Medical choices for injured workers

Group 152

Table of Contents

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. 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.