If you have never heard the term idiopathic and the first time you do is when you have a work related injury, you probably are not very happy you heard it. As I have discussed in previous posts,  in order for a work injury to be compensable, it  must “arise out of” and “in the course” of your employment.  An injury arises out of employment where there is some causal connection between the work environment under which you worked and your injury. Now, if your injury is denied based on an idiopathic injury, it means the employer and insurer believe your work environment did not cause your injury.

An idiopathic injury is defined as an injury which is either peculiar to the individual or arising spontaneously from an obscure or unknown cause.  The key of course in these types of cases is determining what the “cause” of the injury or accident was really from. Consequently, whether an idiopathic injury is compensable will depend on the facts  surrounding the accident. 

One of the most common examples of an idiopathic injury for which the cause of the harm is unknown is the unexplained fall in the course of employment. Injuries from true idiopathic falls do not arise out of the employment unless the employment increases the risk or aggravates the injury by, for example, placing the employee in a position which increases the dangerous effect of the fall, such as on a height, near machinery or sharp corners, or in a moving vehicle.

In situations where your injury has been denied based on an alleged “idiopathic injury”, you may want to consult with an attorney to assist you with your claim.  An experienced attorney should be able sit down and discuss with you whether you injury is truly idiopathic or, in fact, a compensable work related injury.

Jerry Sisk

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When I was in grade school I remember my math teacher telling me that it was not enough to show just your answer, instead, you needed to show how you got the answer. The same goes for establishing certain work related injuries. You need to be able to show ( prove) a relationship between your injury and your medical condition. Most of the time this is done by getting a medical doctor to write a report or provide in his medical notes that your work injury is the cause to your disability.

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Opciones Médicas para trabajadores lesionados

Después de haber sufrido una lesión de trabajo en Minnesota, muchos trabajadores piensan que el empleador y el sistema de compensación de los trabajadores en Minnesota pagaran automáticamente por los gastos médicos y la compensación relacionadas al accidente.  Desafortunadamente hay muchos casos en que el seguro niega la reclamación y reúsa pagar por los tratamientos médicos. Esto obliga al empleado a buscar por si solo el tratamiento médico necesario hasta que una determinación legal se lleva a cabo. Dependiendo en cada caso puede tomar hasta un año antes de que se lleve a cabo una determinación legal que cubra los gastos y otorgue una compensación. El empleado tiene opciones limitadas entre las que se encuentran la sumisión de honorarios médicos en que haya incurrido a su seguro personal, a solicitar asistencia médica del estado o a endeudarse hasta donde le sea posible y a veces a simplemente a no recibir el tratamiento que sea necesario y razonable.

En los Estados Unidos hay más de 43 millones de personas que no tienen seguro médico.  De acuerdo al Center on Budget and Policy Priorities (Centro de Presupuesto y Política de Prioridades) un 24.4 por ciento de la población con ingresos menores de $25,000 no tienen seguro médico. Esto representa casi tres veces al promedio de 8.5 por ciento de la población que tienen ingresos de más de $75,000. Dentro de la población Áfrico-Americana existe un 19.6 por ciento sin seguro médico y entre la población Hispánica hay 32.7 por ciento sin seguro médico, comparado con la población Caucásica en donde solo hay un 11.3 por ciento sin seguro.

Aproximadamente 666,000 Minnesotanos pueden recibir atención medica a través de tres programas que otorgan cuidados de salud básica y que son de de carácter publico  — Medical Assistance (MA) — Minnesota’s Medicaid program, General Assistance Medical Care (GAMC) y MinnesotaCare.  Para obtener más información acerca de estas instituciones haga clic aquí.  clic here. Aun con la ayuda provista por estos programas, de acuerdo al Departamento del Censo de los E.U.,  hay más de 453,000 Minnesotanos que no tienen seguro médico.

El Departamento de Servicios Humanos del estado de Minnesota, (DHS por sus siglas en inglés) administra estos programas y paga parcial o completamente por las cuentas medicas de las personas inscritas en estos programas, por ejemplo:

Medical Assistance (MA) (Minnesota’s Medicaid program) es el programa más extenso de los programas proveedores de salud.  Cubre las necesidades de salud y el costo de los medicamentos prescritos al mes para un promedio de 507,000 ciudadanos con discapacidades de ingresos económicos de la edad avanzada, niños, familias, y personas con discapacidades a través del calendario fiscal.

General Assistance Medical Care (GAMC) provee con cuidados médicos por un mes a un promedio de 33,000 (datos del año fiscal de 2007) Minnesotanos de bajos recursos que no califican para recibir ayuda del MA (ver arriba) o ayuda de otros programas federales o estatales  — los recipientes principalmente son adultos con bajos ingresos económicos entre las edades de  21 a 64 años, que no tienen niños que dependan de ellos.

MinnesotaCare es un programa de carácter público de subsidio para residentes del estado de Minnesota que no tienen acceso a una cobertura médica que puedan pagar. Para poder  ser elegido a recibir estos servicios deben llenar las siguientes características:

• Tener un número de seguro social o estar dispuestos a obtener un numero ( a menos de que tengan objeciones de carácter religioso);
• Ser residentes en el estado de Minnesota;

• Si usted es un adulto y no tiene niños viviendo con usted, o si su niños son mayores de 21 años, usted debe haber residido en el estado de Minnesota por más de 6 meses;
• Ser ciudadano Americano o si no lo es, ser un residente legal en el país;
• No tener ninguna otro seguro medico o haber tenido cualquier otro seguro medico, incluyendo Medicare, por lo menos 4 meses previos, con la excepción de subscriptores a la Asistencia Médica, cuyas primas del seguro de salud fueron pagadas por Asistencia Médica; y
• No poder obtener seguro medico a través del empleador quien pueda ofrecer pagar por lo menos la mitad del costo de la prima mensual.

Para obtener ayuda en su solicitud haga clic aquí – here.

La única manera en que un trabajador pueda retornar a sus labores es cuando se obtiene el tratamiento médico necesario. Si usted no tiene un seguro médico y el seguro de la compensación de los trabajadores rehúsa pagar por su tratamiento médico, trate de obtener asistencia contactando al estado o al condado.  Otro sitio que podría proporcionarle ayuda es MinnesotaHelp.info.

Si su reclamación es negada, contacte a un abogado. Un abogado puede asistirle con el proceso y darle a usted opciones para obtener lo que usted necesita.

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Medical Options for Injured Workers

After a Minnesota work related injury, many injured workers assume that the Minnesota employer and workers’ compensation insurer will automatically pay for the injury and the related medical expenses. Unfortunately, there are many times when the insurance company denies the claim and refuses to pay for the medical treatment. The injured worker is then responsible for obtaining the necessary medical treatment on his or her own until a judicial determination can be made. Depending on the case, this could take in upwards of a year before the case is heard. The injured worker is left with limited options including, submitting the bills to their private health insurance, applying for medical assistance, going into debt as long as possible or not receiving the reasonable and necessary treatment.

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.

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Minnesota Work Comp

In any Minnesota workers’ compensation case, the injured worker bears the burden of proving a work related injury. This is not always easy to do if there is no evidence corroborating the injured worker’s story and facts of the case.  After a work injury it is important to keep in mind the following:

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