Frequently Asked Questions about Work Related Injuries

What is workers' compensation and who is entitled to it?

Workers' compensation is a mandatory insurance program that provides for the payment of medical expenses and wage loss replacement for people who are injured while on the job. It is a no-fault system and all employers must participate in the workers' compensation system.

Any employee who is injured in the "course and scope" of their employment is entitled to file a claim.

Who pays for workers' compensation?

The University of MN is self-insured. Sedgwick was hired by the University to administer the claims. The University of Minnesota funds all claim payments.

Why do we send employees to a "Designated Medical Provider?"

"Designated" medical providers are clinics that are chosen by the University of MN because they are staffed by physicians who are trained in occupational medicine (the treatment of injured employees). The clinics chosen are in close proximity to the University; and are committed to seeing injured employees within 24 hours. These clinics often tour the employer's premises to see the types of work that can cause injuries as well as the types of work that can be utilized for temporary alternate duty. They will directly send the bills to the insurance payer so the employee does not have to submit any additional paperwork.

What do I do if the employee does not want to go to our recommended physician?

Under Minnesota law, an employee is entitled to choose his or her own treating physician. This can be the "designated" medical provider or some other physician or clinic. You may encourage and request that the employee go to the "designated" provider for the reasons listed above. You may inform the injured employee that the first visit with the "designated" provider will be paid for by workers' compensation, even if they also choose to see their own physician or chiropractor. Do not force the employee to go to the "designated" provider. If they are unwilling, attach a note to the First Report of Injury (FROI.) if the FROI has already been sent, call Sedgwick and advise the adjuster.

What do I do if I'm not sure the injury is work-related?

If you are not sure, or do not believe, that an injury is related to work, you should call the claims administrator and discuss why you think it is not related. Filing a First Report of Injury or completing an incident report is not an admission of liability. A supervisor should never deny the claim. It is the job of the claim adjuster to investigate the claim and determine if it will be accepted.

What if the injury migrates to a different part of the body (i.e. from the arm to the back)?

If an employee's injury changes in nature, work with Sedgwick Claims Management who will consult with the treating doctor or an independent medical provider to determine if the injuries are related. We strongly urge that you do not attempt to resolve these matters independently because delays in notification and treatment, if required, may significantly delay the injured worker's recovery and could result in monetary penalties being imposed against the University.

Why should I return to work an employee who cannot do his or her complete job?

Supervisors are responsible for their employees when they are healthy and also when they have suffered a work-related injury.

One of the important reasons for trying to return injured employees to work is that studies show that employees heal more quickly and often more completely, if they remain active and at work with their co-workers. Working, even if only in a limited capacity, gets an employee up and moving, using muscles and prevents disability syndrome from setting in.

Will this impact our budget?

The University of MN has a self-funded Workers' Compensation program. Regardless of whether the injured employee receives wages or lost time benefits, the University pays. Any productivity benefits the University of MN.

Why would I want to bring an employee back to work with restrictions? What if they get re-injured?

Most physicians are fairly conservative when giving work restrictions, and it is unlikely that the employee will re-injure him or herself. Often times when first returning to work, an employee may complain of soreness due to the lack of activity he/she experienced while being off of work. If the injured employee begins complaining while on modified duty, he/she should be sent back to their physician to be re-evaluated. The physician may assign new restrictions or simply provide reassurance.

Where do I go if I have questions?

• The University's Workers' Compensation Department at 612-627-1859(1858)
• Sedgwick Claims Management Services at 952-826-3800 or 1-800-231-0165.
• ¨ The Department of Labor and Industry at 651-296-2432 or 1-800-342-5354

What is workers' compensation and who is entitled to it?

Workers' compensation is a mandatory insurance program that provides for the payment of medical expenses and wage loss replacement for people who are injured while on the job. It is a no-fault system and all employers must participate in the workers' compensation system.

Any employee who is injured in the "course and scope" of their employment is entitled to file a claim.

Who pays for workers' compensation?

The University of MN is self-insured. Sedgwick was hired by the University to administer the claims. The University of Minnesota funds all claim payments.

Why am I requested to go to the clinic the University recommends?

"Designated" medical providers are clinics that are chosen by the University of MN because they are staffed by physicians who are trained in occupational medicine (the treatment of injured employees; generally are in close proximity to the University of MN; and are committed to seeing injured employees within 24 hours. These clinics often tour the employer's premises to see the types of work that can cause injuries as well as the types of work that can be utilized for temporary alternate duty. They will directly send the bills to Sedgwick so you do not have to submit any additional paperwork.

Do I have to go to the "designated" clinic?

You have the right to choose your own doctor. However, Sedgwick Claims Management Services or the University of MN can request that you be examined by the designated clinic in addition to being seen by your own physician.

What if I want to treat with my own physician?

You may choose to treat with your own physician. However, Sedgwick or the University of MN may also ask you to be seen by their doctor at the same time.

What do I do if my claim is denied or I have other problems with my claim?

If your claim is denied, you will receive a Notice of Denial of Liability. The Notice will give the reason and facts explaining why your claim was denied. If you disagree with the denial, you should first talk with the claim adjuster. (See suggestions below)

Most workers' compensation claims are paid without any problems. If you think the insurance company is not paying you correctly or your bills are not being paid, you should:

1. Call the claim adjuster to discuss the issues at 612-826-3800 or 1-800-231-0165.
2. Call the Workers' Compensation Department at 612-627-1859(1858)
3. Discuss your problem with a specialist at the Department of Labor and Industry. The Specialist will help you resolve the dispute or help arrange an informal conference.
4. If the problem can not be resolved with the above steps, the Department of Labor and Industry specialist can explain the dispute resolution options and help you decide what option is best for your situation.

What benefits am I entitled to?

Under the Minnesota's Workers' Compensation system, an injured worker is entitled to:

• Reasonably necessary medical services related to the injury.

  The Medical Fee Schedule limits the amount insurers pay for treatment. The Department of Labor and Industry has developed treatment standards to help determine if treatment is reasonable. A medical provider is not allowed to ask you to pay additional fees or to pay for unnecessary treatments. The insurer will not pay for treatments unrelated to the workers' compensation injury.

  The insurer may refuse to pay bills if the doctor has not sent all information that explains the services provided. You can assist the process by making sure that your doctor is regularly sending all bills and other medical information to your insurer.

• Part of your wage loss or inability to earn a full income

  You are entitled to receive wage-loss benefits (Temporary Total Disability -TTD) if you are unable to work more than three days because of a work related injury or illness. The first three days are considered a waiting period and are not paid unless you are off ten (10) or more days due to the injury. If this is the case, the first three days will be reimbursed.

  TTD is paid until:

  • You return back to work or 104 weeks;
  • You have been released back to work which may be with or without any physical restrictions from the work related injury;
  • You retire for reasons other than your injury;
  • 90 days have passed since you reached Maximum Medical Improvement (MMI) or the end of an approved retraining program;
  • Other events occur that can be legal reasons for stopping benefits.

  A Notice of Intent to Discontinue Benefits will be sent to you before benefits are discontinued.

  If you work but because of your injury, you are earning less than before your injury, you may qualify for Temporary Partial Disability benefits (TPD). TPD pays two-thirds of the difference between your date of injury wage and your new wage. There are time limits on how long TPD benefits are paid.

• Benefits to dependents for work related death
• Compensation for permanent loss of use of or loss of body function

  Some injuries are permanent. If you have a permanent injury, you might receive Permanent Partial Disability (PPD) benefits. The physician sets the level or percentage of a disability, pursuant to Minnesota rules governing permanency ratings. This benefit is paid in weekly amounts after your temporary total disability benefits end.

• Vocational rehabilitation services if you cannot return to the job or to the employer you had before the injury.

  If you cannot return to your pre-injury job, you may ask for vocational rehabilitation. To do so, you should notify SCMS in writing of your request.

How are my wage loss benefits calculated?

You are entitled to receive wage-loss benefits (Temporary Total Disability -TTD) if you are unable to work more than three days because of a work related injury or illness. The first three days are considered a waiting period and are not paid unless you are off ten or more days due to the injury. If this is the case, the first three days will be reimbursed.

The wage loss benefit is designated to replace two-thirds of the before tax average weekly wage you received at the time of your injury. The benefit is generally not taxable. There is a minimum and maximum rate set by the state.

Where do I go to get my questions answered?

• The University of Minnesota's Workers' Compensation Department at 612-627-1859(1858)
• Sedgwick Claims Management Services at 952-826-3800 or 1-800-231-0165.
• The Department of Labor and Industry at 651-296-2432 or 1-800-342-5354

Why does the University try to get me back to work before I am completely healed?

Studies show that employees heal more quickly and often more completely if they remain active and at work with co-workers. Working, even if only in a limited capacity, gets you up and moving and keeps you in a routine.

Do I have to go back to work when I am released with restrictions?

Your temporary total disability benefits may be permanently discontinued if you refuse a job consistent with your doctor's restrictions. (If you are concerned that the job provided is not consistent with the restrictions, discuss the issue with your supervisor, your adjuster, the Director of Workers Compensation for the University and/or your doctor).

Do I need an attorney?

You always have the option to hire an attorney at any time during the process. However, in general, you do not need an attorney to file a claim or to collect benefits. Minnesota's Workers' Compensation statute describes and defines the benefits to which you are entitled. The claim adjuster and/or the University's Workers' Compensation department are also available to answer your questions.

If you retain an attorney, the state statute provides for the attorney's fees to be paid from the workers' compensation benefits you receive or based on the benefits awarded. Many times there are simple miscommunications or misunderstandings, which could easily be corrected by open communication with the claims adjuster or the Department of Labor and Industry; therefore you may want to try to resolve the issues yourself prior to obtaining representation.