If your workers' comp claim has been wrongfully denied by your employer's insurance company, you can appeal the denial with the Minnesota Department of Labor & Industry (MDLI). This article explains how to file and prepare for an appeal in your workers' comp case. (To learn about the available benefits, see our article on Minnesota workers' compensation benefits.)
Before filing a claim, you should review the reasons the insurer gave for denying your claim. When an insurer denies a claim, it must send you a form that clearly explains the factual and legal grounds for its decision. One of the most common reasons for a denial is that the insurance company disputes that the worker's injuries are work-related.
To start the appeals process, you must file a form called an Employee's Claim Petition. The Petition requires you to explain when and how your workplace injury happened, what medical treatments you have received, and what benefits you are seeking. Along with your Petition, you must also submit a doctor's report supporting your claim. You can find the form on the MDLI's website.
You must file your Petition with the MDLI at the following address:
Minnesota Department of Labor and Industry
Workers' Compensation Division
PO Box 64221
St. Paul, MN 55164-0221
You must also send a copy of the Petition to your employer and its workers' compensation insurer. You generally have three years from the date of your employer's report of your accident to file your Petition.
You may represent yourself in the appeal process, or you may hire a lawyer to represent you, in which case he or she will help you file the Petition. Because the issues involved in appealing a denial of benefits can be complex, you should consider hiring an attorney unless the dispute is simple or your injuries are minor.
If your Petition shows that the only issues in dispute are related to medical treatment or rehabilitation services, the MDLI will attempt to resolve your dispute as soon as possible. Either you or the insurance company may file a Medical Request or Rehabilitation Request with the MDLI. Upon receiving such a request, the MDLI will typically schedule an administrative conference.
At the conference, a mediator will hear from both parties and receive relevant evidence, such as medical records and bills. The mediator will encourage the parties to reach a voluntary agreement during the conference. However, if the parties do not reach an agreement, the mediator will normally make a decision that is binding on the parties (called a "Decision & Order"). Either party can appeal the decision by filing a Request for a Formal Hearing.
In simple cases, where there is sufficient information in the petition and response forms, the MDLI may simply issue a Decision and Order without holding an administrative conference. This often happens, for example, when the only question is whether a medical bill is too expensive.
In more complex cases, such as where the case involves a unique question of law, the MDLI may send the case directly on to the Office of Administrative Hearings (OAH) without making a decision. In this case, a more formal administrative hearing will be held by a workers' comp judge (the OAH hearing process is described below).
Petitions involving an insurer's refusal to authorize surgery, or an injured worker's claim of severe financial hardship, are typically sent directly to the OAH . Petitions that do not involve medical or rehabilitation disputes are also usually routed to the OAH, unless both parties request the MDLI's assistance in reaching a settlement. For example, the parties may request mediation or non-binding arbitration from the MDLI before going to an OAH hearing.
An OAH judge will be appointed to conduct your hearing and all preliminary matters associated with your Petition, including holding settlement conferences and ruling on procedural issues. The OAH hearing is similar to a civil trial in that the parties will present evidence and testimony; however, unlike a civil trial, there is no jury. The OAH judge alone will hear the case, make rulings on procedure and evidence, and determine what testimony and documents to consider.
Like a civil trial, witnesses may be questioned by the parties or their attorneys at the OAH hearing. A court reporter will transcribe the proceedings. The length of the hearing varies, depending on the number of witnesses, the number of issues in dispute, the volume of evidence, and whether any expert testimony is presented. (Expert witnesses are individuals with specialized knowledge, such as doctors.) Although OAH hearings can be completed in a single day, they can sometimes take several days or even weeks.
The OAH has a short guide for "pro se hearing preparation" (that is, workers representing themselves) online at its Pro Se Hearing Preparation page. However, because of the complexity of OAH procedures and Minnesota workers' comp law, most workers will need assistance from an experienced workers' comp attorney to handle the OAH hearing.
After the hearing, the OAH judge will issue a written decision, typically within 30 to 60 days.
If you disagree with the judge's decision, you can file an appeal to the Minnesota Workers' Compensation Court of Appeals (WCCA). You must file your appeal within the time limit stated in the OAH judge's written decision. However, the appeal to the WCCA is not an opportunity to present your entire case again. Rather, the focus is on showing that the judge's decision was not supported by enough evidence, or that the OAH judge made an error of law.
If you disagree with the WCCA's decision, you can appeal the decision to the Minnesota Supreme Court. You have only 60 days to file that appeal. Because there are complex rules involved in filing an appeal through the court system, you should consider hiring a workers' comp attorney to represent you.