The workers’ compensation insurer is primary. This means that medical providers should always bill the workers’ compensation insurer first, even if everyone knows that the workers’ compensation insurer will deny payment.

If the workers’ compensation insurer denies payment and/or delays too long, then the medical provider should document the delay and/or denial (as there may be a need for proof of that non-payment) and then bill the injured worker’s personal/private health insurer as soon as possible.

The personal/private health insurer may require proof that the workers’ compensation insurer has denied the medical care before they pay. That is why the medical provider should document its communications with the workers’ compensation insurer.

If the medical provider takes too long to the bill the personal/private health insurer, then Minnesota medical billing laws may prevent the medical provider from recovering any money from anyone for those bills.

If the personal/private health insurer refuses to pay for the work-related medical treatment, that is probably because it thinks the treatment is work-related. We may agree and will be sure to file a claim to force the workers’ compensation insurer to pay for the treatment. But, in the meantime, the personal/private health insurer is required to pay for medical care that has been denied by the workers’ compensation insurer. This is to prevent delay to the injured worker receiving necessary treatment and to make sure the medical provider is promptly paid.

The personal/private health insurer will be given the opportunity to file a claim to recover any payments it made on medical care that is later shown to be work-related. This is called a notice of intervention rights, and our office is responsible for sending those notices out to all entities (medical providers, insurers, etc.) who may have a financial interest in the injured worker’s claim. The personal/private health insurer can file an intervention claim to recover its payments.

The medical provider may receive less money from the personal/private insurer than it would from the workers’ compensation insurer. This is called a “Spaeth” balance and can be recovered through an intervention claim filed by the medical provider.

Find out more about intervention from the State of Minnesota here: