This is one of the official Workers' Compensation forms for the state of Minnesota.
Minnesota Medical Request for Workers' Compensation
Category:
State:
Minnesota
Control #:
MN-MQ03-WC
Format:
PDF;
Rich Text
Instant download
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Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.
Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.
If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.
We protect your documents and personal data by following strict security and privacy standards.
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FAQ
A worker is disqualified where the injury: (1) is caused by the worker's own intoxication (alcohol or other controlled substance as defined by the Health and Safety Code; (2) is intentionally self-inflicted; (3) occurs out of an altercation (mutual combat) where the claimant was the initial physical aggressor; (4)
Workplaces must prioritise your health and safety. They must facilitate your return to work. They must balance this against your privacy rights. This means that access to medical records may be necessary, but your employer has an obligation to request and access only the information required and nothing more.
No, you should not sign the HIPAA authorization for the release of your medical records. Often, the insurance company will act as though they cannot begin to decide how much money to offer you until they have all of your medical records.
Get your weekly disability check started, if you're not receiving it already. Maximize your weekly benefit check. Report all super-added injuries. Seek psychological care, when appropriate. Seek pain management care, when appropriate. Don't refuse medical procedures. Be very careful what you tell the doctor.
Many insurance companies use generic forms that are broad in scope and grant blanket access to all of your medical records. The Medical Authorization form may even give the claims adjuster or insurance defense attorney permission to speak with your doctors and nurses without you present.
Workers' comp insurance provides coverage to help your employee pay for medical expenses related to a work-related injury or illness. This can include emergency room visits, necessary surgeries and prescriptions.
As a general rule of thumb, you should never discuss anything except the basic facts of the accident, including where it occurred, the date and time it occurred, what type of accident it was, and which body parts were injured.
Always ask what the net amount will be after deducting lawyers' fees. A good California Workers' Compensation attorney should make sure that all medical expenses for your treatment are taken care of by the insurance company either prior to settlement or included in the settlement. You should not owe anyone.
Yes, you are required to release your medical records if requested when you file a workers' compensation claim after a workplace injury.
