Issue: TREATMENT PARAMETERS
Johnson v. Darchucks Fabrication, Inc., No. A18-1131 (Minn., April 24, 2019)
In this case, the employee suffered an ankle injury in 2002. Eventually, the employee was diagnosed with “complex regional pain syndrome” (CRPS), which is recognized and governed by the Minnesota treatment parameters. Liability was accepted. The parties reached a settlement in 2004. The Stipulation left medical benefits open, and employer and insurer agreed to pay ongoing medical expenses that were reasonably required to cure and relieve the employee’s symptoms.
In May 2016, the employee underwent an IME, which opined that the source of employee’s symptoms were not caused by his CRPS. Based on the report, the insurer advised the employee’s physician that it was discontinuing coverage for treatment and medication for employee’s CRPS. The insurer requested that employee’s physician begin a plan within 30 days to wean the employee from his opioid medication and bring his treatment pursuant to the treatment parameters relating to long-term use of opioid medications (Minn. R. 5221.6110). The employee’s physician did not put a compliance plan in place. The insurer suspended all payment of expenses and employee filed a Medical Request seeking payment to cover the cost of his medications.
A Hearing was held in July 2017. The compensation judge concluded that by asserting the employee’s CRPS had resolved, the employer had in effect “denied liability” for the injury, and therefore the treatment parameters do not apply. The Workers Compensation Court of Appeals (“WCCA”) affirmed the compensation judge’s decision, concluding that treatment parameters did not apply because the employer in effect denied that a causal connection existed between the employee’s work-related injury and his present symptoms.
On appeal to the Supreme Court, the issue was whether the WCCA erred in concluding that the treatment parameters do not apply to the employee’s course of treatment. The rules provide that the treatment parameters do not apply to treatment if the employer “denied liability for the injury.” But even if an employer denies liability, the treatment parameters “do apply to treatment initiated after liability has been established.” Minn. R. 5221.6020, subp. 2.
The Supreme Court concluded that the phrase “liability for the injury” in Rule 5221.6020, referred to the employer’s obligation to pay statutory benefits for personal injuries that are covered by the workers’ compensation act. Consequently, an employer may not invoke treatment parameters when it denies liability, that is, when the employer claims that it is not obligated to pay compensation for an injury. The treatment parameters nevertheless “apply to treatment initiated after liability has been established.” Minn. R. 5221.6020. Stated differently, once a dispute about an injury is resolved in favor of benefits coverage – by the determination of a compensation judge, or stipulation of the parties – the ongoing treatment of the covered injury is then subject to the parameters set forth in the rules. The Court concluded that the ban on applying the treatment parameters under the rule applies only when an employer denies that it has an obligation under the act to pay compensation for an alleged workplace injury.
In this case, because the employer did not contest its liability to pay for treatment that was reasonably required to cure and relieve the effects of the employee’s workplace ankle injury, it had not denied liability for the injury under Rule 5221.6020, subpart 2. Therefore, the treatment parameters apply. The Court reversed the decision of the WCCA and remanded the case to the workers’ compensation judge for further proceedings consistent with the opinion.
Summary by: Michelle I. Kelly