Have you been diagnosed with PTSD following a work-related accident? If you have, there’s a chance you’re reading this after you were denied a workers’ compensation claim in Minnesota.
You’re not alone.
In Minnesota, insurers have denied more than 90% of the PTSD claims filed from 2014 through 2023. By comparison, denials for every other kind of work injury never passed 20%.
There’s a pattern when you make the comparison.
A denied workers compensation claim in Minnesota says almost nothing about whether your PTSD is real. Denial is simply how insurers open these cases.
Yes, a denial is the insurer’s opinion. Luckily, there’s still something you can do about the outcome, and the law gives you several ways to change it.
Why Do Insurers Deny So Many PTSD Claims?
It all has to do with what workers’ comp laws were written for – broken bones and physical disabilities.
Comp deadlines were built for physical work-related injuries. You have 14 days to report the injury to your employer, and the insurer gets 14 days to accept or deny.
Unfortunately, PTSD doesn’t develop or show symptoms as quickly. The manual the law relies on says symptoms must last at least a month before a diagnosis can exist.
So, insurers often hit their deadline before a firm diagnosis is even possible, and the fastest answer available is no.
What Does a Valid PTSD Claim Need?
Minnesota treats PTSD unlike any other mental health condition. It is the only mental injury the comp system covers on its own, with no physical injury attached.
For your claim to hold up, your claim must clear three legal requirements:
- The right diagnosis from the right provider: A licensed psychiatrist or psychologist must diagnose you under the newest edition of the DSM, the manual mental health professional’s use. A diagnosis from a therapist or counselor will not satisfy the law, however skilled they are.
- A connection to your work: Your PTSD must have come from your job. One terrible call can do it, and so can years of exposure that added up.
- No good-faith employer action as the cause: PTSD traced to discipline, a layoff, a demotion, or a firing handled in good faith falls outside the law.
Clear all three conditions, and you’ll build your PTSD claim.
Does the First Responder Presumption Help?
Did you work as a police officer, firefighter, paramedic, EMT, dispatcher, corrections officer, sheriff’s deputy, State Patrol member, or a nurse giving emergency care outside a facility?
If so, the law presumes your PTSD came from the job, for any injury dated January 1, 2019, or later. The Minnesota Supreme Court has ruled the presumption kicks in the moment a qualifying diagnosis exists.
Hence, the insurer cannot stall while its own expert weighs in, and any facts used against an injured first responder must appear in a denied workers compensation claim in Minnesota.
What Should You Do After the Denial Letter Arrives?
The letter you received must have a formal name, a Notice of Insurer’s Primary Liability Determination. It must also contain why the insurer denied your PTSD claim.
Those reasons are where your response begins.
Read the Reasons They Gave You
First, you should match each stated reason against your file.
If they cite a late report, check when your employer actually knew.
If they cite weak medical evidence, the physician who signed your diagnosis and which manual they used is where you should start.
If you fall under the presumption, look for the specific facts the law requires them to disclose. A vague denial stuffed with boilerplate is itself something a lawyer can attack.
Put Your Challenge on the Record
A denied workers compensation claim in Saint Paul moves forward the same way as one from Duluth.
More specifically, you file a claim petition with the state’s workers’ compensation court, or you first request free mediation through the Department of Labor and Industry. A compensation judge then issues a binding decision after a hearing, and appeals run from there.
Two details help while you wait. The state offers vocational rehab, meaning help getting back to work, even while your denied claim is being challenged. Qualifying for benefits does not restart from zero because someone said no.
Can an Insurer’s Doctor Override Yours?
Expect the insurer to send you to an examiner of its choosing and expect that report to disagree with your treating provider.
The Minnesota Supreme Court has already limited how far the disagreement reaches. In Smith v. Carver County, the court held the law requires only a diagnosis by a licensed psychologist or psychiatrist under the latest DSM.
A judge cannot toss your diagnosis by reading the manual personally. Only another professional’s opinion can be weighed against it.
The insurer’s exam is one expert’s argument. A PTSD lawyer in Saint Paul answers it with your treating provider’s records, your work history, and cross examination.
We Can Help
A denial arrives at the worst possible time. Work feels out of reach, and the bills keep their own schedule.
As your PTSD lawyer in Saint Paul, Minneapolis, or anywhere in the state, we will read the stated reasons, supply what the insurer claims is missing, and argue your case in front of a judge if that is what it takes.
We’ve spent decades on PTSD claims for first responders and civilian workers across the Twin Cities. We have watched denied claims become paid ones once the right evidence reaches the file.
Let Our Firm Help You Turn Your Denial Around
Whether you hold a denied workers compensation claim in Minneapolis or a denied workers compensation claim in Saint Paul, we’re a call away in the Twin Cities.
Contact our law firm today to schedule a consultation and start your comeback journey.