General FAQ’s

General FAQ’s About Workers’ Compensation

  • If the claim is for record only /incident only, meaning no medical attention is required or going to be obtained, the claim will be put in a “suspended or closed status” and nothing further will occur. Should the injured worker decide to seek medical attention, please notify TBG Claims as such.
 
  • If the injury requires medical attention outside of your facility, the claim will be created as a “medical only” unless it is determined that there will be compensable lost time (more than 3 consecutive days away from work). Any medical treatment incurred will be paid off of the claim. A letter of acknowledgement will be sent to you with the claim number and name of the adjuster. You can call the NurseCare Hotline if medical advice is needed for non-life threatening injuries by calling: 1-844-412-7951. If you are a member of the UCWCP, please see the medical providers listed on their website for an EPO provider that the injured worker can be referred to.
 
  • If the injury is or will become lost time, it will be created as an “indemnity” claim. An indemnity reserve will be set and lost time benefits will be paid off of the claim per the MN statute. A letter of acknowledgement will be sent to you with the claim number and adjuster name. Lost time payments need to be made within 14 days or the State could penalize both TBG and the employer, so timely claim filing is essential.
  • For the safety and work-life integrity of the employee, ensure that appropriate medical care is obtained before filing a First Report of Injury (FROI).
 
 
  • Complete the First Report of Injury completely and file the claim as soon as possible following the incident, so the claim can be set up and managed appropriately. ***
 
 
  • Let your claims adjuster know who the appropriate point of contact is and keep this updated.
 
  • Notify the adjuster of any medical treatment or lost time as soon as possible.
 
 
  • Provide the adjuster with any medical updates, return to work slips, or employment changes.
 
 
  • Provide light /limited duty within the established restrictions when possible to avoid lost time payments or additional claim costs/assessments. Call the adjuster with any questions.
 
 
  • Communicate with the injured employee regularly if possible; this keeps you informed, and keeps them engaged and feeling that they are valued, and motivates them to return to work.
 
 
  • Work with the QRC /Rehab person if assigned to the claim.
 
 
  • If you receive any legal documents or requests for information from anyone other than TBG, please contact your TBG claims adjuster before responding, and they will assist you.
 
  • Employees should NOT report their own claim.
 

*** It is important for you to fill out as much of the First Report of Injury as you can regardless of whether the claim is lost time, medical only, or Record only. This will not only help in setting up the claim faster, but will also ensure appropriate benefits are delivered timely and also comply
with the State of Minnesota requirements when the claim is submitted to them.

  • Contact the employer, injured worker, and medical provider, confirm / provide claim information.
 
  • Determine whether or not claim is compensable and manage the claim to established guidelines.
 
  • Determine if resources are needed to manage the claim, ie: Nurse, QRC, Defense Attorney, etc.
 
  • Obtain wage information from the member and calculate the benefits owed as applicable.
 
  • Work with the member to get the employee back to work as soon as medically released.
 
  • Manage the litigation process as necessary.
 
  • Coordinate resources and follow up for claim finalization or settlement as applicable.
  • Report the claim to the employer timely.
 
  • Obtain timely and appropriate medical treatment for the injury, and attend all medical appointments to maximize recovery from the injury.
 
  • Provide all workability reports to the employer to confirm medical and disability status.
 
  • Cooperate with QRC /Rehab individuals, the employer, and TBG claims.
 
  • Return to work as soon as released and don’t work outside of any established medical restrictions.
  • In Minnesota, the Initial Date Disability Began is always the first date of any claimed lost time or wages due to the injury, whether or not it was a full day or authorized by a health care professional. This date is also always the first day of the Waiting Period, regardless of whether the employee returns to work on that day. The Waiting Period is always three consecutive calendar days, regardless of whether the employee returns to work and/or was scheduled to work on any of those days. It is important to note that counting the Waiting Period and owing benefits for the Waiting Period are two separate issues.
  • Lost time benefits are generally calculated based on the employee’s average weekly earnings for the 26 weeks prior to the date of injury. The employer provides that information to the claims department. The “AWW” is then multiplied by 2/3 (.666) and the result is the temporary total disability or TTD rate, subject to state maximum. If there is a return to work at less than full time or pay, temporary partial disability or TPD is paid until full pay is reached. This payment is determined from the gross weekly earnings, which need to be supplied to the TBG claims department.
  • Lost time benefits begin on the 4th day of disability following the three day waiting period. The first payment is due by the 14th day following the first day of lost time. If the disability lasts beyond 10 calendar days, the three day waiting period is also then paid. No workers’ compensation benefits are paid for the first three days of disability unless the disability lasts beyond 10 days. An injured worker must be medically authorized off of work to be paid.
  • An employers’ actual knowledge of the occurrence of the injury by the employer, or written or verbal notice to the employer by the injured worker or a dependent or someone on behalf of either. Notice can be given to anyone at the employer such as a foreman, supervisor, lead, manager, human resources, etc. This should trigger the filing of a First Report in Injury.
  • A QRC is a Qualified Rehabilitation Consultant. They are licensed by the State of MN and are mandated on certain claims. They work as a liaison between the employee, employer, and insurance company. Their job is essentially to communicate the status of the individual and coordinate the return to work at the employer. In the event that a return to the date of injury employer is not possible, the QRC will coordinate job search or other activities necessary that lead to successful re-employment.
  • Notify the TBG claims department in all instances where information is being requested from you other than from TBG or TBG defense counsel, or if you receive any legal /litigation notices such as a Claim Petition or Rehabilitation Plan, etc. The claims adjuster will provide you with any necessary direction relative to this. If the situation requires legal representation, the TBG claims department will assign an attorney who will then follow up with you as needed.