefits or receive such benefits after 450 weeks beyond the date of injury, whichever comes first.
- Permanent total disability (PTD): If an employee is unable to ever return to a steady job and earn a living from work due to the work injury or illness sustained after Oct. 1, 2018, he or she may be eligible for PTD benefits until age 72, unless the employee is injured after age 67. In that case, PTD ends five years after the date of injury.
A Notice of Intent to Discontinue (NOID) is filed when temporary total disability ends, temporary partial disability is initiated and/or when temporary partial disability ends.
Wage loss benefits are based upon the employee’s average weekly wage at the date of injury. If wage loss benefits are still being paid year after year, the wage loss benefit remains at the rate payable on the date of injury. The statute provides for a cost of living adjustment in the years following the date of injury. When an employee is receiving workers’ compensation benefits, the workers’ compensation statute controls the amount, not employer practices, union contracts or the insurer.
Vocational rehabilitation is intended to restore the injured employee to a job related to his or her former employment or to a job in another work area that produces an economic status as close as possible to what the employee would have enjoyed without the disability.
The employee may request a qualified rehabilitation consultant (QRC) to assist in job placement. If the injured worker has not returned to his or her date of injury job after 13 weeks of lost time, and has not previously requested it, a qualified rehabilitation consultant is appointed to determine if the employee is an eligible employee for vocational rehabilitation services.
Factors used to determine appropriate rehabilitation include the employee’s former employment, age, education, previous work history or experience, interest and skills.
Qualified rehabilitation consultants may contact the member for assistance in returning the employee to the date of injury job or to find alternative employment with the date of injury employer. If this occurs and the member has questions, the member should contact MCIT’s claims staff.
Return to Work Ability (ROWA)
When an employee’s injury is being treated by a physician, the employee receives an Return to Work Ability form, outlining what his or her restrictions are or are not related to that injury. These forms state what an employee is able to do physically at work.
These slips must be sent to MCIT. It is critical that employers work with employees to find ways to accommodate the restrictions or notify MCIT if they are unable to do so. An employee is not obligated to perform any tasks outside the range of their restrictions and could risk re-injury or an aggravation if they do.
Health Care Provider Report (HCPR)
The health care provider report is a form completed by the treating physician when addressing whether an employee has reached maximum medical improvement and/or sustained a permanent partial disability rating. The health care provider must complete and return the form within 10 days of receiving the request from an employer, an insurer or the commissioner.
Maximum Medical Improvement (MMI)
Maximum medical improvement is the date after which no further significant recovery from or significant lasting improvement to a personal injury can reasonably be anticipated, based upon reasonable medical probability.
Factors used in determining MMI:
- There has been no significant lasting improvement in the employee’s condition and significant recovery or lasting improvement is unlikely, even if there is ongoing treatment.
- All diagnostic evaluations and treatment options that may reasonably be expected to improve or stabilize the employee’s condition have been exhausted or declined by the employee.
- Any further treatment is primarily for the purpose of maintaining the employee’s current condition or is considered palliative in nature.
- Any further treatment is primarily for the purpose of temporarily or intermittently relieving symptoms.
Permanent Partial Disability (PPD)
Permanent partial disability is compensation for the loss of use or permanent damage to body parts (such as a hand, finger or leg). These payments are based on a disability schedule created by the Department of Labor and Industry, which assigns a specific dollar amount to each part of the body or diagnosis. The disability schedule is found in the Minnesota Rules that deal with permanency ratings.
Permanent partial disability is generally calculated at the time that maximum medical improvement is reached or at the time the employee returns to work. Permanent partial disability benefits are paid after temporary total disability ends, at approximately the same rate and intervals. An employee may request a payment of PPD in a lump sum, which can be discounted to present value with 5 percent discount factor.
Effective Jan. 1, 2016, an employee may request an employer or insurer to send workers’ compensation benefit payment due by electronic funds transfer to a bank, savings association or credit union.
The Notice of Benefit Payment (NOBP)
Permanent partial disability is generally payable at the same weekly rate as temporary total disability benefits. Because PPD is calculated as a lump sum payment, the payment terms vary depending on the compensation rate of the injured worker.
When permanent partial disability is initiated and again when payments cease, the Notice of Benefit Payment is filed to make all parties (the employer, employee and Department of Labor and Industry) aware that benefits have been paid appropriately. The medical report (usually an HCPR) is attached to the form outlining the rule/schedule for the rating.
Facilitating Return to Work
The employer can offer an injured employee temporary work within his or her restrictions during the healing period. If the employee unreasonably rejects an offer of such work, workers’ compensation benefits may be suspended. Once the employee has reached maximum medical improvement and has received final restrictions governing his or her return to work, the employer must determine whether it can return the employee to his or her former employment position or suitable alternative employment.
An employee is not required to accept light-duty work if he or she is disabled due to a condition that would qualify the employee for unpaid leave under the Family and Medical Leave Act (FMLA). If the employee qualifies for FMLA leave, the employer is not able to terminate the employee for absenteeism or take any other actions prohibited by the FMLA until the employee’s entitlement to FMLA leave has been exhausted.
Members should always work with the county attorney’s office, outside legal counsel or Human Resources to review issues related to the Americans with Disability Act, which may require some form of interactive process when returning an employee to work.
Minnesota statutes provide a civil penalty against an employer for failing to offer suitable employment if the employer has a position that could reasonably be made available to the employee. The employer may be liable for one year’s wages, up to a maximum of $15,000.