In the United States there are over 46.3 million people without health insurance. According to the Center on Budget and Policy Priorities some 24.4 percent of people with incomes below $25,000 were uninsured, almost triple the rate of 8.5 percent among people with incomes over $75,000. African-Americans (19.6 percent uninsured) and Hispanics (32.7 percent) were much more likely to be uninsured than white, non-Hispanic people (11.3 percent).

Roughly 666,000 Minnesotans receive health care through the state’s three publicly funded basic health care programs — Medical Assistance (MA) — Minnesota’s Medicaid program, General Assistance Medical Care (GAMC) and MinnesotaCare. For more information click here. Even with these programs in place,over 453,000 Minnesotans go without health insurance according to the U.S Census Bureau.

The Minnesota Department of Human Services (DHS) administers these programs and pays all or part of enrollees’ medical bills for:

Medical Assistance (MA) (Minnesota’s Medicaid program) is the largest of the health care programs, providing health care coverage and prescription medication coverage for a monthly average of 507,000 low-income senior citizens, children and families, and people with disabilities in fiscal year (FY) 2007.

General Assistance Medical Care (GAMC) provides medical care for a monthly average of 33,000 (FY 2007) low-income Minnesotans who don’t qualify for MA or other state and federal programs — primarily low-income adults, ages 21 and 64, who do not have any dependent children.

MinnesotaCare is a publicly subsidized program for Minnesota residents who don’t have access to affordable health care coverage. In order to eligible you must meet the following:

• Have a Social Security number or be willing to apply for one (unless you have religious objections);
• Live in Minnesota;
• If you are an adult and do not have children living with you, or if your children are over age 21, you must have lived in Minnesota for six months;
• Be a U.S. citizen or non-citizen lawfully residing in the U.S.;
• Not have other health insurance now or have had health insurance (including Medicare), for at least four months except for Medical Assistance enrollees whose health insurance premium was paid for by Medical Assistance; and
• Not be able to get health insurance through an employer who offers to pay at least half the monthly cost.

Assistance in applying can be found here.

The only way an injured worker can get back to work is to get the necessary medical treatment. If you find yourself without medical insurance and the workers’ compensation insurer refuses to pay for your medical treatment, look into contacting the state and/or county for assistance. MinnesotaHelp.info is another great resource for help.

If you find yourself with a denied claim, contact an attorney. An attorney can assist you by guiding you through the process and providing you with options.

FCE’s and JDA’s through the assistance of a physical therapist can determine your strengths, abilities, weaknesses and needs. It can establish the level of physical performance within your tolerance.

An FCE typically includes:

An in-depth questionnaire is used to determine other conditions and specific limitations you may have, whether directly or indirectly related to your job duties.

Real and Simulated Work such as lifting, pushing/pulling, squatting with and without weights, overhead activities and endurance activities, such as maintaining a position for a specified length of time or walking for a specified distance, plus any other work-specific activities you may perform when at work.

An FCE can last several hours to a couple of days, depending on the scope of testing. It is important during your testing that you be honest and truthful. You have the right to refuse to continue any test procedure at any time. However, if appropriate and safe, the Therapist may ask you to continue despite minor pain. It is only during this period that a proper assessment of the degree of functional ability or disability can be made.

The FCE can be very beneficial in finding appropriate work for an injured worker. The exact restrictions and limitations can open doors to jobs or opportunities that may have been excluded but for the FCE.

Wage Replacement Benefits

Temporary total disability benefits (TTD). TTD benefits are a form of compensation available to an injured employee who is unable to work because of the work injury, or who is released to work with restrictions but is unable to find work within those restrictions. The TTD rate is two-thirds of the employee’s gross wage at the time of the injury, subject to certain maximum and minimums.

Temporary partial disability benefits (TPD). TPD benefits are partial wage loss compensation for an injured employee who is back to work but is earning less than the date of injury wage due to the effects of a work injury. TPD is calculated at two thirds of the difference between the pre-injury wage and the employee’s current ability to earn.

Permanent Total Disability Benefits (PTD). PTD benefits are wage loss compensation where the injured employee’s physical disability causes the employee to be unable to find anything more than occasional employment resulting in insubstantial income. This means that the worker cannot secure a steady job and earn a living from work. The rate payable for PTD benefit is two-thirds of the employee’s gross weekly wage at the time of the injury.

Functional Impairment or Permanent Partial Disability Benefits (PPD)

Permanent partial disability or “permanency” is a payment for the loss of use of, or the loss of body function. These benefits are paid according to the compensation schedule established by the Workers’ Compensation Division. The amount and duration of the benefit are controlled by the permanent partial disability rating. It may be payable in one lump sum or in weekly increments. In cases where there is no specific schedule for that injury, the courts have allowed what is called a “Weber” rating. Under Weber, a doctor may provide an alternative permanent disability rating.

Medical Benefits

The employer and insurer are responsible for payment of “reasonable and necessary” medical treatment, which will aid in curing or relieving the effects of the work injury. Covered treatments include hospitalization, surgery, physical therapy, occupational therapy, chiropractic services, injection therapy, chronic pain management and many other forms of medical care. The right to receive these benefits may be impacted by the Minnesota Workers’ Compensation Treatment Parameters depending on various factors including whether the injury is admitted or denied.

Vocational Rehabilitation Benefits

Vocational rehabilitation benefits are designed to assist the injured worker returning to former employment or to a job related to that employment. In the alternative, rehabilitation services assist the injured employee to return to a job in another work area, which produces an economic status as close as possible to that enjoyed but for the disability. This assistance may include direct job placement, on-the-job training or formal retraining. Rehabilitation services can include the use of a Qualified Rehabilitation Consultant (“QRC”) to help with medical management, return to work, and job placement.

When you have specific questions about the workers’ compensation benefits available to you contact the DOLI or an attorney. Most attorneys offer free consultations however you want to make sure you choose the right one.

Some of the results include:

• For comparable injuries, when WC pays higher prices than GH for specific services, those services tend to be used more often in WC than in GH;
• The proportion of WC medical cost that is subject to physician fee schedules is declining by about one percentage point per year;
• The Medicare fee schedule is very useful as a starting point for the design of WC medical fee schedules, but has notable shortcomings for WC, including too little emphasis on return to function and too little sensitivity to cost differences among states;
• Particularly in specialty areas such as surgery and radiology, fee schedules can result in WC reimbursement rates that are especially high compared with GH;
• While fee schedules tend to concentrate reimbursements at the maximum allowable rate, there are many payments that are either greater than or less than the maximum allowable rate;
• Reimbursement for care that physicians provide at hospitals and other facilities is more likely to exceed the fee schedule than care provided in their offices. This is partly because the fee schedule need not always apply when facilities bill for these services;
• A higher proportion of reimbursements are at or below the fee schedule when WC medical services are provided through a network as opposed to when they are not.

A medical provider in Minnesota is only allowed to seek reimbursement for the fee scheduled medical bill. They may not try to recover from the injured worker the difference between the outstanding bill and the fee scheduled amount.  If a medical provider tries to recover in that situation the injured worker should contact the Department of Labor and Industry and speak with a Benefit Management and Resolution specialist.

(Effectiveness of Workers Compensation Fee Schedules—A Closer Look | NCCI)

As a general rule, the court has given great latitude in choosing and changing physicians. Reasons that have been allowed have included:

• Loss of confidence in a doctor’s ability to effectively treat the injured worker;

• Lack of improvement in the employee’s condition; and

• A  breakdown in communication with the physician.

Please note that a compensation judge shall not approve a request to change primary providers, where:

1. a significant reason underlying the request is an attempt to block reasonable treatment or to avoid acting on the provider’s opinion concerning the employee’s ability to return to work.
2. the change is to develop litigation strategy rather than to pursue appropriate diagnosis and treatment;
3. the provider lacks the expertise to treat the employee for the injury;
4. the travel distance to obtain treatment is an unnecessary expense and the same care is available at a more reasonable location;
5. at the time of the employee’s request, no further treatment is needed; or
6. or another reason, the request is not in the best interest of the employee and the employer.

If you are having difficulty changing physicians, it may be in your best interest to contact an attorney to evaluate your options. The longer you wait to change physicians, the more difficult it may become for you to change doctors.

Spine Health published an article discussing the various symptoms of herniated disks.  The article goes through the various levels of the spine and outlines the various symptoms associated with a herniation at that level.

L4-5 causes L5 nerve impingement, sciatica pain, foot drop, numbness and pain can also be felt on top of the foot.

L5-S1 causes S1 nerve impingement, sciatica, weakness when standing on the toes, numbness and pain into the sole of the foot and the outside of the foot.

C4-5 causes C5 nerve root impingement, weakness in the deltoid muscle in the upper arm but do not usually feel numbness or tingling sensations, shoulder pain.

C5-6 causes C6 nerve root impingement. This level is one of the most common areas for a cervical herniated disc to occur. It can cause weakness in the biceps, wrist extensor muscles, pain, numbness and tingling into the thumb side of the hand.

C6-7 causes C7 nerve root impingement, weakness in the triceps, in the extensor muscles of the fingers, numbness and tingling along with pain can radiate down the triceps and into the middle finger.

C7-T1 causes C8 nerve root impingement, weakness when gripping with the hand, numbness, pain, and tingling that radiates down the arm and to the little finger side of the hand.

Herniated discs in thoracic region are rarely symptomatic and rarely produce pain, but if they are symptomatic, the pain is usually felt in the upper back and/or chest area.

It is always important to seek the proper medical care and treatment if you are experiencing these types of symptoms.  If an injured worker waits too long before seeking treatment the more likely the employer and insurer will deny his or her benefits.

There are various back injuries including sprains/strains, herniations, bulging disks, and fractures. OSHA reports in their technical manual that back disorders result from exceeding the capability of the muscles, tendons, discs, or the cumulative effect of several contributors including:

• Reaching while lifting.
• Poor posture–how one sits or stands.
• Bad body mechanics–how one lifts, pushes, pulls, or carries objects.
• Poor design of job or work station.
• Repetitive lifting of awkward items, equipment, or (in health-care facilities) patients.
• Twisting while lifting.
• Bending while lifting.
• Heavy lifting.
• Fatigue.
• Poor footing such as slippery floors, or constrained posture.
• Lifting with forceful movement.
• Vibration, such as with lift truck drivers, delivery drivers, etc.

Often times, back injuries are short in duration and workers are able get back to normal. About 90 % of people with back injuries will get better without treatment or with conservative therapies. Treatment can include a various modalities including physical therapy, chiropractic, injections and medication. For some, the pain and suffering is long-term. And for a small percentage of people, it is lifelong. For employees with long-term, disabling musculoskeletal injuries, the ability to earn a living and quality of life goes down.

In some cases, when conservative measures have failed, surgery may be warranted. Typically, surgery is reserved in cases where the nerve is pinched, spinal cord is compressed or there is too much space between the vertebra. Symptoms which typically mean there is serious underlying condition include symptoms( i.e. numbness, tingling, pain, etc) into the extremities and lost of bladder or bowel control.

Back injuries can occur from the heaviest to the lightest type work. Workers’ compensation benefits are available to afford an injured employee the time and resources to get better. The Mayo clinic recommends to prevent recurrent back problems to use good body mechanics, keep your back muscles conditioned with regular exercise and stretching, and control your weight.

Feel feel to leave your comments including any recommendations.

Thank you.

(photo: Flickr)

He first recommends that you look on the Minnesota Board of Medical Practice’s website. This is the the agency that licenses and disciplines doctors. From there you can look at the  list of disciplinary actions. There is also information available by searching the professional profile.

The board launched the searchable professional profile about two years ago, so “consumers can make informed health care decisions,” executive director Robert Leach told Mr. Shiffer.

If you are concerned about your medical professional, these resources are good a way to determine if any sanctions or disciplinary action has been brought against them in the past.

(photo: Meyerson & O’Neil)