August 2004

Minnesota Department of Labor and Industry

CONTENTS
2 Electronic data interchange: faster, cheaper and
more accurate

3 Submitting retraining plans so all parties benefit

3 Coming soon — advanced-level Compliance TABLES

Services training 13 Number of medical-issue complaints by
type of complainant, 2000-2003
4 Results of 2004 Special Compensation Fund
assessment 14 Complaint cases closed Jan. 1, 2002,
through Dec. 31, 2003
5 Workers' compensation primary liability determination
21 Statewide average weekly wage

12 FAQs: primary liability determination 22 Compensation rates as of Oct. 1, 2004

13 DLI action on medical-issue complaints 23 Number and incidence rate of

musculoskeletal disorders in Minnesota
19 Request for comments: possible amendments to rules involving days away from work

20 Free publications available online 24 WMSDs in the United States, Minnesota

and neighboring states, private
employers, 2002
21 New benefit and provider fees levels effective
October 2004

23 Ergonomics disorders: 40 percent of all Minnesota

days-away-from-work cases

D-1 Court decisions: April through June 2004

Work comp
primary DLI action on
liability medical-issue
determination complaints Court decisions:
April through June 2004

5 13 D-1
 Electronic data interchange:
faster, cheaper and more accurate

By Cindy Valentine, Chief Information Officer vision. Staff members in DLI's Information
Information Technology Services Technology Services (ITS) unit have been working
on ways to increase the amount of FROI data
Electronic data interchange received via EDI and to enhance the DLI technical
(EDI) is a way of transmitting environment to enable more of the work to be
data electronically between done electronically. ITS staff members have been
two entities or trading planning and implementing technical solutions,
partners. At the Department including adding a secure FTP server and an ANSI
of Labor and Industry (DLI), it translator, to the ways the department accepts data.
means the receipt of first report of The department hopes to implement these technical
injury (FROI) data from seven enhancements by March 2005.
insurers.
DLI currently employs IAIABC Release 1 for
An insurance company can receipt of FROI data. Along with increasing the
transmit a stream of data containing number of technical solutions available for current
information about at least one injury, and up to and potential trading partners, DLI staff members
many injuries, to an electronic mailbox. DLI in ITS and the Workers’ Compensation Division
automatically retrieves files from the mailbox two are reviewing data elements and programs to
times each business day (7 a.m. and 4:30 p.m.) plan migration to either IAIABC Release 1.2 or,
and the data is transmitted directly to the workers’ ultimately, Release 3. Both releases provide for
compensation database. DLI received about 15 more and larger data fields that may address some
percent of the total FROI data submitted in 2003 concerns potential trading partners have. It would
via EDI. also accommodate subsequent reporting, following
submission of the FROI. This would allow trading
Data received via EDI is generally more accurate partners to send additional data electronically. No
than data received on a paper form. The programs firm dates have been set for beginning this phase
that transmit the data to and from the mailbox of the EDI expansion efforts; however, an internal
contain editing programs that catch any serious or review has been completed.
obvious errors. Insurers can find out quickly if their
FROI has been received at the department; they EDI, as well as the Web-based FROI form, has
receive an acknowledgement electronically from set the stage for a streamlined, customer-focused,
DLI when it has been accepted. Finally, it costs the
electronic environment at DLI. The future holds
department about 75 percent less to process an EDI
even more electronic business-processing,
FROI than it costs to process a paper FROI. including expanding EDI to more customers and
forms, and adding additional Web applications.
Doing business with customers electronically is DLI's goal is to offer customers faster, cheaper
a centerpiece of Governor Pawlenty’s technology and more accurate ways of doing business.

2 • COMPACT • August 2004

 Submitting retraining plans so all parties benefit
By Ed Spitler, Rehabilitation Specialist
Compliance Services

Retraining is often an important

part of a rehabilitation plan
focused on helping an
injured worker return
to suitable gainful
employment.
During the first six
months of 2004, 37 retraining
plans were submitted by qualified
rehabilitation consultants (QRCs) to the
Department of Labor and Industry. As of this
date:
• Twelve training plans were approved, with
all parties in agreement or after a Decision
and Order or Findings and Order approved
the retraining plan.
Coming soon
The Department of Labor
and Industry's Compliance
Services unit is finishing work
on advanced-level training
materials regarding permanent
partial disability (PPD) payment
and the PPD schedules.
Compliance Services hopes to offer the
half-day training sessions in the fall. Check
the DLI Web site for more information:
www.doli.state.mn.us/wctrain.html.

• Four retraining plans required no action because settlements were reached.

• Fourteen of the plans are in dispute and have been or will be scheduled for a conference.

• Seven of the plans are awaiting approval by the insurer.

One obstacle when approving or denying retraining plans arises when plans are submitted without
all the signatures and with no indication of whether all parties are in agreement. If the parties are in
agreement, all designated parties should sign the plan before it is submitted for approval.

Ideally, the plan should be signed by the QRC and employee before it is sent to the
insurer. Failing that, the R-14 form can be sent in twice, once with the employee’s
signature and once with the QRC’s signature.

Please do not include any information that was previously submitted; we don’t
want two sets of everything in the system. If the parties disagree, a Rehabilitation
Request for Assistance form needs to be filed with the retraining plan
and attachments unless a claim petition or rehabilitation request has
already been filed by another party.

We realize retraining plans take a lot of hard work and effort on your
part. It’s great to see you taking all rehabilitation services into account
when other options aren’t working.

3 • COMPACT • August 2004

Results of 2004 Special Compensation Fund assessment
By John Kufus, Accounting Officer
Financial Services

The Special Compensation Fund (SCF) assessment funds Minnesota's workers' compensation
programs. Most of the assessment dollars go to funding the supplementary and second-injury benefit
programs. The assessment also pays the operating expenses of the Workers' Compensation and
OSHA divisions of the Department of Labor and Industry, the Workers' Compensation Court of
Appeals and portions of the Department of Commerce and the Office of Administrative Hearings.

As a result of legislation by the 2002 Minnesota Legislature, the assessment process has changed.
Companies are no longer required to report on a semi-annual basis. The reporting is now done on an
annual basis and the reports are due by April 1 of each year.

The Special Compensation Fund assessment is now directly invoiced by the Minnesota Department
of Labor and Industry. The first half of the assessment is due Aug. 1 of that year. The second billing
is due Feb. 1 of the following year.

The estimated state fiscal-year 2005 funding requirement for SCF was determined to be $104
million. The liability was divided between the insurers and self-insurers by the ratio of their 2003
indemnity payments to the total indemnity reported by both groups.

2003 Ratio Estimated DSR pure

indemnity liabilities premium
Insurers $309,671,598 76.47% $ 79,524,000 $720,747,228
Self-insurers $ 95,310,832 23.53% $ 24,476,000
Total $404,982,430 100.00% $104,000,000 $720,747,228

Insurer premium surcharge rate

The insurer premium surcharge rate applied for the purpose of determining the Special
Compensation Fund assessment was 11.0335 percent. The rate was determined by dividing the
insurer portion of the SCF state fiscal-year 2005 liability ($79,524,000) by the 2003 designated
statistical reporting pure premium reported by all insurers to the Minnesota Workers' Compensation
Insurers Association ($720,747,228).

Self-insured assessment rate

The imputed self-insured assessment rate was 25.6802 percent. It was determined by dividing the
self-insured portion of the Special Compensation Fund state fiscal-year 2005 liability ($24,476,000)
by the total 2003 indemnity reported by the self-insured employers ($95,310,832).

Call Jim Feckey, SCF director, at (651) 284-5455, if you need further information.
 Workers' compensation primary liability determination
By Beth Hargarten, Assistant Commissioner
Workers' Compensation Division

Editor's note: This information contains portions of an article previously

published in COMPACT (August 2002) and written by former Assistant
Commissioner Gary Hall. The information is intended to give insurers and self-
insured employers some direction regarding the information the Department of
Labor and Industry (DLI) looks for when evaluating the sufficiency and validity
of denials of primary liability. DLI believes this article may be particularly
helpful for those insurers that are working with a variety of different workers’
compensation laws. The examples cited are not rules and any denials filed that are
similar to the examples would continue to be evaluated on a case-by-case basis.
However, the examples are intended to give our stakeholders a better sense of the
types of denials we receive and the issues we see with them.

DLI's goal is to improve the quality of denial notices by providing a framework

for understanding, evaluating and communicating the underlying basis for a
particular denial. Accomplishing this goal will require increased educational
efforts, increased compliance efforts and, most of all, cooperation with and
a commitment from those stakeholders that file denials with the agency. This
information sheet can be used as both a reference tool and a training or
discussion resource.

What injuries are compensable?

Injuries or occupational diseases that arise out of and in the course
of employment are compensable under the Minnesota Workers’
Compensation Act. For an injury to be compensable, it is sufficient
that the employment is a substantial contributing factor to the
condition or to an aggravation or acceleration of a pre-existing
condition.

It is not necessary that the employment be the only cause of the

condition. The Workers’ Compensation Court of Appeals indicated
in Vanda v. Minnesota Mining & Manufacturing:

The long-standing rule, applied by this court in

numerous cases, is that when the usual tasks ordinary
to an employee’s work substantially aggravate,
accelerate or combine with a pre-existing disease or
latent condition to produce a disability, the whole
disability is compensable, no apportionment being
made on the basis of relative causation of the pre-
existing condition and the work activities.

There are four types of compensable injuries.

1. Specific injuries include those injuries that arise out of a

specific event.

5 • COMPACT • August 2004

 CA/CS: Interaction with DLI

2. Cumulative trauma injuries DLI's Customer Assistance (CA)

arise out of and in the course of
job duties that cause cumulative
repetitive minute trauma. An
example of this would be carpal
tunnel syndrome.
3. Occupational injuries arise out of
and in the course of employment
and are peculiar to the occupation
in which the employee is engaged
and due to causes in excess of the
hazards ordinary of employment.
Asbestosis could be considered an
occupational injury.
4. Consequential injuries are
subsequent injuries that are a
direct and natural consequence
of a previous compensable injury.
Hip or back problems as a result
of an altered gait caused by leg
injury could be considered a
consequential injury.
unit may contact the author of a
denial concerning its content, after
receiving a call from a claimant
concerning the denial.
DLI’s dispute prevention and
resolution specialists will try to
clarify the issues surrounding the
denial, particularly those issues
that could lead to the conclusion
that the denial is nonspecific or
frivolous.
The specialists may suggest the
use of mediation as a method for
resolving the problem; mediation
is a service DLI provides.
Contacts from DLI's Compliance
Services (CS) unit may come
as a result of a review of claims
files, customer contacts and
penalty referrals. The compliance
officers often seek information to
determine whether a penalty is
appropriate.

When are insurers to make primary liability determinations?

Minnesota Statutes §176.221, Subd. 1, provides: “Within 14 days
of notice to or knowledge by the employer of an injury compensable
under this chapter the payment of temporary total compensation shall
commence.” If liability is denied, the insurer is required to file a Notice
of Insurer’s Primary Liability Determination (NOPLD) form with the
department and serve a copy on the employee, indicating the basis for
its denial of liability. If there is a basis to deny, denials must be served
on the employee and filed with the department within 14 days of notice
to the employer or knowledge by the employer of a claimed injury that
is required to be reported to the department.

The same statute also states that if the insurer has commenced payment
of compensation, but determines within 60 days of notice to or
knowledge by the employer of the injured worker that the disability is
not the result of a work-related injury, payment of compensation may be
discontinued solely by filing of a NOPLD form giving the reasons and
facts for the denial within 60 days of notice or knowledge. This provides
an opportunity for an insurer that completes an investigation after the
initiation of payment of benefits to submit another NOPLD form if facts
are discovered that provide a basis for denial of the claim.
 Denials of liability
An NOPLD form denying the claim as not compensable must cite
the legal basis and state, in detail, the facts forming the basis for
the denial. Denials lacking a legal and factual basis are subject to
penalties under M.S. Chapter 176. Specific reasons must be provided
that explain why the claimed injury was determined not to be
within the scope and course of employment. Any legal and factual
basis for the denial must also be clear, so the injured worker and
the department can understand the reason without further inquiry.
Denials lacking a specific reason are subject to penalties under M.S.
Chapter 176.

If a claim appears to be questionable, but the insurer does not have a

valid reason to deny the claim, the statute allows the insurer to accept
liability and begin any appropriate payments, and then deny the claim
within the 60 days noted above by filing an NOPLD form if a valid
reason for denial is obtained. To discontinue payment and deny the
claim after the 60 days, the insurer must file a Notice of Intention to
Discontinue Workers' Compensation Benefits (NOID) form.

What are nonspecific or frivolous denials and prohibited

practices related to denials?
When the department reviews denials of primary liability to
determine whether they conform with the law, it takes into
consideration the type of injury and facts surrounding the reporting
of the injury.

The following are some of the statements the department sees on

denials, along with the reason why that statement – by itself – is not
a statement of fact or does not provide a specific legal basis for a
denial.

• “The injury did not arise out of and in the course of

employment.”
Minnesota Rules, part 5220.2570, Subp.2 E, indicates “a denial
that states only that the injury did not arise out of and in the
course of employment ... is not specific within the meaning of
this item.”

• “The injury was not caused, aggravated or accelerated

by work activities.”
This does not provide a legal and factual basis for the denial.

• “We respectfully deny the employee is entitled to work

comp benefits.”
This does not provide facts to support that the work injury did
not occur.

7 • COMPACT • August 2004

 • “The employee was not credible.”
This does not provide a factual basis for the doubts about the
employee’s credibility.

• “In spite of repeated calls, the employee has not been

available.”
This does not provide facts to support that the work injury did not
occur.

• “The injury was idiopathic.”

This statement is an acknowledgement an injury occurred, but does
not indicate why it was determined to be not work-related. Also, use
easily understandable terms.

• “There was no witness to the injury.”

This statement does not provide a factual and legal basis that the
injury did not arise out of and in the course of employment. It may
have been a fact, but it does not provide a legal basis. There is
no requirement in the workers’ compensation law that an injury be
witnessed; it may well be compensable although no other person
witnessed it.

• “We have no medical information that relates the injury

to the employment” or “We do not have any medical
reports that support the claim.”
Minn. Rules, Part 5220.2570, subp 2E, indicates a denial that states
only that the injury was denied for lack of a medical report is not
specific within the meaning of this item. If the denial is based on a
medical reason, the medical report that provides the basis for the
denial should be attached.

A medical report is not always a necessity in order to accept

liability. If a medical report is necessary to determine
compensability but is not available, state on the denial why a
medical report is needed, who was contacted about the report, when
this request was made, etc. If a medical report is not necessary, the
specific reasons for the denial need to be explained. If the medical
report is available, it needs to be sent with the denial.

Other invalid denial statements

Sometimes, denials indicate an investigation is not complete and is
continuing. Even though the investigation is continuing, a denial that
includes this language still must have a specific and valid legal and
factual basis for denying the claim. Examples of statements that need
additional specific and valid legal and factual bases include:

• “This investigation continues.”

 • “We are in the process of a full investigation."

• “This claim is under investigation.”

• “Conditional denial: We have not obtained the medical

records.”

• “We will need to review the medical reports.”

• “An authorization to obtain medical records for a pre-existing

condition has been sent.”

• “This claim is disputed until the results of an IME can be

reviewed.”

Denials are sometimes based on facts that – by themselves – do not

provide a legal basis for a denial. Examples of statements that do not
provide a legal basis for the denial include:

• “The employee had a pre-existing condition.”

• “The employee did not comply with the company’s policy of

reporting injuries.”

• “The employee did not go directly to a doctor.”

• “The injury was not reported to the employer until after the
medical treatment was sought by the claimant.”

• “The employee did not seek treatment for two weeks and was
able to continue working."

• “The employee did not miss time from work until weeks after
the injury.”

• “The employee has been terminated by the employer.”

• “The employee refused light-duty work.”

• “The employee is getting disability benefits from the employer.”

• “All medical bills have been submitted to the health insurer.”

• “There is no medical documentation that the employee should

be off work due to the work injury.”

9 • COMPACT • August 2004

What are the penalties related to denials?
The Department of Labor and Industry can issue penalties for prohibited
practices and late, nonspecific and frivolous denials. The department’s
review of denied claims takes into consideration the type of injury and
facts surrounding the reporting of the injury. There are various penalties
that apply to denials of primary liability; there may be multiple penalties
related to one denial. The statutory provisions and rules that include
penalties related to denials include the following:

Nonspecific denials
M.S. §176.221, Subd. 1 – A notice of denial of liability
must state in detail the facts forming the basis for the
denial and specific reasons explaining why the claimed
injury or occupational disease was determined not to be
within the scope and course of employment and shall
include the name and telephone number of the person
making this determination.

M.S. §176.84, Subd. 1 – Specificity required – Notices of

discontinuance and denials of liability shall be sufficiently
specific to convey clearly, without further inquiry, the
basis upon which the party issuing the notice or statement
is acting. If the commissioner or compensation judge
determines that a notice or statement is not sufficiently
specific to meet the standard under this section, the
notice or statement may be rejected as unacceptable
and the party issuing it shall be informed of this. The
rejected notice or statement may be amended to meet the
requirement of this section or a new one may be filed.

Minn. Rules, Part 5220.2570, Subp.2, Denial of liability

form – A denial of primary liability under M.S. §176.221,
subdivision 1, must be fully completed and on a form
prescribed by the commissioner, containing substantially
the following:

• 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 that 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
from any health care provider contact that
forms the basis for the denial.

Minn. Rules, Part 5220.2570, 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.

Frivolous denials
M.S. §176.225, subd. 1, Grounds – Upon reasonable
notice and hearing or opportunity to be heard, the
commissioner, a compensation judge, or upon appeal,
the court of appeals or the Supreme Court shall award
compensation, in addition to the total amount of
compensation award, of up to 30 percent of that total
amount where an employer or insurer has:

• (e) frivolously denied a claim. (For the

purpose of this section, “frivolously” means
without a good faith investigation of the facts
or on a basis that is clearly contrary to fact or
law.)

Minn. Rules, part 5220.2570, Subp. 10, Penalty;

Frivolous denial –

A. A frivolous denial under M.S. §176.225,

subdivision 1, clause (a) or (e), includes one that:
(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.

Prohibited practices, denials

M.S. §176.194, subd. 3, Prohibited conduct – The
following conduct is prohibited:

(4) filing a denial of liability for workers’

compensation benefits without conducting an
investigation.
See the frequently asked questions about primary liability
determination on the next page.
11 • COMPACT • August 2004
 FAQs: primary liability determination
Q. A.
It’s the 14th day, I just got the First
Report of Injury form and I haven’t been
able to contact anyone. It looks like there is
lost time beyond the waiting period. What
should I do?
A. You can choose to either commence
payment and then deny liability later if
necessary, by filing another NOPLD form
within 60 days, or you can deny liability
making sure the reasons are legal and factual,
as well as specific. If your determination is
not made within the 14-day period, you run
the risk of being penalized for a late payment
or late denial of benefits.
Q. The employer said to deny the claim. Is
that all I need to do?
A. You must still conduct an investigation
of the claim. Any denial must be based
on legal and factual reasons.
Q. I have no medical reports and haven’t
been able to speak to the health care
provider. Can I deny the claim just because I
don’t have the reports?
A. Decide if it is necessary to have the
medical reports to determine liability.
Why are the reports necessary? The law
allows you to obtain relevant health care
provider reports within seven days. You may
contact DLI for help in obtaining medical
records. If you choose to deny, be specific in
your reasons to deny, explain why the reports
are necessary and what health care provider
contact attempts have been made. For another
option, see the answer to the first question.
Q. Despite all the information I have, I still
feel the claim should be denied. Can I do
this?
12 • COMPACT • August 2004
A denial must be based on legal and
factual reasons and must also be specific.
Basing a denial only on your “feeling” alone
would not be appropriate.
Q. It’s now the 14th day. I’ve begun the
investigation and I don’t have all the
answers to my questions. What are the
options?
A. You can choose to either commence
payment and then deny liability later, if
necessary, by filing another NOPLD form
within 60 days or you can deny liability
making sure the reasons are legal and factual,
as well as specific. If your determination is
not made within the 14-day period, you run
the risk of being penalized for a late payment
or late denial of benefits.
Q. I denied a claim that had only a small
amount of lost time and medical bills.
New information has become available that
makes me question my earlier decision, but
isn’t persuasive enough for me to change
my mind. The injured worker has mentioned
getting an attorney. What are my options?
A. You can continue to investigate the
claim to get additional information that
will help with your decision making. You can
wait to see if a claim petition is filed and deal
with the expense of defending the denial.
Mediation is also an option where the parties
can work toward a mutual resolution of the
claim.
DLI's Customer Assistance unit offers
mediation services. For more information,
call (651) 284-5032 or 1-800-342-5354.
More information is also available online at
www.doli.state.mn.us/irdspres.html.
 DLI action on medical-issue complaints
By Sandra Keogh, Medical Compliance Specialist
Compliance Services

The Minnesota Department of Labor and Industry (DLI) enforces

compliance with workers’ compensation laws and rules by health
care providers (Minnesota Statutes §176.103; Minnesota Rules
part 5221.8900) and certified managed care organizations (M.S.
§176.1351; Minn. Rules parts 5218.0800 and 5218.0900). The
disciplinary process is delineated in these laws and rules.

The department also has authority to investigate complaints of

noncompliance with workers’ compensation laws and rules under
M.S. §176.251. The department investigates complaints about
insurers’ or employers’ noncompliance concerning medical issues.

Anyone may file a complaint with DLI about a health care provider, certified managed care
organization, employer or insurer. The number of complaints received from various types of
complainants is detailed in Table 1.

Table 1. Number of medical-issue complaints by type of complainant, 2000-2003

Year Employer Health Employee Certified DLI Other** Total

or care or managed
insurer provider attorney care plan*
2000 25 3 8 0 2 0 38
2001 36 5 3 2 2 0 48
2002 34 5 9 0 2 1 50
2003 12 4 6 0 1 0 24

*A certified managed care organization is an entity that has a contract with an insurer to provide certified managed
care plan coverage to an employer's employees under M.S. §176.1351.

**Other entities may include a qualified rehabilitation consultant, or a preferred provider network or case
management vendor that is not a managed care plan certified under M.S. §176.1351.

The number of complaints received and investigated by a medical compliance specialist gradually
increased from 1996 to 2002. DLI began documenting complaints alleging a violation of a workers’
compensation medical rule in 1996. The number of complaints submitted by insurers and self-
insured employers increased more than other types, possibly because insurers are more aware of this
resource within DLI. The most frequent complaint from insurers and self-insured employers was that
a health care provider did not respond to their request for a permanent partial disability (PPD) rating.

The number of recorded complaints about medical issues dropped by half from 2002 to 2003. A
likely reason for this drop in complaints is that DLI staff reductions necessitated procedural changes
in how complaints are processed. In early 2003, the process for handling an insurer’s request for
help in obtaining a PPD rating was decentralized. Prior to 2003, these insurer letters were processed
13 • COMPACT • August 2004
 and tracked by a medical compliance specialist as alleged violations of Minn. Rules part 5221.0410.
Now these insurer letters are distributed to the auditors within Compliance Services. The auditors
assist the insurer in obtaining a PPD rating; however, the identity of the provider and the outcome are
not centrally recorded or tracked. Thus, the 2003 decrease in the number of complaints from insurers
about noncompliant health care providers is likely due to changes in the department’s recordkeeping.

Complaint outcomes

An individual complaint may allege several violations of workers’ compensation statutes or rules.
During the course of an investigation, additional noncompliance issues by the subject of the
complaint are sometimes identified. However, only the most serious outcome is recorded for each
complaint.

All information about a complaint is private unless disciplinary action, such as a hearing or penalty,
occurs. This report contains summary information about medical complaints closed by a medical
compliance specialist between Jan. 1, 2002, and Dec. 31, 2003.

Table 2. Complaint cases closed, Jan. 1, 2002, through Dec. 31, 2003

Subject of Closed as Closed with Closed with Total closed

complaint unsubstantiated instruction discipline
or dismissed
Health care 32 31 5 68
provider
CMCO* 4 5 0 9
Employer/insurer 8 1 0 9
Other** 0 1 0 1
Total 44 38 5 87

*A certified managed care organization (CMCO) is an entity that has a contract with an insurer to provide certified
managed care plan coverage to an employer's employees under M.S. §176.1351

**Other entities may include a qualified rehabilitation consultant, or a preferred provider network or case
management vendor that is not a managed care plan certified under M.S. §176.1351.

Forty-four complaints closed in the two-year period (2002 and 2003) were dismissed. A complaint
may be dismissed if the complainant does not provide information necessary to investigate the
complaint. A complaint also may be dismissed if the alleged violation or noncompliance is not
supported by information obtained through investigation. Finally, the department may dismiss a
complaint if there is litigation on related issues or the department does not have jurisdiction to
proceed.

In some cases, a violation cannot be substantiated or discipline is not warranted, but the subject
may not have acted optimally. A letter of instruction may be sent to the subject of the complaint
to identify the issues or actions that contributed to the problem and recommend actions that could
reduce the likelihood of similar complaints. A letter of instruction is not a disciplinary outcome.
Thirty-eight complaints were closed with a letter of instruction to the subject of the complaint.

14 • COMPACT • August 2004

 Complaints closed with discipline are those complaints where the investgation supports that a
violation or noncompliance with a workers' compensation statute or rule has occurred. Disciplinary
actions that the department may take are specified by statute or rules and may include a warning,
penalties, a hearing under M.S. Chapter 14 at the Office of Administrative Hearings or a stipulated
agreement that often requires behavioral change and payment of a fine. Five complaints were closed
with a stipulated agreement.

Complaints closed in 2002 and 2003 that resulted in a letter of instruction or discipline, are
summarized below.

Closed complaints about health care providers

Complaints about health care providers most frequently involved one of three issues:

1. Failure to respond to a request for a required report from the insurer or employer

Minn. Rules part 5221.0410 requires a health care provider to respond to a request for required
information on a prescribed form (Health Care Provider Report and Report of Work Ability) within
10 days.

The most frequent complaint about health care providers is failure of

a health care provider to respond to an insurer’s request for required
medical information (usually a permanent partial disability (PPD) rating)
on the Health Care Provider Report form. During 2002 and 2003, DLI
recorded 33 such requests for assistance from insurers.

Outcome: In all recorded cases, the provider submitted the requested

PPD and/or maximum medical improvement (MMI) information to
the requestor, or to DLI following a written request. Nineteen of the 33
cases were closed with a letter of instruction to the health care provider
concerning her or his responsibility to promptly respond to the employer,
insurer or department’s request for information on a Health Care Provider
Report form. A penalty was not warranted on any of these complaints.

2. Attempting to collect from an employee payment for services related to a condition accepted
by a workers’ compensation payer

M.S. §176.136, subd. 2, and Minn. Rules part 5221.0500, subp. 3, prohibit a health care provider
from attempting to collect payment from an employee or any other source, for charges that exceed
the maximum specified in Minn. Rules part 5221.0500, subp. 2.

M.S. §176.135, subd. 7, and Minn. Rules part 5221.0700, subp. 2, prohibit a health care provider from
attempting to collect payment from an employee before submitting an appropriate record to the insurer.

Investigation into collections complaints indicates two factors are predominant:

(a) The employee does not inform the health care provider that the condition is work-related;
15 • COMPACT • August 2004
 (b) Today’s health care provider often uses a complex administrative support system, including
central billing, payment and medical records systems. These administrative systems may
be in different locations or even different cities or states. The various units may not coordinate
their functions to ensure records are sent with a bill or that a request for records to the billing
office is forwarded to the medical records department. In two cases, the provider did not
properly credit payment to the account for more than a year, because the patient’s account
number did not accompany the payment.

Outcome: In six complaints, the provider was instructed to develop and implement internal
procedures for workers’ compensation claims, including:
• bill the workers’ compensation insurer directly;
• on the bill, instruct the payer to remit payment with the statement so the appropriate account
is identified;
• submit an appropriate record with the bill or promptly upon request;
• respond promptly to calls and letters concerning billing problems; and
• do not automatically channel identified WC claims to a collection agency.

3. Failure to respond to a request for existing medical records

M.S. §176.138 provides that release of existing written medical data related to a current claim
for workers’ compensation to the employer, insurer, employee or to the Department of Labor and
Industry shall not require prior approval of any party to the claim. Health care providers must
provide existing written medical data within seven days of a written request.

Minn. Rules part 5221.0700, subp. 2, requires providers, except hospitals, to supply an appropriate
record with the bill. Hospitals must provide the medical record upon request by the payer.

Health care providers have been more reluctant to release medical information since the federal
Department of Health and Human Services implemented Standards for Privacy of Individually
Identifiable Health Information under the Health Insurance Portability and Accountability Act
(HIPAA) in April 2003. Any entity covered by HIPAA regulations may incur significant penalties for
violation of the HIPAA privacy rule.

HIPAA provides an exception for workers’ compensation: a provider may disclose protected health
information as authorized by, and to the extent necessary to comply with, laws relating to workers’
compensation.

Some health care providers refused to release requested medical records without the employee’s
signature on a valid authorization form. These providers were often unaware of the HIPAA workers’
compensation exception and the relevant Minnesota laws. In other cases, the provider’s medical
record unit neglected to ensure the requested record was sent.

Outcome: Four complaints were closed with a letter of instruction explaining the Minnesota laws
requiring release of medical data related to a current claim for compensation. “Law change: A
primer about HIPAA and Minnesota workers’ compensation,” (COMPACT, May 2003) is often sent
with the letter of instruction.

16 • COMPACT • August 2004

 Complaints against health care providers closed with discipline

1. Provider billed for services using an inappropriate billing code

Minn. Rules part 5221.0700, subp. (3), requires that a provider assign the correct approved
billing code in effect on the date of service using the appropriate provider group designation and
the instructions in the fee schedule. Subp. 3, C (5), requires that services provided by a licensed
chiropractor must be coded using the procedure codes listed in Minn. Rules part 5221.4060.

Three providers were engaged in a business where a physician prescribed treatment and the
treatment was provided by a licensed chiropractor. The chiropractor’s services were coded using
the physician codes. Under the fee schedule the physician codes were reimbursed at a higher rate
than chiropractor codes. The treatment was incurred in 2000, prior to the Minnesota fee-schedule
amendment effective Jan. 1, 2001, which changed chiropractor codes to CPT codes.

Outcome: A stipulated agreement provided for a $1,000

penalty against each of the three health care providers.

2. Provider billed for services actually provided by

someone else and provider did not direct or supervise
the services provided

Minn. Rules, parts 5221.0700, subp. 2(A)(1), and

5221.0700, subp. 3(C)(1), require direct billing by the
provider actually providing the service.

The provider arranged for electrodiagnostic testing of an employee with a diagnostic testing
company. Under the provider’s contract with the diagnostic testing company the provider rented
the equipment and the services of a technician to perform the testing. The provider allowed the
technician to change the order to allow testing of additional areas in accordance with the testing
company’s protocol. The provider billed the workers’ compensation insurer an amount exceeding
the cost for rental of equipment and services of a technician. The testing company billed the insurer
separately for interpreting the results of the test.

Outcome: There were two separate complaints. In each case the provider entered into a stipulated
agreement based on the facts of each case. One provider paid a penalty of $300; the other paid a
penalty of $600.

Closed complaints about certified managed care plans

Complaints about certified managed care plans concerned the plan’s medical case management
function. The following managed care rules are pertinent to these complaints:

M.S. §176.1351, subd. 2, (1), provides a certified managed care plan is required to ensure an
employee receives quality medical and health care services that meet uniform treatment standards in
a manner that is timely, effective and geographically convenient for the worker.

M.S. §176.1351, subd. 2 (6), and Minn. Rules part 5218.0100, subp. 1, K, state that a certified
managed care plan must provide aggressive case management for employees, a program of early
17 • COMPACT • August 2004
 return to work and cooperative efforts by the workers, employer and the managed care plan to
promote workplace health and safety consultative and other services.

Minn. Rules part 5218.0760, subp. 1, describes the role of a medical case manager as one who must
monitor, evaluate and coordinate the delivery of quality, cost-effective medical treatment and other
health services needed by an injured employee, and must promote an appropriate, prompt return
to work. Medical case managers must facilitate communication among the employee, employer,
insurer, health care provider, managed care plan and any assigned qualified rehabilitation consultant
to achieve these goals.

Employees or their attorneys’ complained that the nurse case manager inappropriately directed the
employee’s treatment by restricting employee access to a health care provider or that the nurse case
manager inappropriately communicated with the employee or a health care provider.

Outcome: Letters instructed the plan to initiate and maintain communication with all parties on
any medical or return-to-work issues and to work diligently with the parties to resolve concerns and
disputes.

Closed complaints about employers and insurers

1. Employer or insurer directed employee to a designated health care provider

M.S. §176.135, subd. 1 (f), provides that an employer may require that treatment and supplies
required to be provided by this section be received in whole or in part from a managed care plan
certified under section 176.1351, except as otherwise provided by that section.

Some insurers have contracted with a network of providers for primary care or specific services, such
as diagnostic radiology. The insurer required an injured employee to receive care from one of the
network providers.

Outcome: A letter of instruction informed the insurer that while it may contract with a network of
providers, the insurer must not require employees to receive medical services from the provider
network unless the employer is covered by a certified managed care plan.

Conclusion

Investigation of complaints serves three purposes. First, problems in specific claims are identified
and the behavior is corrected through instruction or discipline. If the noncompliance is repeated, the
department may consider past complaints when similar problems are reported. Second, Compliance
Services may identify recurring problems or trends that may be addressed proactively with training
to help prevent future problems and complaints. Compliance Services provides training to adjusters
and health care providers about medical issues, including communication and billing requirements,
the medical fee schedule, treatment parameters and certified managed care. Third, DLI considers
issues raised in complaints when reviewing workers’ compensation rules for any necessary
amendments.

Please direct complaints or questions about the medical complaint program to Sandra Keogh,
medical compliance specialist, by phone at (651) 284-5173 or 1-800-342-5354, or by e-mail at
sandra.keogh@state.mn.us.
18 • COMPACT • August 2004
 Request for comments
Possible amendments to rules governing pharmacy
services and fees, certified managed care plans
Request for comments on possible amendment
to rules governing: Pharmacy Services and Fees,
Minnesota Rules, part 5221.0700 and 5221.4070;
and Certified Managed Care Plans, Minnesota
Rules, chapter 5218
Subject of rules
The Minnesota Department of Labor and
Industry requests comments on its possible
amendment to rules governing pharmacy services
and fees. Although amendment of all rules
governing pharmacy billing and payment are
being considered, the department is specifically
considering changing the maximum fees for
payment of drugs and supplies prescribed for
treatment of workers' compensation injuries in
Minnesota Rules part 5221.4070. The department
is also considering amendments to the rules
governing certified managed care plans under
Minnesota Statutes §176.1351. Although all
aspects of the certified managed care rules may
be considered for amendment, the department is
specifically considering the following amendments:
eliminating the requirement in Minn. Rules
5218.0600 prohibiting certified managed care
plans from negotiating fees with its participating
providers; accepting credentialing or approval by
established credentialing organizations or other
state agencies in lieu of some requirements in
the certified managed care rules; clarifying how
pharmacies fit into certified managed care plan
networks; amending managed care plan reporting
and filing requirements; revising the requirements
for utilization and peer review; and clarifying
application of the employee notice requirements in
Minn. Rules part 5218.0250.
Persons affected
The rule amendments would likely affect
participants in the workers' compensation system,
including injured employees; employers; workers'
compensation insurers; pharmacies, and hospitals
and other health care providers that dispense drugs
19 • COMPACT • August 2004
or fill prescriptions for injured workers; workers'
compensation certified managed care plans; and
health care providers who treat injured workers
covered by certified managed care plans.
Statutory authority
Minnesota Statutes §176.136, subdivisions 1(a)
and 1b(c), and §176.83, subdivision 4, authorize
the commissioner to establish maximum fees for
services, articles and supplies used to treat work-
related injuries. Minnesota Statutes §176.1351,
subdivision 6 authorizes the commissioner to adopt
rules necessary to implement certified managed care
plans. Minnesota Statutes §176.83, subdivisions
1 and 15 authorize the commissioner to adopt,
amend or repeal rules to implement the workers'
compensation law, and to prescribe forms and other
reporting procedures to be used by providers and
others subject to the workers' compensation law.
Public comment
Interested persons or groups may submit comments
or information about these possible rules in writing
or orally until further notice is published in the
State Register that the department intends to adopt
or to withdraw the rules. The department does not
contemplate appointing an advisory committee to
comment on the possible rules.
Rules drafts
The department has not yet prepared a draft
of the possible rule amendments. Drafts of the
amendments, when available, will be posted on the
department's Web site at www.doli.state.mn.us.
Agency contact person
Written comments, questions, requests to receive
a draft of the rule amendments when they are
prepared and requests for more information about
these possible rules should be directed to: Kate
Berger, Legal Services, Minnesota Department of
Labor and Industry, 443 Lafayette Road N., St.
Paul, MN 55155. Comments can also be submitted
Comments to page 20
 Comments from page 19

to Berger by phone at (651) 284-5295; by fax at (651) 284-5725; or by e-mail at kate.berger@state.mn.us.

TTY users may call the department at (651) 297-4198. Questions about these possible rules can also be
directed to Sandra Keogh, Compliance Services, at (651) 284-5173 or at sandra.keogh@state.mn.us.

Alternative format
Upon request, this Request for Comments can be made available in an alternative format, such as large print,
Braille or audiotape. To make such a request, contact the agency contact person at the address or telephone
number listed above.

Note
Comments received in response to this notice will not necessarily be included in the formal rulemaking
record submitted to the administrative law judge when a proceeding to adopt rules is started. The agency
is required to submit to the judge only those written comments received in response to the rules after they
are proposed. If you submitted comments during the development of the rules and you want to ensure that
the Administrative Law Judge reviews the comments, you should resubmit the comments after the rules are
formally proposed.

Free publications available online

These publications — and others — are available free on the Department of Labor and Industry Web site.

Minnesota Workers’ Compensation System Report 2002

• Report highlights: www.doli.state.mn.us/wccost02.html
• Full report: www.doli.state.mn.us/rsreport.html

Minnesota Workplace Safety Report, 2002

• Full report: www.doli.state.mn.us/rsreport.html

Workers' compensation claims characteristics, 2002

• Brochure: www.doli.state.mn.us/pdf/wc_claimcharacter02.pdf

Prompt First Action Report on Workers’ Compensation Claims, 2003

• Full report: www.doli.state.mn.us/pubwkcp.html

Collection and Assessment of Fines and Penalties, 2003

• Full report: www.doli.state.mn.us/pubwkcp.html

An Employee’s Guide to the Minnesota Workers’ Compensation System, 2000

• Complete guide: www.doli.state.mn.us/guide.html

An Employer’s Guide to Employment Law Issues in Minnesota, 2002

• Complete guide: www.deed.state.mn.us/publications/index.htm
(published by the Department of Employment and Economic Development)

Publications are also available in printed versions. To request a copy, contact Customer Assistance by phone
at (651) 284-5030, by fax at (651) 296-9634 or by e-mail at dli.brochure@state.mn.us.

20 • COMPACT • August 2004

 New benefit and provider fees levels effective October 2004
By Brian Zaidman, Research Analyst
Research and Statistics
The statewide average weekly wage (SAWW)
effective Oct. 1, 2004, is $740, a 3.06 percent
increase over the current SAWW of $718, which
has been in effect since Oct. 1, 2003. [See the table
on this page.] The levels for minimum and maximum
weekly benefit payments are presented in the table
on the following page. The statewide annual average
wage will change to $38,441 on Jan. 1, 2005.
The new SAWW is based on 2003 payroll and
employment figures supplied by the Department
of Employment and Economic Development and
the calculation procedure in Minnesota Statutes
§176.011, subd. 20. The increase in the SAWW
is the basis for the M.S. §176.645 annual benefit
increases.
Only injured workers meeting the eligibility
requirements of M.S. §176.645 will receive adjusted
benefits. Benefit increases for workers injured prior
to Oct. 1, 1992, are limited to 6 percent. Benefit
increases for workers injured between Oct. 1, 1992,
and Sept. 30, 1995, are limited to 4 percent. For
workers injured on or after Oct. 1, 1995, the initial
annual adjustment is made on the fourth anniversary
of the date of injury and is limited to 2 percent. [See
COMPACT, February 1999, pages 10-11.]
The vocational rehabilitation annual adjustment of
hourly fees is limited to the 2 percent maximum
increase (Minnesota Rules 5220.1900 subp. 1b, 1c
and 1e). On Oct. 1, 2004, the maximum qualified
rehabilitation consultant (QRC) hourly fee will
increase to $83.77 and the maximum hourly rate for
rehabilitation job development and placement services
will increase to $64.43. Notices of hourly fee changes
must be filed with the DLI commissioner. QRCs and
registered rehabilitation vendors can ensure their
hourly rates are on file by completing forms
R-21 or R-23 (available on the Department of Labor
and Industry Web site at www.doli.state.mn.us/
wcforms1.html; scroll to bottom of page).
Pursuant to M.S. §176.136, subd. 1a, which provides
for annual adjustments of the medical fee schedule
21 • COMPACT • August 2004
conversion factor by no more than the change in the
statewide average weekly wage, the commissioner is
adjusting the conversion factor by 1.5 percent, which
is the percent change in the producer price index for
offices of physicians (PPI-P) developed by the U.S.
Department of Labor, Bureau of Labor Statistics. The
conversion factor will increase to $76.31 for services
provided on or after Oct. 1, 2004, subject to approval
by an administrative law judge.
Minnesota Rules, part 5219.0500, subp. 4, provides
for adjustment of the maximum fees for independent
medical examinations in the same manner as the
adjustment of the conversion factor. Therefore,
the independent medical examination fees will
be increased by 1.5 percent for services provided
on or after Oct. 1, 2004, subject to approval by
an administrative law judge. An official notice of
the medical fee schedule conversion factor and
independent medical examination fee increases
approved by the administrative law judge will be
published in the State Register in September.
Statewide average weekly wage
Effective Oct. 1 of the indicated year
Statewide Percentage
Year average change from
weekly wage previous
year
1990 ................ $428 ............... 3.63%
1991 ................ $443 ............... 3.50%
1992 ................ $459 ............... 3.61%
1993 ................ $484 ............... 5.45%
1994 ................ $492 ............... 1.65%
1995 ................ $505 ............... 2.64%
1996 ................ $524 ............... 3.76%
1997 ................ $553 ............... 5.53%
1998 ................ $579 ............... 4.70%
1999 ................ $615 ............... 6.22%
2000 ................ $642 ............... 4.39%
2001 ................ $680 ............... 5.92%
2002 ................ $702 ............... 3.24%
2003 ................ $718 ............... 2.28%
2004 ................ $740 ............... 3.06%

Statewide average weekly wage (SAWW) = $740
Percentage change in SAWW from previous year = 3.06%
(Apply Minnesota Statutes §176.645 adjustment as necessary based on date of injury.)
Maximum under M.S. 176.101 and 176.111
100% of SAWW
10-01-77.............$197.00
10-01-78.............$209.00
10-01-79.............$226.00
10-01-80.............$244.00
10-01-81.............$267.00
10-01-82.............$290.00
10-01-83.............$313.00
10-01-84.............$329.00
10-01-85.............$342.00
10-01-86.............$360.00
10-01-87.............$376.00
10-01-88.............$391.00
10-01-89.............$413.00
10-01-90.............$428.00
10-01-91.............$443.00
105% of SAWW
10-01-92 ........... $481.95
10-01-93 ........... $508.20
10-01-94 ........... $516.60
Set by Statute
10-01-95 ............ $615.00
10-01-00.............$750.00
Compensation rates as of Oct. 1, 2004
Minimum under M.S. 176.101, subd. 1(2) Supplementary benefits under M.S. 176.132
(Minnesota Statutes 1994)
and permanent total minimum under
50% of the SAWW or gross wage, whichever is
M.S. 176.101, subd. 4
less, but in no case less than 20% of the SAWW
(for injuries 10-1-95 and later)
50% 20%
10-01-77.....$ 98.50 (gross wage - $147.75)... $ 39.40
10-01-82...............$188.50 (65% of $290)
10-01-78....$104.50 (gross wage - $156.75)... $ 41.80
10-01-83...............$203.45 (rounded to $204)
10-01-79....$113.00 (gross wage - $169.50)... $ 45.20
10-01-84...............$213.85 (rounded to $214)
10-01-80....$122.00 (gross wage - $183.00)... $ 48.80
10-01-85...............$222.30 (rounded to $223)
10-01-81....$133.50 (gross wage - $200.25)... $ 53.40
10-01-86...............$234.00 (round)
10-01-82....$145.00 (gross wage - $217.50)... $ 58.00
10-01-87...............$244.40 (rounded to $245)
10-01-83....$156.50 (gross wage - $234.75)... $ 62.60
10-01-88...............$254.15 (rounded to $255)
10-01-84....$164.50 (gross wage - $246.75)... $ 65.80
10-01-89...............$268.45 (rounded to $269)
10-01-85....$171.00 (gross wage - $256.50)... $ 68.40
10-01-90...............$278.20 (rounded to $279)
10-01-86....$180.00 (gross wage - $270.00)... $ 72.00
10-01-91...............$287.95 (rounded to $288)
10-01-87....$188.00 (gross wage - $282.00)... $ 75.20
10-01-92...............$298.35 (rounded to $299)
10-01-88....$195.50 (gross wage - $293.25)... $ 78.20
10-01-93...............$314.60 (rounded to $315)
10-01-89....$206.50 (gross wage - $309.75)... $ 82.60
10-01-94...............$319.80 (rounded to $320)
10-01-90....$214.00 (gross wage - $321.00)... $ 85.60
10-01-95............. $328.25 (rounded to $329)*
10-01-91....$221.50 (gross wage - $332.25)... $ 88.60
10-01-96...............$340.60 (rounded to $341)*
20% of the SAWW or the employee's actual
10-01-97...............$359.45 (rounded to $360)*
weekly wage, whichever is less
10-01-98...............$376.35 (rounded to $377)*
10-01-92 ........... $91.80
10-01-99...............$399.75 (rounded to $400)*
10-01-93 ........... $96.80
10-01-00...............$417.30 (rounded to $418)*
10-01-94 ........... $98.40
10-01-01...............$442.00 (round)
Set by statute, the listed amount or the employee's
actual weekly wage, whichever is less 10-01-02...............$456.30 (rounded to $457)*
10-01-95 ........... $104.00 10-01-03 ...............$466.70 (rounded to $467)*
10-01-00 ........... $130.00 10-01-04...............$481.00 (round)
*Rounding applies to supplementary benefits.
 ERGONOMICS DISORDERS: 40 percent of all Minnesota
days-away-from-work cases

By Brian Zaidman, Research Analyst

Research and Statistics
The U.S. Department of Labor, Bureau of Labor Statistics (BLS), recently released the 2002 survey state-level
estimates for work-related musculoskeletal disorders (WMSDs). These statistics are based on cases with at
least one day away from work (DAFW) collected as part of the annual Survey of Occupational Injuries and
Illnesses. The data shows there were approximately 13,300 DAFW cases with WMSDs in Minnesota in 2002,
accounting for 40 percent of all DAFW cases. Because of changes by OSHA to its recordkeeping requirements,
the data for 2002 is not comparable with data for prior years. (The recordkeeping changes are explained at the
end of the article.)

BLS defines WMSDs as disorders of the muscles, nerves, tendons, ligaments, joints, cartilage and spinal discs
that are not caused by slips, trips, falls, motor-vehicle accidents or other similar accidents.

The BLS tables provide data for private industry in the country as a whole and for each state that participates in
the BLS survey. Information about WMSD cases involving state and local government employees are available
for some states, including Minnesota.

Figure 1 shows:
• There were an estimated 13,310 WMSD cases in Minnesota in 2002. Between 2000 and 2001, the
overall number of WMSD cases decreased from 16,340 to 13,150.

• The estimated number of cases in 2002 is similar to the estimate for 2001. Because of the
recordkeeping changes, it is unclear whether actual changes in job safety occurred or whether there
was an effect from the recordkeeping itself.

Figure 1: Number and incidence rate1 of musculoskeletal

disorders in Minnesota involving days away from work

Year Private industry State government Local government

Number Incidence Number Incidence Number Incidence
rate rate rate
1998 13,550 76.4 360 46.0 1,240 71.0
1999 14,520 80.5 230 33.3 1,290 68.7
2000 14,870 80.5 230 37.9 1,240 68.7
2001 11,830 66.7 200 31.5 1,130 55.1
2002 12,030 68.7 210 35.5 1,070 53.5

1
Incidence rates represent the number of injuries and illnesses per 10,000 full-time workers.
Source: Bureau of Labor Statistics, U.S. Department of Labor.

23 • COMPACT • August 2004

 Figure 2 shows, for private employers in 2002:
• The percentage of DAFW cases that were WMSDs was similar in Minnesota, Iowa and Wisconsin, and
was slightly above the national rate. These percentages were nearly unchanged from the previous year.

• The rate of WMSD injuries in Minnesota was above the national rate, slightly above Iowa’s rate and
13 percentage points below Wisconsin’s rate.

• Minnesota WMSDs had a lower median number of days-away-from-work than the neighboring states
and the national average.

Figure 2: WMSDs in the United States, Minnesota

and neighboring states, private employers, 2002

Minnesota Iowa Wisconsin United

States
Total DAFW cases 29,380 15,740 38,430 1,436,200
Number of WMSDs 12,030 6,180 15,170 488,000
Percent of all DAFW cases1 40.9% 39.3% 39.5% 34.0%
WMSDs per 10,000 FTEs 68.7 64.2 81.5 55.3
Median days-away-from-work:
all injuries 5 5 6 7
all WMSDs 6 7 7 9
carpal tunnel syndrome 27 18 38 30

1
Days-away-from-work (DAFW) cases occur when workers miss at least one day away from work after the
day of the injury. WMSD injuries are only identified among DAFW cases.
Source: Bureau of Labor Statistics, U.S. Department of Labor.

Recordkeeping changes
The OSHA recordkeeping changes affect which injuries and illness are recordable, how injuries and illnesses
are categorized, and how days away from work are counted. These changes make direct comparisons between
the 2002 results and those for earlier years unreliable. Data from earlier years is provided to show the trend
during the previous years.

Some of the recordkeeping changes that affect the number of WMSD cases are:
• An aggravation of a case where signs or symptoms have not been resolved is not a new case, even if the
aggravation was caused by a new event or exposure. Previously, each new event or exposure was treated
as a new case.

• Under the previous requirements, a cumulative trauma disorder was considered a new case if no care
was received for the previous 30 days. The new requirements have no such criteria. In the absence of
a new work-related event or exposure, the reappearance of signs or symptoms may be treated as part
of the previous case.

• WMSDs are recordable when general recording criteria are met. Previously, WMSDs were recordable
under the general criteria or when identified through a clinical diagnosis or diagnostic test.

For more Bureau of Labor Statistics survey information about WMSD cases, contact Brian Zaidman by
e-mail at brian.zaidman@state.mn.us.
24 • COMPACT • August 2004