Provided By AdvisorNet Benefits Workers Compensation Employee Benefits

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1 Provided By AdvisorNet Workers Compensation Employee Minnesota s workers compensation laws determine the benefits available to employees who are injured in the course and scope of employment. An injury qualifies for workers compensation coverage if the damage or harm an employee suffers is the direct result of an accident or exposure to a hazardous environment in the normal course of his or her employment. Workers compensation benefits include coverage for medical expenses, burial costs, death benefits and wage replacement. The Division of Workers Compensation (DWC), part of the Minnesota Department of Labor and Industry (DLI), investigates and handles workers compensation claims throughout the state. MEDICAL CARE BENEFITS Employers must provide prompt and adequate medical benefits at their expense to treat their employees work-related injuries or illnesses. Employers may require their employees to seek medical care, in whole or in part, from a certified managed care plan. If an employer does not provide medical benefits to an injured employee, the employer may become liable for the medical treatment the injured employee receives from any health care provider of the employee s choice. The DWC defines a certified managed care plan as an organization that has been certified by the state to manage health care for injured workers. Employers must inform their employees if they are covered by a certified managed care plan. Injured employees cannot be required to receive treatment from a doctor in a plan or network that is not certified by the DWC. Medical care benefits include: Medical, psychological, chiropractic, podiatric and hospital treatment and supplies. Medical treatment also includes physical rehabilitation. At the employee s option, Christian Science treatment may be provided instead of medical treatment, chiropractic medicine and medical supplies. Employees wishing to receive Christian Science treatment must notify their employer in writing of their intention at the time of hire. Employers may opt out of providing a Christian Science treatment option by notifying the DLI in writing; Nursing services. In cases of permanent total disability, employers may be required to pay for the reasonable value of nursing services provided by a member of the employee's family; Medicines. Employers may designate a pharmacy or network of pharmacies that employees must use to obtain outpatient medication. Employees are required to use designated pharmacies only if the pharmacies are located within 15 miles of their place of residence; This guide is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. It is provided for general informational purposes only. It broadly summarizes state statutes and regulations generally applicable to private employers, but does not include references to other legal resources unless specifically noted. Readers should contact legal counsel for legal advice. Crutches and apparatus. Employers must also replace or repair artificial members, glasses or spectacles, artificial eyes, podiatric orthotics, dental bridge work, dentures or artificial teeth, hearing aids, canes, crutches or wheel chairs if these are damaged in a work-related injury; and 2015 Zywave, Inc. All rights reserved. JPA 03/15

2 Surgery. Employers must cover surgical treatment when it is reasonably required to cure and relieve the effects of personal injury or occupational disease. However, employers cannot compel injured employees to undergo surgery. At the employer s expense, injured employees may receive a second opinion regarding the necessity of surgery. Employees may be required to cover a portion or the entire cost of a surgery if the DWC determines the surgery was not reasonably required. The DWC regulates the procedures available for medical care and the fees that health care providers can charge for the treatment of work-related injuries. Any service, article or supply provided by an unlicensed complementary and alternative health care practitioner is not compensable under Minnesota s workers compensation laws. Medical Examinations Employers may require their injured workers to submit to medical examinations at reasonable times to verify the employee s initial or continuous eligibility for medical benefits. Injured employees who refuse to submit to these medical examinations may have benefits suspended until they submit to the mandatory examination. Employers must cover the costs of any required medical examination. These costs include: The actual costs of the examination; Any travel expenses (including mileage, parking, lodging and meals); and Any lost wages resulting from the employee s attendance to the examination. An injured employee may request, at his or her own expense, that his or her personal physician be present at any required examination. A required medical examination must take place within 150 miles from the employee s residence, unless the employer can show the DWC that examination at a farther location is necessary or advisable. These examinations cannot be performed in a hotel or motel facility. Employers that require medical examinations must make the results of the examination available to the injured employee, free of charge. Rehabilitation The purpose of rehabilitation benefits is to enable injured employees to regain employment and return to their pre-injury economic status. Rehabilitation that results in higher income is permitted if it can be demonstrated that the rehabilitation was necessary to increase the injured employee s likelihood of reemployment. Minnesota law requires employers to provide a rehabilitation consultation to their injured employees upon request. The request may be made by the employee, the employer or the DWC. The consultation must be performed by a qualified rehabilitation consultant (QRC). The QRC will develop a rehabilitation plan for the employee, which must be filed with the DWC and must take into consideration employee qualifications, age, education, previous work history, interests, transferable skills as well as present and future labor market conditions. After a plan is filed, an injured employee may object to the employer s selection of the consultant within 60 days. The DWC informs injured employees of their right to request a rehabilitation consultation. Likewise, employers must notify the DWC whenever an employee s temporary total disability (TTD) will likely exceed 13 weeks. Employers must provide this notification within 90 days of injury or the time the employer determines that TTD benefits are likely to exceed 13 weeks. In cases of employee death, the surviving spouse is also entitled to receive rehabilitation services or any assistance he or she may need to become self-supporting. However, surviving spouses who receive rehabilitation assistance are not entitled to receive retraining benefits. 2

3 Rehabilitation benefits include: The cost of rehabilitation evaluation and the preparation of a plan; The cost of all rehabilitation services and the supplies necessary for implementing the plan; The reasonable cost of tuition, books, travel and custodial day care; The reasonable costs of board a lodging when rehabilitation requires the employee to live away from his or her customary residence; The reasonable costs of travel and custodial day care during the job interview process; The reasonable relocation costs if the employee finds a job in a location beyond a reasonable commuting distance (after a diligent search within the present community); and Any other expense the employer agrees to pay. Employers must cover the charges for services provided by QRCs or qualified rehabilitation vendors (QRVs). Employers are liable for these charges only if they receive a bill for QRC or QRV services within 45 days or when ordered by the WCD (even when the bill is received after 45 days). For , the maximum QRC fee is $ per hour, and the maximum rate for rehabilitation, job development and placement services (whether provided by QRVs or QRC firms) is $76.79 per hour. These rates are updated on October 1 of each year. A rehabilitation plan may be suspended, terminated or altered for good cause. To prove good cause, the party requesting suspension, termination or alteration must show that: A physical impairment does not allow the employee to pursue the rehabilitation plan; The employee s performance level indicates the plan will not be successfully completed; The employee does not cooperate with his or her plan; The plan or its administration is substantially inadequate to achieve the plan s objectives; or The employee is not likely to benefit from further rehabilitation services. DEATH AND BURIAL BENEFITS Employers must provide up to $15,000 in funeral expenses for employees who die because of a workrelated injury or illness. Death benefits, a benefit intended to compensate an employee s surviving dependents for their loss of income, are available at a rate of up to 66 and two-thirds percent of the employee s average weekly wage (AWW), subject to the minimum and maximum rates described below. Death benefits for the deceased employee s dependents may be adjusted in the event of remarriage (in the case of a spouse) or reaching the age of 18 (in the case of dependent children). Lifetime death benefits may available for surviving dependents who are unable to support themselves because of a mental or physical disability. Some benefits may also be available for individuals who were partially dependent on the deceased employee. WAGE REPLACEMENT BENEFITS If an employee cannot return to work because of a work-related injury or illness, he or she may qualify for wage replacement benefits (also called disability, indemnity or cash benefits) while he or she recovers. Usually, these benefits are immune from wage assignments, creditor claims, levies, executions, attachments and other remedies for debt collection. In Minnesota, wage replacement benefits are also tax exempt. 3

4 Total Disability An injured employee has total disability when he or she sustains an injury that prevents him or her from returning to work. Total disability can be temporary or permanent. Temporary Total Disability (TTD) TTD benefits are awarded to injured workers for a period during which they are considered totally disabled and unable to work. These benefits are available to injured employees who are expected to recover from their injuries or illnesses. Weekly TTD benefits are 66 and two-thirds percent of the employee s average weekly wage (AWW), subject to the minimum and maximum rates described below. These benefits are usually available during the period of disability or until: The employee returns to work; The employee withdraws from the labor market; The total disability ends and the employee fails to diligently search for appropriate work within the scope of his or her physical restrictions; The employee has been released to work without any physical restrictions; The employee refuses an offer of work that is consistent with a rehabilitation plan; 90 days after the employee has reached maximum medical improvement (MMI); or The employee receives 130 weeks of TTD benefits. Employers can discontinue paying TTD benefits to retired employees. An employee is considered to be in retirement if he or she receives any service-based government retirement pension, such as Social Security benefits. Service-based government retirement pensions do not include disability-based government pensions. Employers must offer sufficient evidence to show an employee is retired. Injured employees cannot rebut a presumption of retirement with a subjective statement. Permanent Total Disability (PTD) Injured employees qualify for PTD benefits only if one or more of the following physical or mental limitations apply: Total and permanent loss of the sight of both eyes; Loss of both arms at the shoulder Loss of both legs so close to the hips that no effective artificial member can be used; Complete and permanent paralysis; Total and permanent loss of mental faculties; or Any other injury which totally and permanently incapacitates an individual from working at an occupation that brings an income, if the employee s permanent partial disability rating is: o o o 17 percent or higher; At least 15 percent and the employee is at least 50 years of age at the time of injury; or At least 13 percent, the employee is at least 55 years of age at the time of injury and the employee has not completed grade 12 or obtained a GED certificate. PTD benefit rates are 66 and two-thirds percent of the employee s daily wage at the time of injury, subject to the maximum rate described below. However, PTD benefit payments may be reduced to account for pre-existing disabilities or disabilities derived from a congenital condition. PTD benefits are payable throughout the duration of the injured employee s disability. However, after the first $25,000 in compensation are paid, an injured employee s PTD benefits will be reduced by the amount the employee 4

5 receives from any government benefit (local or federal), such as Social Security income or survivor insurance benefits. In addition, PTD benefits may end for an injured employee who turns 67 years of age, because he or she is presumed to be retired from the labor market. However, this presumption is rebuttable if the employee can prove that he or she is not retired or out of the labor market. The employee must overcome this presumption with more than a subjective statement. Finally, PTD benefits are not available for individuals who are imprisoned in a public institution, unless there are others who are wholly dependent on the injured employee for their support. Partial Disability Partial disability benefits are available to individuals who have sustained a work-related injury or illness but retain some capacity to work. Receiving either permanent or temporary partial disability benefits is not mutually exclusive. Injured employees may receive permanent partial disability benefits in addition to temporary partial disability benefits if: They have returned to work for at least six months; and Have completed a rehabilitation plan (if applicable). Permanent Partial Disability (PPD) PPD benefits are available for injured employees who sustain a permanent functional loss because of a work-related injury or illness. Since 1984, PPD benefits in Minnesota have been based on a percentage of whole body disability the impairment rating. To calculate the actual amount of PPD benefits for an injured employee, employers must multiply the impairment rating by a dollar amount or number of weeks determined by law. Below are the predetermined amounts that have been in effect since Oct. 1, Impairment Rating (percent) Amount Impairment Rating (percent) Amount Less than 5.5 $75, to less than 55.5 $165, to less than 10.5 $80, to less than 60.5 $190, to less than 15.5 $85, to less than 65.5 $215, to less than 20.5 $90, to less than 70.5 $240, to less than 25.5 $95, to less than 75.5 $265, to less than 30.5 $100, to less than 80.5 $315, to less than 35.5 $110, to less than 85.5 $365, to less than 40.5 $120, to less than 90.5 $415, to less than 45.5 $130, to less than 95.5 $465, to less than 50.5 $140, up to and including 100 $515,000 PPD benefits are available to employees who no longer receive TTD benefits. In most cases, injured employees may request their PPD benefits in a lump sum. Lump sum payments are payable within 30 days of the request and may be discounted to their present value. Otherwise, in limited circumstances (such as retirement or when receiving temporary partial disability benefits) PPD benefits must be paid in installments at the same intervals and in the same amount as TTD benefits. Temporary Partial Disability The benefit for temporary partial disability is 66 and two-thirds percent of the difference between an employee s pre- and post-injury wages, subject to the minimum and maximum amounts described below. 5

6 TPD benefits are available through the duration of the employee s disability, 225 weeks or 450 weeks after the date of injury, whichever comes first. To receive TPD benefits, an injured employee must be employed and earning less than his or her preinjury wages. In addition, employee wages must be lower because of the employee s injury. TPD benefits may be reduced for injured employees who receive post-injury wages that exceed 500 percent of the state average weekly wage (SAWW). Waiting Period Injured employees are not eligible to receive wage replacement benefits for the first three calendar days of their disability. However, if the injury results in more than 10 calendar days of disability, benefits for the first three days must be paid retroactively. A disability is considered to begin on the first calendar day when the employee is unable to work. Minimum and Maximum Benefit Amounts The minimum amount of disability benefits under Minnesota s workers compensation laws is $130 per week or the injured employee s actual weekly wage (whichever is lower). The maximum amount of benefits is 102 percent of the state average weekly wage (SAWW). The SAWW is calculated each year by October 1 and becomes effective the following year on January 1. The maximum disability amount for the period is $ per week. Injured apprentice employees are entitled to receive the maximum rate for TTD, TPD and PTD. Employees under the age of 18 who sustain work-related injuries are entitled to receive the maximum rate for PTD. Remodeling Minnesota law may require employers to cover the costs of alteration or remodeling an injured employee s principal residence if alterations or remodeling are necessary to adequately accommodate an employee s permanent work-related disability. The alterations must, among other things, reasonably enable the employee to move freely into and throughout his or her residence. Minnesota law sets the limit for this benefit to $75,000 per personal injury. The injured employee may use this award to purchase or lease another principal residence that provides better accommodations for the employee s disability if altering his or her current residence is not practicable. Employers must provide remodeling benefits only after the DWC or a court determines that the employee s disability substantially prevents the employee from functioning within his or her principal residence. The remodeling or alteration project must be supervised and certified by a licensed architect, unless the project is: Approved by the Council on Disability; Performed by a licensed residential building contractor or remodeler; and Approved by a certified building official or certified accessibility specialist (the official or specialist must state in writing that the proposed remodeling or alterations are reasonably required to enable the employee to move freely into and throughout the residence and to otherwise accommodate the disability). MORE INFORMATION Contact AdvisorNet or visit the DWC website for more information on workers compensation laws in Minnesota. 6