The Minnesota Supreme Court recently clarified when an employer may assert a workers’ compensation medical treatment parameters defense to a claim for medical benefits. The Court concluded the ban on applying the treatment parameters applies only when an employer denies that it has an obligation under the act to pay compensation for an alleged work injury.
In William Johnson v. Darchuks Fabrication, Inc., Johnson suffered a right ankle injury. The parties then entered into a stipulation to settle Johnson’s claim for benefits. Under the agreement, the employer accepted workers’ compensation liability and agreed to pay ongoing medical expenses that were reasonably required to cure and relieve Johnson’s symptoms.
About ten years later, Johnson’s ability to manage his daily life slowly declined and the employer required Johnson to undergo an independent medical examination. The independent medical examination report casted doubt on the source of Johnson’s symptoms and his complex pain syndrome diagnosis. The employer asked Johnson’s physician to begin a plan to wean Johnson from his opioid medication and bring his treatment plan into alignment with the treatment parameters governing long-term use of opioid medications. Johnson’s physician did not put a compliance plan into place and a Medical Request was filed.
The compensation judge concluded that by asserting that Johnson’s complex pain syndrome diagnosis had resolved, the employer and insurer had in effect “denied liability” for the injury and therefore the treatment parameters do not apply. The Workers’ Compensation Court of Appeals affirmed.
The rules provide that treatment parameters do not apply if to the 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.”
The Minnesota Supreme Court concluded that the phrase “liability for the injury” refers to the employer’s obligation to pay statutory benefits for personal injuries that are covered by the workers’ compensation act. An employer may not invoke the treatment parameters when it denies liability, that is, when the employer claims that it is not obligated to pay compensation for an injury. Under these circumstances, the employer denies responsibility for any compensation or benefits, as opposed to a particular treatment recommendation or regime. The Court conclude that the ban on applying the treatment parameters applies only when an employer denies that it has an obligation under the act to pay compensation for an alleged work injury.
Please click here to download a copy of the Court’s decision.
If you have any questions, please contact Lauren Harvey at lnh@mccollumlaw.com.