I Have Been Scheduled For An Independent Medical Examination, Now What?

As a former insurance company attorney I have schedule hundreds of "independent medical examinations" for injured workers. The term independent medical examination is not always accurate. Though there are reputable doctors who will perform a thorough examination and write a neutral report, there are many who will do and say almost anything. Many defense attorneys believe it is their job to chose the " doctors who will do and say almost anything"!

When I worked as a defense attorney I thought having a neutral independent doctor was truly important. It helped me assess and fully understand the injured worker's claim. It also gave me credibility before the compensation judges. Later in my career as a defense attorney I began to get flack from a kool-aide drinking "old time" defense lawyer who chastised me for choosing these independent physicians and telling me I needed to get on board and work with the "adverse examiners". Despite the fact that this attorney had only gone to a full hearing a handful of times in the past decade, he was going to try his hardest to win a case at almost any cost! This didn't sit well with my years of experience and the reputation I developed. This was one of the reasons I now represent only injured workers and share these stories.

An employer and workers compensation insurer have the right to have you seen for an independent medical examination or adverse examination regardless of whether your claim is admitted or denied. They need to reimburse you for your expenses and must schedule it within 150 miles of your home. Keep in mind that this doctor is not nor will he ever be your treating physician. There is no doctor patient confidentiality, everything you tell the doctor will be shared with the employer and insurer. Sometimes the examinations last a few minutes and other times they can take close to an hour with an extensive physical examination and questions.

You will usually receive the report as an attachment to a service of Maximum Medical Improvement or a Notice of Intent to Discontinue Befits in the mail. As this is the goal of the adverse examination, your medical and/or wage loss benefits will likely be stopped as the result of your "independent medical examination".

As a defense attorney I understand the flaws in these reports and the mistakes that can be made in preparation for the same. As your attorney I will surgically dissect these reports and the accompanying letters providing the physician with "foundation" or their opinion. My job is to look for contradictory medical evidence and obtain an opinion from your own treating physician and if necessary a truly independent doctor. If you would like to discuss your claim in more detail, feel free to contact me directly at 651-324-9514. All calls are returned within a few hours. Don't be afraid to contact me after hours as I do take all calls.

How Do I Choose A Minnesota Workers Compensation Attorney?

Though there are many attorneys who can represent you in a workers compensation matter, I strongly urge that you select one that has at least 10 years experience, have never been disciplined by the professional board of responsibility, and limits their practice to representing disabled or injured workers.  

Many attorneys advertise that they can help you if you have been involved in a car accident, dog bite, slip and fall, or even a workers compensation matter.  This may be true, but given the complexity of Minnesota Workers Compensation laws one needs to ask how well can they represent me in this specialized area.  Some questions you should ask your attorney include:

1. Do you limit your practice to workers compensation,

2. Have you ever been discipline by the Minnesota Supreme Court,

3. Can they name 10 workers compensation judges from memory and ALL of the members of the Workers Compensation Court of Appeals,

4. Have they ever taken a work comp case up the Minnesota Supreme Court,

5. Do they have any special experiences which can assist you in your case (personal experience with work comp case, represented employers, insurers and injured workers).

I suggest that you use tools like the internet to research the attorney you plan to hire.  Find out whether the attorney has ever been disciplined (link on my web site), determine how long the attorney has been out of law school (link on my web site), call them on the phone or visit their office to see if you can work with this person.  You need to find an attorney that will be a "good fit" for you and your case.  

I have turned down clients seeking representation and referred them to other experienced workers compensation attorneys who might be a better fit than myself.  I pride myself in a personal approach to representing my clients and I want them to feel same about me.  If you would like to meet to discuss how I can assist you with you injury claim, feel free to contact me directly at 651-324-9514 or visit my website www.mndisability.com

My Employer Won't Complete An Incident Report or First Report of Injury, What Should I Do?

What If My Employer Didn’t Complete a First Report of Injury?

 

First Reports of Injury refer to a workers compensation form that is required by the Minnesota Department of Labor to be completed whenever there is ANY work related injury.  In my practice I have seen literally hundreds of instances where a First Report of Injury for a workers compensation injury was intentionally not completed.  In many of those instances the Employer believes they can save money and avoid an increase in their insurance rates by continuing the Employee’s pay (in some instances) and covering the medical expenses under the Employee’s health insurance.  Unfortunately this is not only illegal, but also it often turns into a defense by the Employer that the injury never occurred.

 

As an injured worker if your Employer refuses to turn in a First Report you have the absolute right to complete a copy yourself.  Unfortunately, injured workers are often fearful that doing so will result in termination of their job.   This usually doesn’t occur, but if itdoes, there are strict civil remedies separate from your workers compensation rights that can be pursued.  I often suggest the following to my clients the following; “A work injury will likely affect you for your entire life.  Employment, no matter how well it is going today, usually only lasts for a few years.”

 

I strongly urge you to protect your health for the sake of yourself and your family.  Even if your injury is years old and your Employer never completed the First Report of Injury, in many instances a workers compensation claim can still be made.  I can review your case and will usually be able to advise you of the same during our first meeting. 

 

I represent injured workers at Atkinson Law Offices and Minnesota Disability.  My entire practice is focused on sharing the secrets and tips that the workers compensation insurers refuse to tell you.  In almost every instance where I meet with a client, I find a benefit that is overlooked and not being properly paid.  Whether you have an admitted or denied injury, I would be happy to discuss your case with you.  You can reach me directly at 651-324-9514.  Remember there is NEVER EVER a fee unless you recover a benefit.  This means there is no retainer or payment ever made by you to me! 

Work Related de Quervain's Tendonitis

The condition known as de Quervain's tendonitis, or tenosynovitis, results from the tendons at the base of the thumb becoming irritated or inflamed. When the tendon gets inflamed, the tunnel that surrounds it swells, and it becomes painful to move the thumb or wrist. Those who suffer from de Quervain's tendonitis feel pain when they hold things or try to form a fist.

Causes of De Quervain's Tendonitis

Formally known as first dorsal tendonitis, de Quervain's tendonitis is caused when the tendons at the thumb's base become irritated, usually as a result of a new repetitive activity. It is a frequent complaint from new mothers, who need to care for their babies with awkward hand positions they are not familiar with. Furthermore, changes in hormone levels from pregnancy and nursing add to the possibility of the condition showing up in new mothers.

A change to the way the wrist normally works and moves because of a fracture, severe strain or overuse in the work place can also trigger de Quervain's tendonitis because of the new and unusual stress the tendons may incur.

Signs & Symptoms

The main symptom of de Quervain's tendonitis is pain in the side of the wrist near the thumb. The pain might show up either suddenly or over time, but is felt in the wrist's first dorsal compartment. The pain can run up the forearm or down into the thumb. Moving the hand or thumb makes it worse, especially if they are twisted or used to hold onto something firmly.


The base of the thumb may become swollen and a cyst filled with fluid may even appear. The thumb, when moved, may sometimes catch or pop, and it may be hard to pinch. The nerve that lies on top of the tendon's sheath or tunnel may also become irritated and cause the index finger and back of the thumb to become numb.

Diagnosis of Tendonitis

Your hand surgeon will carefully examine your hand and wrist for signs of de Quervain's tendonitis and check if the tendons at the base of the thumb are tender. To test for it, you may be asked to make a fist with your thumb inside your fingers and your hand surgeon may then try to gently bend your fist toward your little finger. If you have de Quervain's tendonitis, this movement will cause pain.

Back to the Top

Non-Surgical & Surgical Treatments

Your hand surgeon will treat the condition so that your pain is removed or lessened by reducing the irritation and swelling in the affected tendons. Your hand doctor may suggest that you wear a splint to rest your thumb and wrist and may recommend some anti-inflammatory medications. Sometimes the inflammation can be relieved by a shot of cortisone or other steroid, and any of these treatments can reduce the swelling and pain. Changing or eliminating the motions that cause the pain can also get rid of them.

If the symptoms are very severe or the treatments tried so far don't work, surgery can often help. During the surgery, your hand surgeon will open up the compartment to give the inflamed tendons more room to move. This procedure eliminates the inflamed tendons swelling even further, which in turn increases the inflammation, and so on. Following the surgery, a splint may be suggested, but once comfort and strength have returned, normal hand, wrist, and thumb function will come back.

They Say I'm at Maximum Medical Improvement, Now What?

The first time most employee's are confronted with the term MMI (Maximum Medical Improvement) is when they go to their mailbox and find a letter attached to a Notice of Intent to Discontinue Benefits on the basis the employee has reached MMI. Most employee's think this can't possibly be correct, after all they still continue to treat with their doctor and they haven't fully recovered from their injury.

Maximum medical improvement (MMI) is defined in Minnesota Statutes §176.011, Subd. 25. It is the date after which no further significant recovery from or lasting improvement to a personal injury can be reasonably anticipated, regardless of subjective complaints. After the date of MMI has been validly determined, the insurer does not need to request any further determinations of MMI unless the employee becomes medically unable to continue working (see Minnesota Statutes §176.101, Subd. 1(e)(2)). For purposes of commencement or recommencement of temporary total disability benefits only, a new period of maximum medical improvement begins when the employee becomes medically unable to continue working due to the injury.

MMI determinations are important because the employee's entitlement to future benefits can cease 90 days after the insurer serves a written report of MMI. If your benefits have been discontinued based upon MMI or any other reason, I strongly urge you to contact an experienced workers compensation attorney. When your benefits are in jeopardy, don't rely on the attorney who dabbles in work comp and can handle your will, divorce or even bankruptcy. Minnesota Disability attorney Tom Atkinson ONLY represents injured and disabled employees! Contact him today at 651-324-9514 or tom@mndisability.com

Exploring Back Surgery - Part III

A spinal fusion surgery is designed to stop the motion at a painful vertebral segment, which in turn should decrease pain generated from the joint. There are many approaches to lumbar spinal fusion surgery, and all involve adding bone graft to an area of the spine to set up a biological response that causes the bone graft to grow between the two vertebral elements and create a fusion, thereby stopping the motion at that segment.

For patients with the following conditions, if abnormal and excessive motion at a vertebral segment results in severe pain and inability to function, a fusion may be considered

• Isthmic, degenerative or postlaminectomy spondylolisthesis.

Other conditions that may be treated by a spinal fusion surgery include a weak or unstable spine (caused by infections or tumors), fractures, scoliosis or deformity.

How spine fusion surgery works

At each level in the spine, there is a disc space in the front and paired facet joints in the back. Working together, these structures define a motion segment and permit multiple degrees of motion. Two vertebral segments need to be fused together to stop the motion at one segment, so that an L4-L5 (lumbar segment 4 and lumbar segment 5) spinal fusion is actually a one-level spinal fusion.

A spine fusion surgery involves using bone graft to cause two vertebral bodies to grow together into one long bone. Bone graft can be taken from the patient's hip (autograft bone) during the spine fusion surgery, harvested from cadaver bone (allograft bone). or manufactured (synthetic bone graft substitute).

In general, a lumbar spinal fusion surgery is most effective for those conditions involving only one vertebral segment. Most patients will not notice any limitation in motion after a one-level spine fusion. Only in rare cases should a three (or more) level fusion surgery for pain alone be considered, although it may be necessary in cases of scoliosis and lumbar deformity.

When necessary, fusing two segments of the spine may be a reasonable option for treatment of pain. However, spinal fusion of more than two segments is unlikely to provide pain relief because it removes too much of the normal motion in the lower back and places too much stress across the remaining joints.

There are several types of spinal fusion surgery options, including:

• Posterior lumbar interbody fusion (PLIF/TLIF))—the procedure is done from the back and includes removing the disc between two vertebrae and inserting bone into the space created between the two vertebral bodies

• Posterolateral gutter fusion—the procedure is done through the back

• Anterior lumbar interbody fusion (ALIF)—the procedure is done from the front and includes removing the disc between two vertebrae and inserting bone into the space created between the two vertebral bodies

• Anterior/posterior spinal fusion—the procedure is done from the front and the back

Exploring Back Surgery - Part II

Like some of my clients, I sustained a work related back injury resulting in the need for surgery. In Part II of Exploring Back Surgery, I will discuss the procedure I underwent to repair a large free fragment disc herniation in my back.

A discectomy is a surgery done to remove a herniated disc from the spinal canal. When a disc herniation occurs, a fragment of the normal spinal disc is dislodged. This fragment may press against the spinal cord or the nerves that surround the spinal cord. This pressure causes the symptoms that are characteristic of herniated discs.

The surgical treatment of a herniated disc is to remove the fragment of spinal disc that is causing the pressure on the nerve. This procedure is called a discectomy. The traditional surgery is called an open discectomy. An open discectomy is a procedure where the surgeon uses a small incision and looks at the actual herniated disc in order to remove the disc and relieve the pressure on the nerve.

How is a discectomy performed?
A discectomy is performed under general anesthesia. The procedure takes about an hour, depending on the extent of the disc herniation, the size of the patient, and other factors. A discectomy is done with the patient lying face down, and the back pointing upwards.

In order to remove the fragment of herniated disc, your surgeon will make an incision over the center of your back. The incision is usually about 3 centimeters in length. Your surgeon then carefully dissects the muscles away from the bone of your spine. Using special instruments, your surgeon removes a small amount of bone and ligament from the back of the spine. This part of the procedure is called a laminotomy.

Once this bone and ligament is removed, your surgeon can see, and protect, the spinal nerves. Once the disc herniation is found, the herniated disc fragment is removed. Depending on the appearance and the condition of the remaining disc, more disc fragments may be removed in hopes of avoiding another fragment of disc from herniating in the future. Once the disc has been cleaned out from the area around the nerves, the incision is closed and a bandage is applied.

What is the recovery from a discectomy?
Patients often awaken from surgery with complete resolution of their leg pain; however, it is not unusual for these symptoms to take several weeks to slowly dissipate. Pain around the incision is common, but usually well controlled with oral pain medications. Patients often spend one night in the hospital, but are usually then discharged the following day. A lumbar corset brace may help with some symptoms of pain, but is not necessary in all cases.

What is endoscopic microdiscectomy?
This is a newer technique utilized by my surgeon. This technique may allow your surgeon to perform a procedure called an endoscopic discectomy. In an endoscopic discectomy your surgeon uses special instruments and a camera to remove the herniated disc through very small incisions.

The endoscopic microdiscectomy is a procedure that accomplishes the same goal as a traditional open discectomy, removing the herniated disc, but uses a smaller incision. Instead of actually looking at the herniated disc fragment and removing it, your surgeon uses a small camera to find the fragment and special instruments to remove it. The procedure may not require general anesthesia, and is done through a smaller incision with less tissue dissection. Your surgeon uses x-ray and the camera to "see" where the disc herniation is, and special instruments to remove the fragment.

Exploring Back Surgery - Part I

As many of your are aware, I am the founder of Minnesota Disability and Atkinson Law Offices where I offer nearly two decades of experience handling workers compensation matters. What you may not know is that like some of you, I have suffered from a workers compensation injury that resulted in back surgery.

Though my surgery has had many positive results, I unfortunately have ongoing complications. In this series of articles I want to explore the types of back surgeries that may be recommended to those of you with chronic back pain in an attempt to answer some of your questions. Surgery is a very serious procedure that can have profound benefits for certain individuals. However, surgery is something that has the potential for downsides and careful consideration must be taken before undertaking the same.

In Minnesota there are currently 6 forms of back surgery that are being performed in most major hospitals. They range from the most common procedure, diskectomy, to the newest and least well know, the artificial disk.

Diskectomy. This involves removal of the herniated portion of a disk to relieve pressure on a nerve. It's done as an open surgery, and typically involves full or partial removal of the back portion of a vertebra (lamina) to access the ruptured disk.

Laminectomy. This procedure involves the removal of the lamina that overlays the spinal canal. It enlarges the spinal canal and is performed to relieve nerve pressure caused by spinal stenosis.

Fusion. Spinal fusion permanently connects two or more bones in your spine. It can relieve pain by adding stability to a spinal fracture or when there's excessive motion between vertebrae. It may also be used to eliminate painful motion between vertebrae that can result from a degenerated or injured disk.

Intradiscal electrothermal therapy (IDET). In this treatment, doctors insert a needle through a catheter into the disk. The needle is heated to a high temperature for up to 20 minutes. The heat thickens and seals the disk wall, reducing disk bulge and the related spinal nerve irritation.

Vertebroplasty. During this procedure, your surgeon injects bone cement into compressed vertebrae. For fractured and compressed vertebrae, this procedure can help stabilize fractures and relieve pain. With a similar procedure — called kyphoplasty — a balloon-like device is inserted to expand compressed vertebrae before bone cement is injected.

Artificial disks. Implanted artificial disks are a treatment alternative to spinal fusion for painful movement between two vertebrae due to a degenerated or injured disk. These relatively new devices are still being studied, however, so it's not yet clear what role they might play as a back surgery option.

Work Related Carpal Tunnel Syndrome

Everyday Minnesota workers deal with a painful condition of the hands and wrists know as Carpal tunnel syndrome (CTS) or median neuritis. Bilateral Carpal Tunnel Syndrome is caused by pressure on the median nerve, which runs from the shoulder down the arm to the hand. In advanced cases, carpal tunnel syndrome can make the simplest chore or activity impossible, such as gripping objects at work to folding laundry at home.  

Carpal tunnel syndrome can occur in one wrist, or both (bilateral carpal tunnel). It affects workers in many industries such as meatpacking, grocery checkout, and assembly work. In nearly two decades of handling Minnesota Workers Compensation matters, attorney Tom Atkinson has found bilateral carpal tunnel syndrome to be especially prevalent among those whose work involves computers, repetitive gripping and grasping of work related parts/tools, fine manipulation, and work with vibratory tools.

Symptoms: In addition to pain, the symptoms of carpal tunnel syndrome include numbness and tingling in the hands. These symptoms are usually felt in the first three fingers and the base of the thumb. Often the pain and other symptoms are worse at night or during sleep.

The figure below shows the parts of the hand and wrist that are involved. Tendons of the fingers, blood vessels, and the median nerve all pass through what is called the carpal tunnel. The carpal tunnel is formed by the carpal ligament in the wrist. Swelling and steady irritation of the tendons that pass through the carpal tunnel create pressure on the median nerve.

Risk factors: The major causes of carpal tunnel syndrome are:

• working with bent wrists;
• a high rate of repetition using the hands;
• vibratory tools;
• a lack of rest for the hands and wrists; and
• forceful hand motions.

All of these risk factors are not necessary to get carpal tunnel syndrome. For example, VDT operators get carpal tunnel syndrome even though modem computers only require a very light force to press the keys. The awkward posture, intense keying, and lack of rest periods are more than enough to cause problems.

Prevention: Carpal tunnel syndrome can be prevented by controlling the risk factors that cause the injury. This is done through the application of ergonomics.Ergonomics means changing the work to fit the worker, rather than making the worker try to fit the work. A comprehensive ergonomics program includes the following elements:

• Engineering controls: This means providing equipment to reduce exposure to risk factors. For example, computer operators need to be able to adjust the height of their chair and/or keyboard in order to avoid having to bend their wrists while keying. Other examples include ergonomically designed hand tools that have angled handles that allow workers to keep their wrists straight while using the tools. 
• Administrative controls: This refers to the pace of work, breaks, other tasks that do not require repetitious hand and wrist movements, and other factors about work organization. 
• Medical management: The management of CTS requires that a correct diagnosis is made and proper medical treatment and follow-up is provided. Working conditions that expose workers to risk factors need to be eliminated or reduced as much as possible. Without such changes, injured workers will still be exposed to the very conditions that caused the problems in the first place, and will likely cause the workers to be injured again. Having injured workers wear wrist braces and then continue to work under the same conditions that caused their injuries is not acceptable or appropriate medical management.

Early and proper treatment is important for this condition. Treatment should start out conservatively with rest and physical therapy. Surgery should not be the first choice. The person's job may have to be redesigned to remove or reduce risk factors at work. Otherwise, the symptoms are likely to get worse and require surgery to relieve the pain.

• Training: Workers and their managers need training about engineering controls, administrative measures, and medical management. Workers should know: how to recognize the signs and symptoms of CTS; who to report them to; how to adjust equipment; when to give their hands and wrists a rest from repetitious and/or forceful motions; and take other steps to prevent getting carpal tunnel syndrome. 
• Program Evaluation: The ergonomics program needs to be evaluated to find out if the number and severity of cases of carpal tunnel syndrome have been reduced. Accurate and complete records need to be kept in order to measure the effectiveness of the program.

If your have experienced bilateral carpel tunnel surgery in the past and were recently laid off OR you have any the symptoms decribed above I urge you to seek medical treatment immediately.  If you do NOT have health insurance please contact me and we can discuss whether your employers workers compensation insurance should provide for your treatment.  I may be reached directly by contacting me at 651-324-9514 (attorney Tom Atkinson) or through my web site www.mndisability.com  The attorneys at Minnesota Disability are available to meet with you throughout Minnesota, seven days a week!

GET PROMPT MEDICAL TREATMENT WITH PROVIDER OF YOUR CHOICE

An employee is entitled to payment of medical, psychological, chiropractic, and other treatment for a work-related condition. Minn. Stat. §176.135. This includes any treatment which is reasonable and necessary to cure and relieve the effects of a work injury.

Almost without exception, the injured worker has the absolute right to choose his or her treating doctor for a work injury. The employee can change doctors within 60 days after medical treatment has commenced, without getting the permission of the employer, insurer, or other interested parties. Minn. Rule Part 5221.0430, Subpart 2. After 60 days, the employee can change primary doctors, but only with the permission of the employer and insurer, or by seeking approval of the court. The rule provides that the employee may not change primary doctors if:

(a) A significant reason for the request is to block reasonable treatment or to avoid returning to work;

(b) The change is to develop litigation strategy rather than to pursue appropriate diagnosis and treatment;

(c) The provider lacks the expertise to treat the employee for the injury;

(d) The travel distance to obtain treatment is an unnecessary expense and the same care is available at a more reasonable location;

(e) At the time of the employee's request, no further treatment is needed; or

(f) For another reason, the request is not in the best interest of the employee and the employer.

In other words, even if the employee's initial treatment is at an emergency room or at an occupational medicine clinic favored by the employer, the employee can change doctors within 60 days. Choosing a qualified physician is important. A general orthopedic surgeon may not be you physician of choice if you have a complex hand injury. There are specialties within specialties and attorney Thomas Atkinson with Minnesota Disability can help you sort through this complex system.

Back & Neck Pain - Part II

Facet Joints

Lumbar facet joint are small pairs of joints on the back side of the spine where the vertebrae meet. These joints provide stability to the spine by interlocking two adjacent vertebrae. Facet joints also allow the spine to bend forward (flexion), bend backward (extension), and twist.

Inflammation of facet joints can occur from injuries or from arthritis. Many times, particularly in the case of injuries, one may not see abnormalities on an x-ray or MRI.

Spinal Stenosis
The term lumbar stenosis refers to any narrowing of the spinal canal. There are many causes of spinal stenosis; the most common is degeneration of the spine, which occurs almost inevitably as a part of the aging process.

Several factors contribute to the narrowing of the spinal canal with degenerative changes. First, wear and tear causes the facet joint to enlarge into the spinal canal. Second, the major ligament of the spinal canal, the ligamentum flavum, undergoes hypertrophy (enlargement) and buckling. Third, the intervertebral discs may bulge backwards or herniate into the canal. Fourth, the vertebrae may slip forward in a condition called spondylolisthesis. Finally, these changes may be superimposed on a congenitally narrow canal.

The hallmark of lumbar stenosis is pain in the back and legs which is aggravated by standing and walking and relieved by sitting or forward bending. The syndrome of pain induced by walking is known as neurogenic claudication (from the Latin claudico, to limp). Neurogenic claudication must be distinguished from is vascular claudication, or leg pain on walking caused by insufficient blood flow to the legs. The features which help to distinguish neurogenic from vascular claudication are the following:

1. Pain occurs after varying amounts of exercise, with standing, or with coughing. Vascular claudication is reliably produced with a fixed amount of exercise, such as walking a certain number of blocks, and is rare at rest.
2. Pain relief with rest is variable and slow, usually requiring sitting or stooping. Resting in a standing position is usually not enough to relieve the pain and may even aggravate the pain. In contrast, the pain of vascular insufficiency is usually quickly relieved by resting in a standing position. This is the main distinguishing feature.
3. Pain from spinal stenosis is usually in a distribution of a spinal nerve rather than the muscles exercised.
4. Sensory loss is also in a nerve root distribution, while with vascular insufficiency it is in a stocking-glove distribution.
5. Signs of vascular insufficiency should be absent: diminished pulses, foot pallor on elevation, and decreased temperature of the feet.

Spondylolysis and Spondylolisthesis
The most common cause of low back pain in adolescent athletes is a stress fracture in one of the vertebrae that make up the spinal column. Technically, this condition is called spondylolysis (spon-dee-low-lye-sis). It usually affects either the fourth or the fifth lumbar vertebra in the lower back. The fracture site is called a pars defect.

If the stress fracture weakens the bone so much that it is unable to maintain its proper position, the top vertebrae can shift forward on top of the bottom vertebrae. This condition is called spondylolisthesis (spon-dee-low-lis-thee-sis).

In adults, a spondylolisthesis is usually caused from degenerative changes in the spine. If too much slippage occurs, the bones may begin to press on nerves and surgery may become necessary to correct the condition.

Causes

• Genetics: There may be an inherited aspect to spondylolysis. An individual may be born with a thin vertebral bone and therefore may be predisposed to this condition. Rapid growth spurts in a teen may also encourage slippage.
• Overuse: Several types of athletics, such as gymnastics, weight lifting and football, put a great deal of stress on the bones in the lower back. They also require that the individual constantly over-stretch (hyperextend) the spine. In either case, the excessive stress can lead to fractures of the vertebrae.
• Spondylolisthesis may also develop because of degenerative changes in the vertebral joints and certain medical conditions such as cerebral palsy.

Sacroiliac Joints
The sacroiliac joint connects the sacrum (the triangular bone at the bottom of the spine) with the pelvis (iliac crest). The joint:

1. Transmits all the forces of the upper body to the pelvis (hips) and legs
2. Acts as a shock-absorbing structure
3. Does not have much motion

The sacroiliac joint can become inflamed from an acute injury or from chronic postural abnormalities such as undue stress on the joint following low back fusion surgery. Pain from sacroiliac joint abnormalities can occur in the low back, buttock/hip, abdomen, groin, or legs.

Ankylosing Spondylitis
Ankylosing spondylitis primarily affects the spine or back. In a person with ankylosing spondylitis, the joints and ligaments that normally permit the spine to move become inflamed and stiff. The bones of the spine may grow together, causing the spine to become rigid and inflexible. Other joints such as the hips, shoulders, knees, or ankles also may become involved.

Other rare causes of back pain include:

• Benign or malignant tumors
• Infections
• Problems of the digestive tract or genitourinary tract
• Vascular problems such as an aneurysm or hardening of the arteries

Back & Neck Pain - Part I

Causes of back pain

Muscles/Ligaments

There are many causes of back pain, the most common of which is a sprain or strain of muscles or ligaments. Muscle spasm can occur after twisting or bending awkwardly, or from a simple sneeze or cough. The majority of muscle spasms tend to get better over time. Severe cases of muscle spasms are treated with medication, physical therapy, or injections.

Discs

Disc Degeneration
Disc problems are common causes of back pain. Discs are usually moist, like a sponge with water in it. After a disc injury, or as we age, discs lose water and deteriorate in a process called disc degeneration.

The earliest form of injury to a disc is in the form of tears or fissures in the annulus fibrosis (outer portion) of the disc. The annulus fibrosis is like a large round ligament that prevents the nucleus pulposus (inner portion) of the disc from pushing outward. Tears in the annulus heal by scar formation resulting in tissue that is not as strong as normal tissue. The repeated cycle of many annular tears healing by scar formation lead to a disc that begins to degenerate.

As a disc degenerates it becomes stiff, narrows, and losses it's ability to act as a shock absorber. Bone from the vertebrae above and below the disc may grow forming bone spurs. If bone spurs get large enough, they may cause pressure on nerves in the spinal canal, causing pain, numbness, and weakness in the arms or legs. The combination of disc degeneration and bone spur formation in the spine is called spondylosis. Any narrowing within the spinal canal, from bone spur formation or from any other cause is called spinal stenosis. Spondylosis or spinal stenosis can occur at any level in the spine-cervical, thoracic, or lumbar.

Bulging Disc, Protruding Disc, Herniated Disc, Extruded disc
Over time, because of injury or degeneration, discs start to change shape. Many terms describe this change in shape including bulging, protruding, herniated, prolapsed, slipped. They generally describe a disc that is displaced beyond the limits of the intervertebral disc space.

The earliest change in shape many times is in the form of a disc bulge-a wide based extension of the disc. Often, disc bulges do not cause pain. As the degenerative process progresses, the central, nucleus pulposus portion of the disc can extend through a tear in the outer annular wall of the disc, resulting in a focal protrusion or herniation of the disc. Disc protrusions can cause symptoms of pain, numbness, or weakness from nerve root pinching. In some individuals however, disc protrusions will not cause any symptoms. A disc extrusion is a severe version of a disc protrusion in which a large portion of the nucleus pulposus is displaced through the wall of the disc. A disc extrusion is almost always symptomatic.

Work Injuries Can Develop Slowly Over Weeks or Even Years

Injuries are generally thought to be the result of a specific occurrence; i.e. you lift a heavy object at work and hurt your back.  However, Minnesota workers’ compensation law recognizes that not all injuries occur as the result of a single incident. Some injuries are the result of a degenerative process caused by the physical stresses of particular jobs over a period of time. These injuries are referred to in workers’ compensation parlance as “repetitive minute trauma,” or “Gillette” injuries.  Gillette injuries can develop over a few weeks or many years of trauma.  Injuries can occur to just about any part of your body and both the employee and his/her treating doctor generally overlook the cause.

Gillette injuries are as compensable as injuries that occur as a result of a specific occurrence.  Because of the nature of these injuries, however, the question arises as to the exact date of injury. This question is significant because generally it is the insurer covering you as of the “date of the injury” which is responsible for providing workers’ compensation benefits. The general rule holds that a Gillette injury has not occurred, or “culminated,” until the employee has either lost time from work or required a change of duties because of his or her physical condition. It should be noted, however, that there are frequent exceptions to this rule depending upon the facts of each individual case.

If you feel you may have sustained an injury over time as described above, please contact attorney Thomas Atkinson at MN Disability and we can examine your work history along with you doctor to investigate the possibility of an overlooked work injury.  Mr. Atkinson sees clients throughout Minnesota and the Twin Cities seven days a week and you can generally reach him in person by calling his office at 651-324-9514. You can also visit his web site www.mndisability.com

I Just Received a Notice of Intent to Discontinue Benefits in the Mail. What should I do now?

I was reminded about the importance of having an attorney review Notices of Intent to Discontinue benefits (NOIDs) after meeting with a new client this afternoon. An attorney who has been handling workers compensation cases as long as myself can look at a NOID and usually find a deficiency or mistake that can help avoid the IMMEDIATE cessation of benefits. If you receive wage loss benefits YOU WILL RECEIVE A NOID at some point in your claim if the insurer is compliant with Minnesota’s Workers Compensation Laws.

When you receive a Notice of Intent to Discontinue Benefits (NOID), you should probably contact an attorney to simply have them review it to ensure you don’t have any defenses. At MN Disability, attorney Tom Atkinson will review your NOID for FREE! The Notice of Intent to Discontinue benefits should be sent to you by mail, along with any supporting documents with which they are relying to stop you benefit payments. The document must also state in clear and concise language the basis for which they intend to discontinue your wage loss benefits.

Insurers often attempt to discontinue temporary total and temporary partial disability benefits for a variety of reasons. The most usual reasons are: reaching Maximum Medical Improvement, your return to work at full or reduced wages, release from work restrictions, or failure to cooperate with rehabilitation efforts. As in the case with my client today, the insurance company’s basis to discontinue benefits was improper on its face. In this instance the medical information referenced in the NOID was not attached by the inexperienced out of state claims handler. This error was compounded by other errors that will allow for additional defenses in the future.

As with most employee’s, you will receive no warning of the receipt of Notice of Intent to Discontinue your benefits. You simply find a letter from your workers compensation insurer along with a two page NOID with a sentence or two attempting to explain why your benefits are terminated. You have a right to immediately object to discontinuance. Though there are some exceptions, if you are not represented, you should IMMEDIATELY call the Minnesota Department of Labor and Industry at 1-800-342-5354 to object by telephone. Next, immediately contact an attorney to review the Notice of Intention to Discontinue benefits. If you do not prevail at the conference, it is a long road to appeal the decision and have the matter heard by a workers compensation judge. Though the time frame can vary, if you do not appeal the NOID within 12 days, you will need to retain an attorney to file an Objection to Discontinue benefits or file a Claim Petition.

Failure to object to a Notice of Intent to Discontinue Benefits can significantly delay your receipt of temporary total or temporary partial disability benefits. I strongly urge you take allow an attorney to provide a FREE review of your NOID to discuss options to the termination of you benefits. Attorney Tom Atkinson with MN Disability will directly take your call at 651-324-9514 EVERY DAY of the week. Don’t wait until Monday morning, call him today.

Temporary Partial Disability Wage Loss Benefits (TPD)

Temporary partial disability (TPD) is a wage-loss benefit payable to employees who are back to work, but earning less than their pre-injury gross weekly wage. It is payable at two-thirds of the difference between what the employee earned at the time of the injury and the current earnings. The benefits are payable only if the employee is employed. Be careful not to confuse "not being employed" with "being employed, but on vacation." If an employee who is collecting TPD takes one week of vacation, the employee is still employed and TPD should be paid for that week at an average weekly rate. TPD benefits can be paid concurrently with permanent partial disability (PPD).

Over the years, the laws regarding entitlement to TPD benefits have changed dramatically. Your injury may have included limitations on the duration of TPD benefits. It is important to remember that the date of injury controls many your rights to workers compensation benefits, so any potential limitations in effect on the date of the injury, may affect the length of payment of TPD. Just because a friend or neighbor is receiving a particular amount for a certain duration doesn’t mean you are limited or entitled to the same amount. That is why it is important to contact attorney Tom Atkinson and MN Disability to discuss your case today at 651-333-3636.

For injuries occurring on or after Oct. 1, 1992

TPD is limited to 225 weeks of paid benefits or 450 weeks after the date of injury, whichever occurs first. All periods of TPD for that date of injury are counted toward these limitations, except benefits paid during an approved training plan.

For injuries occurring on or after Oct. 1, 1995

176.101 Compensation Schedule (1995)
Subd. 2. Temporary partial disability.
(a) In all cases of temporary partial disability the compensation shall be 66-2/3 percent of the difference between the weekly wage of the employee at the time of injury and the wage the employee is able to earn in the employee's partially disabled condition. This compensation shall be paid during the period of disability except as provided in this section, payment to be made at the intervals when the wage was payable, as nearly as may be, and subject to the maximum rate for temporary total compensation.
(b) Temporary partial compensation may be paid only while the employee is employed, earning less than the employee's weekly wage at the time of the injury, and the reduced wage the employee is able to earn in the employee's partially disabled condition is due to the injury. Except as provided in section 176.102, subdivision 11, paragraph (b) and (c), temporary partial compensation may not be paid for more than 225 weeks, or after 450 weeks after the date of injury, whichever occurs first.
(c) Temporary partial compensation must be reduced to the extent that the wage the employee is able to earn in the employee's partially disabled condition plus the temporary partial disability payment otherwise payable under this subdivision exceeds 500 percent of the statewide average weekly wage.

Calculation of Average Weekly Wage (AWW)

As you can see from the statutory language, calculating your benefit amount can be very confusing. However, below is an example that may make it easier for you to understand.

For example, an employee earning $500 a week at the time of the injury is now earning $200 a week. The wage loss is $300 a week and the unadjusted TPD is two-thirds of that, or $200 a week. The $200 is multiplied by any annual adjustments that would apply.
Minnesota’s Workers’ Compensation laws are difficult for lawyers who dabble in workers compensation on occasion as a small part of their practice so it should be no surprise that it is difficult for the injured worker to understand. We can review you existing receipt of workers compensation benefits to ensure you are receiving the correct amounts. Minor mistakes by the insurance adjuster, such as improper calculation of your average weekly wage, can dramatically affect the amount of your benefits.

At MN Disability & Atkinson Law Offices representing injured and disabled workers is ALL we do. We don’t handle slips and falls, write wills or work on family law matters. We have chosen to focus on one area of the law for nearly two decades and that is why his peers have recognized Tom Atkinson as a Super Lawyer! Call 651-324-9514 or tom@mndisability.com

I've Been Injured At Work; Who Pays For My Medical Treatment?

I’ve been injured at work, who pays for my medical treatment?

NOT YOU! If the workers compensation carrier accepts your claim, ALL reasonable and necessary health care treatment related to your work injury must be paid. Unlike most health care plans, there are no deductibles or prepays involved. Fortunately, with few exceptions, you are entitled to choose your own doctor or health care provider to assist you in your recovery.

These are important facts to keep in mind:
1. Prescriptions and reimbursement for mileage to medical appointments are also payable;
2. The insurer may designate a pharmacy or pharmacies that you must use to obtain medicine for your injury, if the pharmacy is within 15 miles of your home;
3. You may choose your own health care provider under most circumstances; Be sure to advise you doctor or medical provider you are treating for a workers compensation injury and to be sure they sends all bills and supporting information to the insurer. The supporting information must explain how the treatments and charges relate to your work injury;
4. Your health care provider must notify the insurer before you have any surgery or hospitalizations, except in an emergency. You or the insurer may ask for a second opinion for any surgery that is not an emergency. The insurer must pay for the second opinion. You cannot be forced to have surgery if you do not want it;
5. Treatment by certain unlicensed complementary and alternative health care providers is not paid. This does NOT apply to chiropractic treatment. In Minnesota, the employer and insurer must provide up to 12 weeks of reasonable and necessary Chiropractic treatment.

What if my employer has a managed care plan?

Most employers do NOT participate in a workers’ compensation certified managed care plan. A certified managed care plan is an organization that has been certified by the state to manage health care for injured workers. Your employer must tell you if you are covered by a certified managed care plan. Some employers or insurers have contracted with a managed care plan or network of doctors who are not certified by the department. You are not required to receive treatment from a doctor in a plan or network that is not certified. If you are NOT required to participate in a managed care plan, you are strongly urged to obtain medical treatment with your regular doctor or clinic unless it is a medical emergency!
At MN Disability & Atkinson Law Offices representing injured and disabled workers is ALL we do. We don’t handle slips and falls, write wills or work on family law matters. We have chosen to focus on one area of the law for nearly two decades and that is why his peers have recognized Tom Atkinson as a Super Lawyer! www.mndisability.com

Layoff of Employees with Minnesota Workers Compensations Injuries

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In the first two months of this year, Minnesota lost 24,000 jobs across a multitude of areas including professional, manufacturing and government. It is important to remember that a lay off does NOT relieve an employer’s obligation to continue providing ongoing workers compensation benefits to an injured worker. What many Minnesotans don’t realize is that aside from unemployment benefits, they may be entitled to substantial workers compensation benefits for ongoing workers compensation injuries. These benefits could include wage loss benefits AND retraining. Minnesota’s Workers’ Compensation law permits laid-off workers to receive wage loss benefits, if a work injury affects their ability to find employment after being laid off. This is often not a very difficult burden to establish given this down economy. Unfortunately, injured workers are sometimes the first employees laid off by an employer despite claims otherwise.

Who is qualified for rehabilitation benefits?

A "qualified employee" entitled to receive rehabilitation services. Minnesota Rule 5220.0100(22) defines "qualified employee" as: An employee who, because of the effects of a work-related injury or disease, whether or not combined with the effects of a prior injury or disability:

A. Is permanently precluded or is likely to be permanently precluded from engaging in the employee's usual and customary occupation or from engaging in the job the individual held at the time of injury;

B. Cannot reasonably be expected to return to suitable gainful employment with the date-of-injury employer; and

C. Can reasonably be expected to return to suitable gainful employment through the provision of rehabilitation services considering the treating physician's opinion of the employee's work ability.

I’ve been laid off, now what do I do?

First, file for unemployment IMMEDIATELY. If you are not receiving workers compensation benefits at the time of layoff or are unsure about your eligibility, I encourage you to apply for unemployment. If you are later found eligible for unemployment, your receipt of workers’ compensation benefits will offset your unemployment benefit. Unlike unemployment, however, your workers compensation wage loss benefits are generally TAX FREE. You can apply online or by telephone by contacting the State of Minnesota through their web site www.uimn.org/ui/

Next contact our office and we will assist you in obtaining a copy of your employment and workers compensation files. With nearly two decades of experience handling cases involving injured worker, Thomas Atkinson and MN Disability can help explain whether your old or current injuries entitle you to rehabilitation benefits or a many other Minnesota Workers Compensation benefits. If you are found to be “qualified” you may be entitled to the assistance of a Qualified Rehabilitation Consultant who will act on YOUR behalf to help you find a new job or seek retraining opportunities. Injured workers entitled to rehabilitation benefits are often entitled to full-time wage loss benefits in the form of temporary total disability as well. If you have already found a new part-time or full time job you may still be entitled to rehabilitation assistance and other wage replacement benefits such as temporary partial disability benefits.

Remember that a lay off does NOT relieve an employer's obligation to continue providing ongoing workers' compensation benefits to an injured worker. If you suffer from the effects of a current or old workers compensation injury, and you have been laid off, call attorney Tom Atkinson at Atkinson Gerber Law Office TODAY for a free consultation. With nearly two decades of experience practicing in ONLY workers compensation, we know how to navigate the work comp maze. We have evening and weekend appointments open throughout Minnesota. tom@workcomplawyers.com or 651-333-3636.

Welcome to MN Disability's Minnesota Workers Compensation Blog

Minnesota Disability was founded with the sole goal of representing disabled and injured individuals living in Minnesota and Western Wisconsin. When Minnesota Disability represents a client, we take charge in preparing all the proper forms, filing the necessary papers, obtaining the medical and vocational evidence needed to support your claim, and aggressively pursue a favorable decision as our only objective. We have decades of experience in handling workers compensation cases from the administrative decision level up to the Minnesota Supreme Court. We also represent individuals who may be qualified to receive disability benefits from the United States Social Security Administration. In many of our Social Security cases, our clients never have to go to the Social Security office.

We are not a general practice law firm; rather, we focus on representing individuals in social security disability and Minnesota workers' compensation matters. By limiting our practice to these two specialties, Minnesota Disability will provide you with an experienced and focused approach to your issues. Minnesota Disability provides better service than general law firms or non-attorney disability groups. We don’t draft a will in the morning and fight traffic tickets in the afternoon. We are licensed attorneys that do one thing: represent injured and disabled individuals. We know disability, and we want to represent you.

Thomas Atkinson

Attorney Thomas Atkinson has over 2 decades of experience in handling workers' compensation disability matters. Tom brings a unique experience to his practice in previously representing employers and insurers in his practice AND having personally fought with these same insurance companies to obtain workers' compensation benefits for himself. This experience transformed his thinking. He understands the fear that comes when bringing a claim against one’s employer as well the frustration in dealing with a system that can appear stacked against the injured worker. Though Tom’s practice is now limited to representing the injured worker, he understands the “tricks” and tactics used by insurers and can use these experiences to your benefit. Tom runs a very efficient practice that allows personal attention to your matter. He is willing to meet with you anywhere in the metro area, or you can meet at his St. Paul location. You may contact Tom at 651-333-3636 or tom@mndisability.com or visit our website at www.mndisability.com.  There is never a fee unless we recover benefits for you.