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Workers' compensation -- Rehabilitation provider




Frequently asked questions -- General questions and issues

1. I have been working as a QRC intern for the past six months. When signing R-forms, reports     or correspondence is it OK to indicate "QRCI" after my name rather than "QRC intern"?


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A:  The rules require that the intern shall sign their name with the intern designation. As such, "QRC intern" should be written after your name (Minnesota Rules 5220.1400, Subp. 3a).

B:  Also, Minnesota Rules 5220.1803, Subp. 5 states, "the rehabilitation provider number assigned by the commissioner shall be on all reports submitted by the rehabilitation provider."

Example using A and B:  Valerie Bieser, QRC intern #313

 

 

2. Is it acceptable to use "client" versus "injured worker" in reports?


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The terms "client," "employee" and "injured worker" are used interchangeably throughout Minnesota 5220 rehabilitation rules. The department has no particular preference about the use of these terms by rehabilitation providers.

 

3. What is the definition of a required progress report (Minnesota Rules 5220.1802, subp. 3     and 4)?


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Minnesota Rules 5220.1802 refers to "required progress records" in some places and to "required rehabilitation reports" in other places.

According to Minn. Rules 5220.0100, Subp. 30, "required progress record" means a record maintained by the rehabilitation provider that documents the rehabilitation provider's services and the employee's rehabilitation progress. The record shall include all case notes and written reports, whether or not they are submitted to the commissioner, and all correspondence received or prepared by the rehabilitation provider about an employee's rehabilitation.

According to Minn. Rules 5220.0100, Subp. 31, "required rehabilitation report" means the rehabilitation consultation report, the plan progress report and any other report that must be submitted to the commissioner whenever a rehabilitation plan is initiated, proposed to be amended, suspended or closed, or when a change of assigned qualified rehabilitation consultant occurs on a case.

 

4. Are the R-form instruction pages to be filed with DLI along with the rehabilitation plan form?


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The instruction section of R-forms need not be forwarded to the department.

 

5. What is a reasonable service time charge for the new R-3 form?


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The department does not provide a specific billing guideline for the completion of any R-form.

 

6. What should the QRC do if a party does not sign an R-2 or R-3?


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If a party does not sign an R-2 or R-3, Minnesota Rules 5220.0410 and 5220.0510 specify what options are available to that person. The QRC would be encouraged to contact the party to see if there is an objection and if it can be resolved. If not, the objecting party must file a Rehabilitation Request for Assistance form with DLI within 15 days of receipt of the proposed plan.

 

7. The insurer's independent medical examination (IME) has released the employee to return to     work with restrictions, but the treating doctor has said "no work." Can the QRC proceed     with placement services?


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The definition of a "qualified employee" anticipated that the QRC consider the treating physician's opinion of the employee's work ability in conjunction with the provision of rehabilitation services. An IME physician is not a primary health care provider as defined in Minnesota Rules 5221.0430, Subp. 1. The health care provider directs and coordinates medical care for the employee; the IME physician is not a health care provider and provides no medical care on behalf of the employee.

Because an independent medical examination is part of claims adjustment, a QRC should not use the IME report recommendations to develop or implement the rehabilitation plan (Minnesota Rules 5220.1801, Subp. 8B).

If the insurer wants the IME report recommendations used to develop or implement the rehabilitation plan, the insurer may file a Rehabilitation Request form with the department. If ordered by a mediator/arbitrator or compensation judge, the QRC must then follow the IME physical restrictions.

 

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If you don't see your question answered here or want more information for rehabilitation providers, send an email message to DLI's Workers' Compensation Division or call (651) 284-5005, toll-free at
1-800-342-5354.

 



Frequently asked questions -- Rehabilitation consultation

1. How does an employee make a request for a rehabilitation consultation?


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Employees usually call the adjuster to ask for a consultation with a qualified rehabilitation consultant (QRC); most adjusters accommodate an oral request. However, as shown below, the rules anticipate the request will be in writing. A written request documents the date the request was made in the event of a dispute. No particular form is required.

Minnesota Rules 5220.0110, Subp. 6. Employee request for consultation. The employee may request a rehabilitation consultation by giving written notice to the insurer requesting a rehabilitation consultation. Notification of the request shall be filed with the commissioner.

 

2. Does a narrative report have to be attached to the Rehabilitation Consultation Report (RCR)     form? If so, how long does the report need to be?


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Minnesota Rules 5220.0130, Subp. 3(C) requires a narrative report to be attached to the RCR form explaining why the employee has or has not been found to be a qualified employee. There is no set length. However, the qualified rehabilitation consultant (QRC) needs to explain their rationale so the parties will understand how the decision was arrived at.

 

3. Does DLI grant extensions to the 14-day timeline for submission of the Rehabilitation     Consultation Report form to the department and all parties?


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The rules do not provide for extensions beyond the 14 calendar-days within which the consultation report must be "received" by the department.

 

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If you don't see your question answered here or want more information for rehabilitation providers, send an email message to DLI's Workers' Compensation Division or call (651) 284-5005, toll-free at
1-800-342-5354.

 



Frequently asked questions -- R-2 Rehabilitation Plan

1. A rehabilitation consultation was performed that determined the employee to be "qualified"     to receive rehabilitation services. However, prior to the development of the R-2     Rehabilitation Plan form, the treating physician determined the employee had no further     effects of the work injury and released him to return to work without any physical     restrictions. What R-form should be completed?


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In this situation, it is recommended the qualified rehabilitation consultant (QRC) review the new medical reports/records. If the QRC determines the injured worker is no longer a "qualified employee," the QRC should then submit an amended Rehabilitation Consultation Report form, with narrative report, stating the employee is not a qualified employee and, therefore, not eligible to receive rehabilitation services. Should any of the parties disagree with the QRC's amended assessment, they may contact the QRC to discuss their concerns and/or file a Rehabilitation Request for Assistance form with the department.

 

2. A rehabilitation consultation was performed that determined the employee to be "qualified"     to receive rehabilitation services. However, prior to the development of the R-2     Rehabilitation Plan form, the employee returned to a job with his pre-injury employer that     was within his physical restrictions and provided suitable gainful employment. Through     contact with the employee, he reported his return to work was going well. What R-form     should be completed?


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In this situation, it is recommended the qualified rehabilitation consultant (QRC) review the new medical reports/records. If the QRC determines the injured worker is no longer a "qualified employee," the QRC should then submit an amended Rehabilitation Consultation Report form, with narrative report, stating the employee is not a qualified employee and, therefore, not eligible to receive rehabilitation services. Should any of the parties disagree with the QRC's amended assessment, they may contact the QRC to discuss their concerns and/or file a Rehabilitation Request for Assistance form with the department.

 

3. What is required to be attached to the R-2 plan when it is filed?


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When the R-2 form is filed, Minnesota Rules 5220.1803, Subp. 5, requires an initial evaluation narrative report about the employee that includes the following information in summary fashion:  medical status, vocational history, educational history, social history, relevant economic factors, transferable skills, employment barriers and recommendations. Narrative information on the R-2 form itself does not satisfy this requirement.

 

4. When must a QRC send the R-2 form to the Safety and Workers' Compensation Division?


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Minnesota Rules 5220.0410, subp. 5, states in part:  "The assigned qualified rehabilitation consultant shall file the rehabilitation plan with the commissioner within 45 days of the first
in-person contact between the qualified rehabilitation consultant and the employee or within
15 days of circulation to the parties, whichever is earlier."

Therefore, qualified rehabilitation consultants (QRCs) should not file the R-2 form with the division at the same time it is circulated to the parties. Under Minnesota Rules 5220.0410, subp 5, the QRC must file the R-2 (or R-3) form at the following times, whichever occurs first:

  • when the parties have all signed it;

  • 15 days after circulation to the parties (or 15 days after recirculation if one of the parties proposed a change within the first 15 days); or

  • 45 days after the first in-person contact with the employee.

If the QRC does not have all of the signatures at the applicable 15- or 45-day filing deadline, the QRC must file the copy with the signature(s) that have been obtained along with a letter or other evidence of the date the plan was sent to each party as required by Minnesota Rules 5220.0410, subp. 6.

About online filing
When preparing the R-2 form online, the QRC should prepare the R-2 for circulation to the parties and then take the following steps:

  1. click "Previous" (not "finished");

  2. click "Save";

  3. click "Print" (to print the document for circulation to the parties; and

  4. when the earliest of the three filing events has occurred (all parties have signed it, 15 days after circulation or 45 days after the first in-person meeting) go back into the online R-2 form, complete the questions related to signatures and then click "finished." Clicking "finished" sends the document to DLI electronically. Do not click "finished" until one of the three filing events listed above has occurred.

-- DLI is revising the online R-2 form to make this process clearer. --

Remember to retain the original document with signatures in the event of a dispute about effective date.

 

5. What should I do if the insurer or employee does not sign and return the R-2 plan as     required within 15 days?


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Minnesota Rules 5220.0410, Subp. 6, requires the R-2 form to be filed with the department with evidence (i.e. copy of letter sent to the party, who didn't sign the R-form) of the date the plan was sent to each party. The plan will be deemed approved when received by the department.

 

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If you don't see your question answered here or want more information for rehabilitation providers, send an email message to DLI's Workers' Compensation Division or call (651) 284-5005, toll-free at
1-800-342-5354.

 



Frequently asked questions -- R-3 Rehabilitation Plan Amendment

1. How should an R-3 form be completed if there are more service categories to record than     there are lines on which to record them?


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A second page may be attached so that each of the individual services to be provided can be clearly identified. At the top of the page, list the employee's name, worker identification (WID) number or Social Security number (SSN), and date of injury. Provide complete information about each additional service category, plan completion date, cost information, etc., using the same format as on the R-3 form.

 

2. How does the online submission system accommodate the need for more lines to record     service categories on the R-3 form?


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The system was designed to add more lines when needed. Go to "Add link," which then allows additional services needed for the plan to be recorded.

 

3. When filing an R-3 form, under item 16 (plan costs to date), does this include
    vendor-placement costs and projections of costs to complete the plan?


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Yes. Minnesota Rules 5220.1802, Subp. 4, requires a placement vendor to submit progress reports and cost information directly to the qualified rehabilitation consultant (QRC) with copies to the employee, insurer and attorneys, and to the date-of-injury employer upon the employer's request. Due to this, the QRC should be able to report the current job placement costs easily.

 

4. Is an R-3 form required when there is a change of QRC within the same rehabilitation firm?


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Yes. Minnesota Rules 5220.0710, Subp. 2, and 5220.0510, Subp. 3a, require the new qualified rehabilitation consultant (QRC) to promptly file an R-3 form with the department indicating the QRC change.

 

5. When an R-3 Rehabilitation Plan Amendment form is filed for the purpose of extending the     existing plan, but there is no change in services, must the services be listed on the form?


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Yes. If the previous plan has expired, the qualified rehabilitation consultant (QRC) must complete a new R-3 form and provide identifying information, proposed amendment, rationale for the amendment, itemization of each rehabilitation service -- including registered rehabilitation vendor names, projected completion dates, costs, etc.

 

6. When may an R-3 Rehabilitation Plan Amendment form be used to fulfill the requirement for     filing a Plan Progress Report (PPR) form?


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Minnesota Rules 5220.0450, Subp. 3, states the Plan Progress Report form is not required to be completed if the R-3 plan amendment contains the information in subpart 2, items A through E, and is filed within 15 days before or 15 days after six months have passed from the date the rehabilitation plan was filed. On the R-3 form, questions 20 through 23 need to be answered.

 

7. On the R-3 form, explain box 23 further. Define or give examples of a barrier and measures     to be taken to overcome it.


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Examples of barriers to successful completion of the rehabilitation plan

  1. The employee continues to experience nonhealing of the lumbar fusion, beyond the doctor's original projection.

  2. The pre-injury employer reported there will not be a job for the employee to return to so she will need to find a new job.

  3. The treating physician, Dr. Smith, provided a diagnosis of severe depression.

  4. The unemployment rate in the 50-mile radius of the employee's home is averaging 10.5 percent. In conjunction with this, there are very few medium to large employers in the area with any job openings.

Examples of measures to be taken to overcome barriers

  1. The doctor has recommended the use of a bone stimulator two times a day for the next six weeks. Additionally, supplements have been prescribed to help with bone growth. If there is no improvement after six weeks, the physician indicated a bone density scan may be required.

  2. Approximately one month before the employee is released to work with limitations, job-seeking skills will be initiated so there will not be a delay in job-search activities.

  3. The employee is receiving medication management from psychiatrist Dr. Jones and psychological treatment from psychologist Ms. Bieser for depression.

  4. The placement specialist will be instructed to actively discuss on-the-job training with prospective employers to enhance the employee's employment opportunities.

 

8. What would be an example of a case that does not have barriers to successful completion?


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If the injury is healing in a predictable fashion and the employer and employee are cooperating in the return-to-work effort, there may be no barriers to report.

 

9. For the barriers and measures comments on R-3, can these attachments be handwritten?


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Typed information is preferable, with a type size of 11. However, there is nothing in the rules that requires information to be typed. If handwriting is used, it must be legible, per Minnesota Rules 5220.1802, Subp. 1.

 

Ask a question


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If you don't see your question answered here or want more information for rehabilitation providers, send an email message to DLI's Workers' Compensation Division or call (651) 284-5005, toll-free at
1-800-342-5354.

 



Frequently asked questions -- R-8 Notice of Rehabilitation Plan Closure

1. If an employee no longer wishes to have rehabilitation assistance, can the file be closed?     What closure category should be used on the R-8?


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There is no obligation for an employee to accept vocational rehabilitation assistance. However, under some circumstances, refusing rehabilitation services could adversely affect an employee's entitlement to other workers' compensation benefits. The QRC should suggest the employee consult with their attorney and/or contact the Department of Labor and Industry about such consequences.

A QRC may only close the case if the employee, employee's attorney and the insurer agree, using the category of agreement of the parties. See Minnesota Rules 5220.0510, Subp. 7 C, Closure report by assigned qualified rehabilitation consultant.

 

2. If an award on stipulation for settlement has been issued, according to the parties, can an
    R-8 form to close the rehabilitation file be submitted to the department even if the QRC has     not received a copy of the stipulation?


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If you have the word of the employee, and/or the employee's attorney, and insurer that an award on stipulation or a mediation award has been issued that closes out entitlement to future rehabilitation benefits, you may close a rehabilitation case and check box B (Award on stipulation/mediation) in item 21 on the R-8 form. You do not have to have a copy of the stipulation in your possession.

Note:  Document the source, who reported the award and the reason for closure of the rehabilitation plan in the R-8 summary of rehabilitation services report (Minnesota Rules 5220.0510, Subp. 7F(4)).

 

3. Is the R-8 narrative report to discuss all the services provided during the rehabilitation plan     from start to finish?


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Yes. Minnesota Rules 5220.0510, Subp. 7F(4) requires the QRC to provide a summary of the rehabilitation services provided and rehabilitation costs by all rehabilitation providers.

 

4. The insurers informed the QRC that they have negotiated a settlement of the employee's     rehabilitation plan, which closes the rehabilitation plan. Due to the reported settlement, the     QRC was instructed to file an R-8 to close the employee's rehabilitation plan. Can the plan be     closed and, if so, what should be marked on the R-8 form under item 21?


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If a settlement plan has occurred, but an award has not yet been issued, the QRC may close the rehabilitation plan with the consent of the employee, the employee's attorney and the insurer. The QRC would check box "d" (Employee and insurer have agreed to close the plan) in item 21 on the R-8 form.

If the employee and/or the employee's attorney do not agree to closure, an R-8 form cannot be filed.

Note:  Document the source, who reported the settlement and the reason for the closure of the rehabilitation plan in the R-8 summary of rehabilitation services report; Minnesota Rules 5220.0510, Subp. 7F(4).

 

Ask a question


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If you don't see your question answered here or want more information for rehabilitation providers, send an email message to DLI's Workers' Compensation Division or call (651) 284-5005, toll-free at
1-800-342-5354.

 



Frequently asked questions -- Plan Progress Report

1. On the Plan Progress Report form, explain box 26 further. Define or give examples of a     barrier and measures to be taken to overcome it.


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Examples of barriers to successful completion of the rehabilitation plan

  1. The employee continues to experience nonhealing of the lumbar fusion, beyond the doctor's original projection.

  2. The pre-injury employer reported there will not be a job for the employee to return to so she will need to find a new job.

  3. The treating physician, Dr. Smith, provided a diagnosis of severe depression.

  4. The unemployment rate in the 50-mile radius of the employee's home is averaging 10.5 percent. In conjunction with this, there are very few medium to large employers in the area with job openings.

Examples of measures to be taken to overcome barriers

  1. The doctor has recommended the use of a bone stimulator two times a day for the next six weeks. Additionally, supplements have been prescribed to help with bone growth. If there is no improvement after six weeks, the physician indicated a bone density scan may be required.

  2. Approximately one month before the employee is released to work with limitations, job-seeking skills will be initiated so there will not be a delay in job-search activities.

  3. The employee is receiving medication management from psychiatrist Dr. Jones and psychological treatment from psychologist Ms. Bieser for depression.

  4. The placement services will be instructed to actively discuss on-the-job training with prospective employers to enhance the employee's employment opportunities.

 

2. What would be an example of a rehabilitation file that does not have barriers to successful     completion?


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If the injury is healing in a predictable fashion and the employer and employee are cooperating in the return-to-work effort, there may be no barriers to report.

 

Ask a question


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If you don't see your question answered here or want more information for rehabilitation providers, send an email message to DLI's Workers' Compensation Division or call (651) 284-5005, toll-free at
1-800-342-5354.

 



Frequently asked questions -- Job placement

1. May an employee decline job placement services?


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Yes. An employee may decline any and all vocational rehabilitation services. However, declining vocational services may be to the employee's disadvantage. A qualified rehabilitation consultant (QRC) should explain the services in detail to the employee, answer any questions the employee has about the services, provide the employee with the phone number to the DLI Alternative Dispute Resolution unit, and encourage the employee to discuss the situation with one of the mediators, to completely understand how declining such services may impact the employee's workers' compensation claim. If the employee is represented by an attorney, the employee certainly should discuss the situation with the attorney before making the final decision about declining available services.

If the employee (or the insurer) disagrees with any major part of the rehabilitation plan, any party or the QRC may file a Rehabilitation Request form and, if necessary, DLI or the Office of Administrative Hearings (OAH) will then decide the issue.

 

2. When an employee with an ongoing rehabilitation plan is laid-off due to economic reasons,     is he or she entitled to placement services?


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Yes. At this point, the qualified rehabilitation consultant (QRC) would propose an R-3 rehabilitation plan amendment to reflect a change in the vocational plan. The services listed in number 18 would include job-seeking-skills training, job placement services, etc.

 

3. The treating physician released the employee, with an ongoing rehabilitation plan, to "full     duty" with the date of injury employer. What rehabilitation or placement services would the     employee be entitled to?


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The term "full duty" is not found in the workers' compensation statutes or rules. As such, use of the term is confusing and should never be relied upon.

The qualified rehabilitation consultant (QRC) should follow up with the physician to determine what exactly the doctor meant by the phrase "full duty." For instance, was the employee released back to his sedentary job, but would have had physical limitations if working at a different job? Or was the employee released to work for any job without any physical restrictions?

Following this, the QRC should determine if the employee still meets the definition of being a "qualified employee" (Minnesota Rules 5220.0100, Subp. 22). If the answer is yes, then the employee should be provided ongoing rehabilitation services to facilitate a return to suitable gainful employment (Minnesota Rules 5220.0100, Subp. 34).

 

4. The insurer's independent medical examination (IME) has released the employee to return to     work with restrictions, but the treating doctor has said "no work." Can the QRC proceed     with placement services?


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The definition of a "qualified employee" anticipates that the QRC consider the treating physician's opinion of the employee's work ability in conjunction with the provision of rehabilitation services. An IME physician is not a primary health care provider as defined in Minnesota Rules 5221.0430, Subp. 1. The health care provider directs and coordinates medical care for the employee; the IME physician is not a health care provider and provides no medical care on behalf of the employee.

Because an independent medical examination is part of claims adjustment, a QRC should not use the IME report recommendations to develop or implement the rehabilitation plan (Minnesota Rules 5220.1801, Subp. 8B).

If the insurer wants the IME report recommendations used to develop or implement the rehabilitation plan, the insurer may file a Rehabilitation Request form with the department. If ordered by a mediator/arbitrator or compensation judge, the QRC must then follow the IME physical restrictions.

 

5. What is the role of the registered rehabilitation vendor in providing placement services?


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See Minnesota Rules 5220.1250 Roles of registered rehabilitation providers. Job placement vendors further need to be mindful of the following rules.

Rule definitions

Vendor services (if within the rehabilitation plan)

Communications

Prohibited conduct

 

6. What are the reporting requirements for vendors when the injured worker is not     participating in the rehabilitation plan?


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The rehabilitation provider should continue to objectively state what is actually happening with the case. If concerns develop about the employee's fulfillment of agreed upon activities, it is suggested the vendor, QRC and employee discuss the rehabilitation plan, the goals established and each of the parties agreed upon efforts to facilitate the employee's return to suitable gainful employment. Also at this time, there may be value in determining if there should be a formal change in the plan to reflect new directions.

If the employee continues to disagree with the direction of the plan or has questions about his or her rehabilitation plan the employee should be encouraged to contact their attorney (if retained) or the department's hotline at 1-800-342-5354. If this does not resolve the situation, the employee, QRC or another party can file a rehabilitation request form for assistance from the department.

 

Ask a question


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If you don't see your question answered here or want more information for rehabilitation providers, send an email message to DLI's Workers' Compensation Division or call (651) 284-5005, toll-free at
1-800-342-5354.



Frequently asked questions -- Retraining

1. What are the Poole factors the Workers' Compensation Court of Appeals applied to     retraining plans and are currently used when considering approvals?


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The Poole factors are found in the case of Poole v. Farmstead Foods, Inc., 42 W.C.D. 970, 978 (WCCA 1989). In that case, the Workers' Compensation Court of Appeals identified factors to be considered in determining whether retraining is appropriate. The factors include:

  1. the reasonableness of retraining as compared to returning to work with the employer or other job placement activities;

  2. the likelihood the employee has the ability and interest to succeed in a formal course of study in a school;

  3. whether retraining is likely to result in reasonably attainable employment; and

  4. whether retraining is likely to produce an economic status as close as possible to that which the employee would have enjoyed without disability.

 

2. If a retraining plan has been signed by all parties (i.e. employee, insurer and QRC) will the     department automatically sign and approve the plan?


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No, see Minnesota Rules 5220.0750, Subp. 5, Retraining plan approval

 

Ask a question


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If you don't see your question answered here or want more information for rehabilitation providers, send an email message to DLI's Workers' Compensation Division or call (651) 284-5005, toll-free at
1-800-342-5354.

 



Frequently asked questions -- Rehabilitation plan disputes

1. Are rehabilitation providers expected to physically attend rehabilitation conferences at the     443 Lafayette Road N. location or can they attend by telephone?


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The QRC is expected to be available in-person or by telephone for rehabilitation conferences addressing eligibility and rehabilitation plan disputes. Attendance in person is preferred.

 

2. When a QRC is sent a notice for a non-rehabilitation conference, must the QRC attend?


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If an attorney or adjuster wants a rehabilitation provider to attend a hearing of any type and is willing to pay the provider's hourly fee, the provider should plan to attend. If the parties see no reason for a rehabilitation provider to attend, there is probably no reason to do so. If possible, a rehabilitation provider should be available by phone during the time, in case an issue arises for which the provider would have valuable input.

 

Ask a question


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If you don't see your question answered here or want more information for rehabilitation providers, send an email message to DLI's Workers' Compensation Division or call (651) 284-5005, toll-free at
1-800-342-5354.

 

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