Notice Of Intention To Discontinue Workers Compensation Benefits {ND01}

MN ND01 - NOTICE OF INTENTION TO DISCONTINUE WORKERS’ COMPENSATION BENEFITS. This form is used in Minnesota by an employer, insurer, or claims administrator to notify an injured worker that their workers’ compensation disability benefits—such as temporary total, temporary partial, or permanent total—are being stopped or reduced. The form specifies the reason for discontinuance, such as the employee returning to work at full or reduced wages, or another basis supported by attached medical or legal documentation. It also outlines the benefits already paid, the employee’s average weekly wage, and any related medical or attorney fee payments. Importantly, the notice advises the employee of their right to object if they disagree with the discontinuance and provides strict deadlines for requesting an administrative conference or formal hearing with the Court of Administrative Hearings. This ensures the employee has the opportunity to contest the decision and present evidence showing why benefits should continue. The form protects due process by providing clear notice, a record of benefits paid, and a pathway for dispute resolution under Minnesota’s workers’ compensation law. www.FormWorkflow.com