Legal Services Division

443 Lafayette Road N.

St. Paul, MN 55155

Frequently asked questions:

Workers’ compensation certified managed care

What is workers’ compensation certified managed care?

Workers’ compensation managed care plans are certified by the Minnesota Department of Labor and Industry, and provide
for the delivery and management of medical treatment for injured employees through a network of health care providers.

An employee covered by managed care selects a treating doctor from the network, which must include medical doctors,
chiropractors, osteopaths, podiatrists, physical and occupational therapists, and specialists. Sometimes the employer and
managed care plan designate a clinic for the initial visit after an injury, but an employee may select any doctor in the plan for
additional treatment that is needed. In some cases, the employee may be able to continue treating with a doctor outside of the
network with whom the employee has established a relationship before the injury.

Certified managed care plan case managers, who are licensed health care professionals, monitor and coordinate the delivery
of quality medical treatment, help the parties communicate with each other and the doctor, and promote an appropriate, prompt
return to work. The certified managed care plan must also include a process for resolving disputes.

How do I know if I am covered by a certified managed care plan?

There are four certified workers’ compensation managed care plans. An employer or workers’ compensation insurer that has
contracted with a certified managed care plan must post a notice, notify each employee of enrollment and tell an employee about
managed care coverage when the employee gives notice of a work injury. There are some workers’ compensation managed
care plans that are not certified. An employee is not required to receive treatment for a work injury from a specific network
of providers if notice of coverage has not been given or if the managed care plan is not certified.

What is the process for resolving disputes under a certified managed care plan?
Workers’ compensation certified managed care is expected to reduce the number of disputes that arise in workers’
compensation, by encouraging quality treatment, communication between the parties and appropriate return to work. However,
if there is a difference of opinion about a medical issue related to managed care, the workers’ compensation law requires that
each certified managed care plan must try to resolve the dispute. An employee or health care provider may start this process
by submitting a written complaint to the managed care plan; some plans will also accept complaints by telephone. The plan must
respond to the employee or health care provider within 30 days after receiving the complaint.

If an employee or health care provider is not satisfied with the response from the managed care plan, or if the managed care
plan does not respond to a written complaint within 30 days, the employee or provider may file a Medical Request form with
the Department of Labor and Industry. A copy of the written complaint that was submitted to the managed care plan, or other
documentation that the managed care plan’s dispute process has been completed, must be attached to the Medical Request.
The managed care plan’s response may also be attached, but this is not required. The requirement that a dispute must be
submitted to the managed care plan first applies only if an employee is covered by a certified managed care plan.

Who can I contact with questions about certified managed care?

Contact the Minnesota Department of Labor and Industry at (651) 284-5159, toll-free at 1-800-DIAL-DLI (1-800-342-5354)
or via at TTY (651) 297-4198.

This material can be provided in alternative formats, such as Braille, large print or audiotape by calling the Department of Labor and Industry at
(651) 284-5505; toll-free at 1-800-342-5354; TTY at (651) 297-4198.