FAQs Archive - Falsani Balmer

Q: What is an "intervention" claim?

Medical providers (and other entities who have a financial interest in the injured worker’s claim) who have provided treatment to injured workers should receive a notice of their intervention rights at some point during a disputed claim. That notice typically includes basic information about the parties in the claim and what the provider should do in order to file an intervention claim in the matter. An intervention claim basically “piggy backs” on the injured worker’s claim and is the best way for a medical provider to recover outstanding expenses for the injured worker. There are very specific deadlines for intervention claims as well as some basic rules, all of which can be found on the State of Minnesota Office of Administrative Hearings’ website: https://mn.gov/oah/lawyers-and-litigants/workers-compensation/intervenor-resources/ If there is a balance after the medical provider receives payment from personal/private insurance (called the “Spaeth” balance), that balance can form the basis for an intervention claim.

Q: Does my medical provider have to get prior approval for all of my work injury treatment?

Minnesota Rule 5221.6050 requires prior notification to the workers’ compensation insurer by the medical provider in some situations. In general, medical providers should request authorization from the workers’ compensation insurer at least seven (7) days before proposed medical treatment. That request can be made in writing or orally. Regardless of the format, the medical provider should keep track of the request. The workers’ compensation insurer then has seven (7) days in which to respond (in writing or orally). If the workers’ compensation insurer does not respond within seven (7) days, then the medical provider can assume that the proposed treatment is authorized and go ahead with the care. If the workers’ compensation insurer requests additional information, requests a second opinion or an adverse medical examination, or simply denies the care, the medical provider should notify the injured worker and/or his/her attorney as soon as possible.

Q: Is my medical provider allowed to send me bills for work comp medical care?

Medical providers are not allowed to attempt to collect payment by an injured worker for medical care related to the work injury. Minn. Stat. §§ 176.135, subd. 7 ; 176.83, subd. 5, paragraph (c) ; and, 176.136, subd. 2a . See also Minn. R. 5221.0500, subp. 3 . If a medical provider or someone acting on behalf of a medical provider collects or attempts to collect payment from an employee for charges on a bill for medical treatment or services related to a claimed workers’ compensation injury, then the provider may be subject to penalties assessed by the Minn. Dept. of Labor and Industry. Please note that this prohibition applies to any co-pays or deductibles that the injured worker would owe if the medical care was NOT work-related. In other words, medical providers cannot bill injured workers for co-pays or deductibles if the personal/private health insurer pays for work-related medical care; instead, those balances should be pursued by the medical provider through an intervention claim.

Q: Are there rules regarding how much work comp insurers have to pay for medical treatment?

Yes. Minnesota workers’ compensation laws have a “fee schedule” that controls how much medical providers are paid by workers’ compensation insurers. More information about fee schedules is available here: https://www.dli.mn.gov/business/workers-compensation/work-comp-medical-fee-schedules

Q: What are the rules on billing for medical care in Minnesota workers' compensation claims?

When an injured worker receives medical care in Minnesota for a work-related injury, the medical provider should bill the workers’ compensation insurer for that medical care. Medical providers are required to comply with Minnesota workers’ compensation rules regarding billing for medical services. One of the most important rules on this is Minn. Rule 5221.0700 , which requires medical providers to bill the workers’ compensation insurer within 60 days.

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FAQs

What is an “intervention” claim?

Does my medical provider have to get prior approval for all of my work injury treatment?

Is my medical provider allowed to send me bills for work comp medical care?

Are there rules regarding how much work comp insurers have to pay for medical treatment?

Who is supposed to pay for my work-injury medical expenses? And, what happens if work comp denies?

What are the rules on billing for medical care in Minnesota workers’ compensation claims?

Talk with our experienced attorney about your rights.