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Worker’s Compensation Patients

Minnesota’s Worker Compensation Law
The state’s worker compensation system is a no-fault system that provides an injured worker with medical care, replaced wages and impairment benefits. The worker does not need to prove fault, but can obtain only the benefits outlined in the worker’s compensation statutes. 

The medical decision making and medical care of work related low back pain is the same as that for accident related low back pain, as reflected in the:

• Initial Presentation Guideline 
• Philosophical Approaches to Managing Spinal Pain 
• What to Consider Before Ordering Diagnostic Imaging Tests 

Tips for Successful Processing of Claims
Minnesota’s worker compensation law has unique administrative processes. Failure to follow the processes results in extra phone calls and denied medical bills. Here are suggestions to guide you through the processes:

• Identify a worker’s compensation patient at registration.
• Treat each distinct work related low back pain episode as a new, rather than established patient. After the initial visit in an episode, subsequent visits to the conclusion of the episode or Maximum Medical Improvement (MMI) are billed as established.
• Obtain the history of the incident surrounding the onset and formulate and document an opinion if the injury is or is not work related.
• Document the date of injury on each patient. This is the date that insurers use to determine the benefits and is a key part of the history for a worker’s compensation injury.
• Determine restricted work activities specifically and discuss with the patient. Complete the Report of Work Ability form for each patient visit.
• Work with the patient, employer, and qualified rehabilitation counselor (QRC) to overcome any barriers to optimum treatment and early return to work. These barriers can be physical, psychological, or system issues. QRCs are hired by the worker’s compensation insurers or self-insured employers to facilitate appropriate modification of jobs to allow injured workers to work harden on the job.
• Provide additional communication concerning the treatment, including:
  • patient care notes sent with bills. Most worker’s compensation insurers will not pay without a copy of the care notes.
  • Report of Work Ability form sent, faxed and/or phoned to employer, insurer and/or managed care organization.
• Determine and document the maximum medical improvement (MMI) date. MMI occurs when low back pain has resolved or when no additional medical care can be expected to improve a patient’s status.  
• Figure a permanent partial disability (PPD) according to the State of Minnesota PPD schedule. The PPD schedule outlines which low back pain diagnoses and conditions are ratable with regard to permanent impairment.

SUMMARY: While the actual decision making and medical care in worker’s compensation low back pain cases are identical to cases in the general medical setting, there are a number of special process steps outlined above, which when followed, optimize the overall patient care. These process steps do require additional clinical care systems, additional patient discussion and additional documentation for worker’s compensation patients.

First published: 03/07/2002
Last updated: 06/01/2002

Reviewed by: Paul Kleeberg, MD