Current through Register Vol. 49, No. 39, March 24, 2025
Subpart
1.
Form.
When an employer or insurer denies liability for a
work-related injury, it shall serve and file the documents prescribed by this
part.
Subp. 2.
Denial
of liability form.
A denial of primary liability under Minnesota Statutes,
section
176.221,
subdivision 1, except a letter denial under subpart 4 or 5, must be fully
completed and on a form prescribed by the commissioner, containing
substantially the following:
A.
information identifying the employee, employer, insurer, and any adjusting
company;
B. the date of the claimed
injury;
C. claim numbers or
codes;
D. the name and telephone
number of the person who made the determination;
E. a specific reason for the denial which
must be in language easily readable and understandable to a person of average
intelligence and education and a clear statement of the facts forming the basis
for the denial. A denial which states only that the injury did not arise out of
and in the course and scope of employment or that the injury was denied for
lack of a medical report, for example, is not specific within the meaning of
this item;
F. a copy of a medical
report or summary of any health care provider contact which forms a basis for
the denial; and
G. instructions to
the employee if the employee disagrees, including the availability of
rehabilitation benefits, the statute of limitations for filing a workers'
compensation claim, and the address and telephone numbers of division offices
the employee may contact for information.
Subp. 3.
Notice of intention to
discontinue benefits.
A denial of primary liability filed more than 60 days after
notice to or knowledge by the employer of a work-related injury which is
required to be reported to the commissioner under Minnesota Statutes, section
176.231,
subdivision 1, and for which benefits are being paid must be made by a notice
of intention to discontinue benefits under part 5220.2630 and must clearly
indicate that its purpose is to deny liability for the entire claim.
Subp. 4.
Letter denial for
new period of temporary total.
A denial of liability for temporary total disability benefits
for a new period of lost time due to a previous work-related injury must be in
writing and include:
A. information
identifying the employee, employer, insurer, and any adjusting
company;
B. the date of the claimed
injury;
C. claim numbers or
codes;
D. the signature, name, and
telephone number of the person who made the decision; and
E. a specific reason for the denial in
language easily readable and understandable to a person of average intelligence
and education and a clear statement of the facts forming the basis for the
denial.
Subp. 5.
Letter denial for other benefits.
A denial of liability for a portion of benefits or any other
compensation where primary liability has been accepted must be in writing and
include:
A. information identifying
the employee, employer, insurer, and any adjusting company;
B. the date of the claimed injury;
C. claim numbers or codes;
D. the signature, name, and telephone number
of the person who made the decision; and
E. a specific reason for the denial in
language easily readable and understandable to a person of average intelligence
and education and a clear statement of the facts forming the basis for the
denial.
Subp. 6.
Service.
The employer or insurer shall serve on the employee the form
or letter under subparts 1 to 5 with any relevant medical or other reports
attached and file a copy with the division.
Subp. 7.
Time for filing.
Denials of liability must be filed with the division within
the following time limits:
A. Where
appropriate, a denial under subpart 2 must be filed with the commissioner and
served on the employee within 14 days of notice to or knowledge by the employer
of an injury which is required to be reported to the commissioner under
Minnesota Statutes, section
176.231,
subdivision 1. Where appropriate, a denial under subpart 2 must be filed with
the commissioner and served on the employee within 30 days after notice or
knowledge where an extension has been requested in the event of a new period of
temporary total or if payment has commenced. When payment of compensation has
commenced, a denial more than 60 days after notice or knowledge must be filed
under subpart 3.
B. A denial of
liability under subpart 3 must be filed with the commissioner and served on the
employee in accordance with part 5220.2630, subpart 4.
C. A denial of liability under subpart 4 must
be filed with the commissioner and served on the employee within 14 days of
notice or knowledge of a new period of lost time due to a previous work-related
injury unless an extension is requested under Minnesota Statutes, section
176.221,
subdivision 1.
D. A denial under
subpart 5 must be filed with the commissioner and served on the employee within
the time frame required by statute for the type of benefit being
denied.
Subp. 8.
[Repealed, 18 SR 2546]
Subp. 9.
Penalty; timeliness.
Failure to pay or deny in a timely manner may result in the
assessment of the penalties in parts 5220.2770 and 5220.2790.
Subp. 10.
Penalty; frivolous
denial.
A. A frivolous denial under
Minnesota Statutes, section
176.225,
subdivision 1, clause (a) or (e), includes one which:
(1) does not state facts indicating that an
investigation has been completed or that a good faith effort to investigate has
been attempted; or
(2) states a
basis which is a clearly inaccurate statement of fact or the applicable
law.
B. In addition to
any workers' compensation benefits due and a penalty under subpart 9, a penalty
may be assessed by the division or compensation judge under parts 5220.2760 and
5220.2770 and Minnesota Statutes, sections
176.221,
subdivision 3a, and 176.225, subdivision 1, for a frivolous denial.
Subp. 11.
Penalty;
nonspecific denial.
A nonspecific denial as defined in subpart 2, item E; 4, item
E; or 5, item E, may result in the assessment of a penalty in the amount of
$500 under Minnesota Statutes, section
176.84,
subdivision 2. A penalty for a nonspecific denial may be assessed without
regard to the substantive validity of the denial of benefits. A penalty under
this subpart may be assessed in addition to the penalties described in subparts
9 and 10 and is payable to the commissioner for deposit in the assigned risk
safety account.
Statutory Authority: MS s
14.388;
175.17;
175.171;
176.129;
176.138;
176.221;
176.225;
176.231;
176.238;
176.83;
176.84
