State News : Minnesota

NWCDN is a network of law firms dedicated to protecting employers in workers’ compensation claims.


NWCDN Members regularly post articles and summary judgements in workers’ compensations law in your state.  


Select a state from the dropdown menu below to scroll through the state specific archives for updates and opinions on various workers’ compensation laws in your state.


Contact information for NWCDN members is also located on the state specific links in the event you have additional questions or your company is seeking a workers’ compensation lawyer in your state.


Minnesota

Heacox Hartman

  651-222-2066

On January 10, 2013, President Obama signed the SMART Act into law. The SMART Act revises the Medicare Secondary Payer Act and penalties associated with Section 111 Reporting. It creates a framework to simplify the process of resolving conditional payment liens. The Act sets a three-year statute of limitations for conditional payment recovery lawsuits. It also revises the mandatory $1,000.00 a day penalty for late reporting and orders the Secretary of HHS to publish new rules on penalties for late reporting. The Act further requires an exception to penalties when the responsible reporting entity has made “good faith efforts to identify a beneficiary. . . for reporting information.”

Please contact Whitney Teel for further information.

Medical Expert Opinion

Scott Polzin v. Canterbury Park and SFM, slip op.
WCCA, filed February 20, 2013 ~ reviewed by Tom Atchison

The W.C.C.A. affirmed the compensation judge’s Findings and Order denying the employee’s claim for wage loss benefits and request for authorization for surgery.  In doing so, the W.C.C.A. held that it was reasonable for the compensation judge to accept Dr. Friedland’s opinion who performed an IME on behalf of the employer and insurer. The treating doctor, Dr. Falconer’s opinion, the W.C.C.A. noted, lacked a sufficient basis to conclude that a diagnostic midcarpal arthroscopy would identify or resolve the Employee’s symptoms.
 
In July 2007 the Employee sustained a left hand injury while working as poker dealer at Canterbury Park.  Ultimately, the Employer and Insurer accepted liability for the Employee’s left hand injury.  Over the following months and years, the Employee underwent multiple treatments to diagnose the cause of his left hand symptoms.  Multiple doctors were unable to identify the etiology of the Employee’s symptoms, including a Mayo Clinic doctor who offered an opinion that he employee could engage in any activities without jeopardy to the left hand.  In light of the unknown etiology, Dr. Falconer recommended a diagnostic midcarpal arthroscopy.  Dr. Falconer did acknowledge that previous MRIs and scans should have revealed joint irritation or arthritic damage and, further, that the surgery might not provide lasting therapeutic benefits if it did not identify the cause of the Employee’s symptoms.  The Employee filed a Claim Petition claiming entitlement to wage loss benefits, a vocational rehabilitation consultation, and approval of the surgery recommended by Dr. Falconer.

The Employee underwent an independent medical examination with Dr. Mark Friedland.  Dr. Friedland concluded that the Employee’s symptoms were without objective anatomic etiology.  Further, he opined that the Employee was not in need of any additional medical care and that he had no work restrictions.  Dr. Friedland also concluded that Dr. Falconer’s  surgical recommendation was not reasonable or necessary.  The compensation judge adopted Dr. Friedland’s opinion that the Employee had no work restrictions effective June 1, 2010, that the Employee was not entitled to wage-loss benefits as alleged, and that Dr. Falconer’s surgical recommendation was not reasonable or necessary.  The WCCA affirmed, reiterating the long held view that the compensation judge’s choice of competing medical opinions will be upheld unless there is a foundational defect.


Subdivision 7 Fees

Lann v. Stan Koch & Sons Trucking, Inc.
WCCA, filed March 6,  2013 ~ reviewed by T. Zachary Chalgren

In case of first impression, the WCCA, over the dissent of Judge Wilson, reversed the compensation judge’s calculation of an award under MS 176.081, subd. 7. The employee’s attorney requested payment of attorney fees, including subd. 7 fees, after successfully representing the employee with respect to a medical issue.  There had been an award of attorney fees and subd. 7 fees after an earlier dispute, where the subd.7 fees were calculated at 30% of the attorney fees awarded in excess of $250. In the present case, the employee calculated the subd. 7 fee at 30% of the fee awarded. The employer and insurer calculated the subd. 7 fee at 30% of the fees awarded in excess of $250. The difference was $75.00. The compensation judge agreed with the employer and insurers calculation. The majority of the 3 Judge panel disagreed and reversed, awarding subd. 7 fees as calculated by the employee. The basis for the reversal was that MS 176.081 states that attorney’s fees for the same dates of injury are cumulative; therefore the statute contemplates deduction of the $250 only once.

Judge Wilson dissented, holding that other provisions of Minn. Stat. § 176.081 contemplate evaluation of fees on a claim-by-claim basis. Wilson argued that the majority’s analysis would apply not only to Subdivision 7, but to calculation of contingent fees under Minn. Stat. § 176.081, subd. 1(a).


Electronic Filing at Minnesota Department
of Labor and Industry

The Minnesota Department of Labor and Industry (DLI) has launched a new online process enabling employees, insurers, attorneys, rehabilitation providers and medical providers to complete and submit Medical Request, Medical Response, Rehabilitation Request and Rehabilitation Response forms electronically to the department. The process is intended to reduce delays caused by manually processing paper requests and responses. Use of this online filing process is optional; parties can continue to file these forms with the department in the conventional paper format.

The process is available to use beginning April 19, 2013. All applicable statutes and rules regarding the filing of Medical Request and Rehabilitation Request forms apply to the forms available electronically from DLI’s website. Data submitted electronically will be accepted as received only during regular DLI business hours, 8 am to 4:30 p.m. (Central Time), Monday through Friday (excluding holidays). Data received after 4:30 p.m. or on a Saturday, Sunday or state holiday will be electronically date-stamped for the next business day DLI is open for business.

The form can be accessed at https://secure.doli.state.mn.us/adrforms/main.aspx. General instructions and directions for completion and submission of Medical Request and Rehabilitation Request forms can be accessed at www.dli.mn.gov/WC/PDF/mq03.pdf or www.dli.mn.gov/WC/PDF/rq03.pdf. If you have questions regarding the submission of these forms, call the Alternative Dispute Resolution unit at (651) 284-5032 or 1-800-342-5354.

Chalgren, Zach WebPrior to joining the Workers' Compensation Practice Group, T. Zachary Chalgren, was a law clerk at two local law firms and a private business. He performed legal research and wrote analysis of state and federal issues, memoranda, pleadings, discovery and assisted with court filings. He obtained his J.D. from William Mitchell and his undergrad from University of St. Thomas.

Heinemeyer, Denise WEBDenise E. Heinemeyer, a seasoned veteran of the insurance industry where she held multiple positions for over 14 years, has also joined the Workers' Compensation Practice. She later became an attorney and worked for various local law firms handling legal research, writing, document review, depositions, mediations, motion hearings and no-fault arbitrations. In addition, she worked in the healthcare insurance industry as a legal and regulatory compliance professional. She obtained her J.D. from William Mitchell and her undergrad from Moorhead State University.

Whitney Teel is a contributing author toThe Complete Guide to Medicare Secondary Payer Compliance, a comprehensive handbook published by Matthew Bender and that be purchased throughLexisNexis.

This legal treatise covers Medicare reporting requirements nationwide, techniques to avoid pitfalls and delays under CMS’ policies and procedures to obtain MSAs, state specific WCMSA requirements, overview of understanding MSA evaluations, avoiding rejection of MSA proposals, achieving better CMS outcomes and avoiding overly inflated MSAs. Teel is the contributing author for the Minnesota section on State Specific WCMSA. Other contributions were provided by insurance industry in-house counsel and private firm attorneys.

Atchinson5442R WEB Print resize  Industry news outlet Work Comp Central recently interviewedTom Atchison regarding the Supreme Court ruling inDykoff v. Xcel Energy.

The article discussed the Minnesota Supreme Court’s endorsement of the “increased risk” test as the standard for compensability.

The article also discussed how Minnesota courts have previously interpreted the statutory requirement that injuries “arise out of and in the course of” employment. According to Atchison, the interpretation has “varied from court to court and case to case” over the years and the recent ruling “clears up a point of uncertainty” for workers, employers, and carriers.

The full article is available from Work Comp Central here.

Thomas Coleman will be a presenter at the March 7 Advanced Workers' Compensation Seminar. The covered topics include: Undocumented Workers’ Right to Work Comp Benefits, Permanent Total Disability Claims Litigation, Evaluating Exposure and Settlement, Employer Protections, Legislative and Case Law Update, WC Attorney and Ethical and Professional Behavior, and A View from the Department of Labor and Industry provided by Commissioner Ken Peterson.

Tom will present on ethics and professional behavior and evaluating exposure and settlement.

For more information on this all day seminar or to register, please visit: Advanced Workers' Compensation Seminar

James Waldhauser will moderate and speak at theWorkers' Compensation Update in Minnesota hosted by Lorman on February 7.

Attendees will hear speakers discuss a general overview of forms, benefits, time lines and penalties, as well as case law, new legislation, interplay between ADA and work comp, subrogation, retaliation and a panel on settlements, fraud and return-to-work.

To learn more specifics about this event or to register, visit www.lorman.com

Requirement to Provide Notice to Employer

Anderson v. Frontier Communications

Minnesota Supreme Court, filed September 5, 2012

The Minnesota Supreme Court reversed the WCCA and affirmed the Compensation Judge’s findings, holding that the failure of the employee to give timely notice of his work related injury to the employer, as well as the employer’s lack of actual knowledge regarding the work related nature of the employee’s injury, precludes recovery of benefits under the Minnesota Workers Compensation Act.

 The Employee worked from 1987 to 2007 as a lineman for a communications company, which was a physical job that required frequent heavy lifting and bending over to mark underground cables.  Pursuant to his testimony given to the Compensation Judge, following the gradual onset and progressive worsening of his low back pain symptoms from 2004 to 2005, and following his consultation with a surgeon in May 2007, the Employee knew that his work activities at the Employer were causing or aggravating his low back problems. However, it was not until May 2009 that the Employee, through his attorney, gave notice to the Employer of the claimed work related nature of his low back condition.

 As the Anderson court held, pursuant to Minn. Stat. § 176.141 and Issacson v. Minnetonka (Minn. 1987), in order to recover workers compensation benefits, an employee must either: (1) give notice of injury no more than 180 days after “it becomes reasonably apparent to the employee that the injury has resulted in, or is likely to cause, a compensable disability,” or (2) must show that the employer had actual knowledge of the injury, or in other words, that the employer had “some information connecting work activity with an injury.”

Here, where the Employee knew in May 2007 that his work activities were contributing to his low back problems, but failed to provide notice to the Employer of this fact until May 2009, and also failed to show that the Employer had actual knowledge of the injury, he was barred from recovering benefits under the Minnesota Workers Compensation Act.

Justices Paul Anderson, Alan Page, and Helen Meyer all dissented. In his dissent, Justice Paul Anderson noted the stoic attitude of the Employee with respect to his own pain symptoms, and provided an interesting and somewhat animated discussion on the point at which the Employee, as a reasonable person, may have realized the compensable nature of the disability he sustained from his work injury.

 

Causation

Preston vs. Hitchin Rail

W.C.C.A., June 4, 2012 ~ Reviewed by Natalie K. Lund

The Employee sustained a work-related injury to her back on September 28, 2004. After subsequent settlement and return to work, the Employee alleged a second specific injury to her back and neck on December 22, 2006. She continued to work with the pre-injury employer, and ultimately alleged her work duties aggravated her back and neck conditions. A Claim Petition was filed asserting injury dates of September 28, 2004, December 22, 2006 and a Gillette injury culminating in July of 2006. Dr. Wengler testified on behalf of the employee, concluding the Employee’s work activities after April 2005 and/or her fall on December 22, 2006 were a substantial contributing cause of her lumbar and cervical spine conditions.  The compensation judge found the employee sustained a Gillette injury to her cervical and lumbar spine arising out of and in the course of her employment in 2005 and 2006, which culminated on March 5, 2007, when the employee was taken off work, and that the December 22, 2006 injury further aggravated the employee’s conditions. Both injuries caused the employee’s need for medical treatment and disability. The employer and insurer appealed.

The WCCA affirmed in part and vacated in part. The employer and insurer’s contention that the employee’s expert, Dr. Wengler, lacked foundation was denied.  The fact that Dr. Wengler did not mention prior chiropractic records in his report was not sufficient to show he assumed there were no prior low back complaints where he acknowledged having read such records in his deposition.  The determination of the compensation judge on the credibility of the employee was also affirmed despite the employee’s inconsistent recollection of her medical history.  The WCCA vacated the finding of the compensation judge that the Gillette injury culminated on March 5, 2007, as the date was irrelevant given the finding as to a specific injury on December 22, 2006. The award was affirmed.

 

Causation/Evidence

Myhre vs. Public Storage, Inc.

W.C.C.A. file June 5, 2012 ~ Reviewed by Natalie K. Lund

The WCCA affirmed the findings of the compensation judge that the employee was not exposed to mold in her employer-furnished apartment and that she was not disabled as a result of that exposure.  From June 2008 through August 2010, the employee lived in an employer-furnished apartment. She reported a foul odor from the basement of the apartment and water damage on the wall of the basement to her district manager. A February 8, 2009 x-ray indicated a one centimeter ovoid nodular density in the right lung. In late 2009 and 2010, the employee treated with symptoms including heavy feeling in her chest and coughing. She reported there was black mold in her basement. However, her medical history included heavy smoking and she had treated in the past for respiratory infection, cough and shortness of breath.  On August 5, 2010, the employee’s residence was inspected for mold exposure by EFI Global, Inc.  The inspection found that there was evidence of water and moisture damage in the basement, but there were no visible signs of fungal growth in the living or basement area of the residence. At hearing, the employee made a claim for temporary total disability benefits and medical expenses based, in part, on two exhibits of medical journal articles. The employer and insurer objected, which the compensation judge sustained. The judge found the employee failed to prove she was exposed to mold in the employer-furnished apartment or that she was temporarily and totally disabled. Within her memorandum, the judge discussed the articles submitted by the employee’s attorney. The employee appealed the decision and the employer and insurer cross-appealed the judge’s consideration of the employee’s exhibits.

The WCCA found substantial evidence supported the compensation judge’s finding that the employee was not exposed to mold. The employee was not disabled as a result of mold exposure.  Finally, where there was no indication the judge’s consideration of the article exhibits formed the basis for her decision, any error by the judge in discussing the exhibits not admitted into evidence was harmless.

 

Notice

 

Dahlen vs. Hiway Amoco, Inc.

W.C.C.A., June 7, 2012 ~ Reviewed by Natalie K. Lund

The WCCA affirmed the findings of the compensation judge that the employee failed to prove she sustained a personal injury on March 9, 2009 and that she failed to provide notice of an injury as required by Minn. Stat. 176.141. The employee alleged that on March 9, 2009, her foot became stuck between two pallets.  As she pulled her foot out, she experienced an onset of pain and her foot began to swell. The employee testified she told her supervisor about the injury the following day. The supervisor testified she was not told about the injury at work. She was only told the employee had injured her foot.  This was supported by a medical records stating the injury had not been reported to workers’ compensation.  Further, another employer witness testified there was no way the employee could have fit her foot in between the two pallets. The compensation judge accepted the testimony of the employer witnesses, as well as the report of the employer’s IME doctor, Dr. Segal. The WCCA found there was substantial evidence to support the compensation judge’s denial of a compensable claim.

 

Jurisdiction

 

Stevens-Stevenson vs. Greater Lake Country Food

W.C.C.A., May 18, 2012 ~ Reviewed by Natalie K. Lund

The employee sustained three work-related injuries in the course and scope of her employment with Greater Lake Country Food: a 1996 right shoulder injury, a 1997 right ankle injury, and a 1998 cervical injury.  In May 2011, the employee filed a medical request for payment or approval of recommended cervical and lumbar MRI scans. The attached medical records included an MRI order form, which indicated the employee had right hand pain and numbness “shooting down legs”. Physical therapy records noted chronic neck pain, bilateral hip pain and decreased lumbar and hip range of motion. In a Decision and Order, the mediator/arbitrator denied the medical request based on his conclusion that inadequate documentation had been established to support the request. A request for formal hearing was filed.  Counsel for the employer and insurer argued at hearing that the compensation judge lacked jurisdiction to determine the employee’s entitlement to the claimed treatment where the employer and insurer had never admitted liability for lumbar spine or hip injuries. The compensation judge awarded the lumbar MRI. The employer and insurer appealed.

 

The WCCA vacated the decision of the compensation judge on separate grounds. The Court found that a claim that a work injury has produced or contributed to a condition in a different body part than the original injury – what is commonly referred to as a consequential injury – raises the issue of causation, not primary liability.  A consequential injury is not a separate injury that must be pleaded by claim petition.  Jurisdiction was appropriate.  However, the employee had produced a medical report two months prior to the hearing, which formed the support for her claim. The employer and insurer had not received sufficient notice of that report, and had been unable to perform responsive discovery. On that basis, the judge’s decision was vacated and remanded for additional proceedings.

 

Causation – Occupational Disease – Expert Medical Opinion

 

Vandenberg v. Swanson & Youngdale, Inc.

WCCA, filed 9/18/12 ~ Reviewed by Joseph D. Amos

 

The WCCA affirmed the Findings of the Compensation Judge that the employee sustained a work-related injury to his kidneys.

 

The employee was exposed to various solvents and chemicals, including latex products, xylene and epoxy products during his career as a commercial painter. The employee obtained causation opinions from three different doctors, who opined that the exposure was the cause of the employee’s kidney problems because they were unable to come up with any other cause. The employer’s expert opined that the exposure was not the cause because it was not the result of an acute, high-level exposure.

 

The compensation judge accepted the opinions of the treating physicians. The WCCA rejected the employer’s arguments that the treating physician’s opinions lacked foundation and were not given to the degree of medical certainty required by law. The WCCA affirmed, granting deference to the province of the compensation judge to decide questions of medical causation.

 

Petition to Discontinue PTD

 

Stevens v. S.T. Services

WCCA, filed October 8, 2012 ~ Reviewed by Jennifer Augustin

The Employer and Insurer filed a Petition to Discontinue the Employee’s PTD benefits with the WCCA, alleging that he was no longer permanently and totally disabled because he had engaged in and was capable of gainful employment. A prior Stipulation for Settlement provided the Employee would continue to receive PTD benefits “subject to the terms and conditions of Chapter 176.” Given this language, the court determined it was evident the parties contemplated continued payments only so long as the Employee continued to qualify as permanently and totally disabled under the statute. The WCCA refused to issue a decision and referred the matter to the Office of Administrative Hearings for a full evidentiary hearing to determine if the Employee was permanently and totally disabled, and whether the Employer and Insurer were entitled to a credit for benefits paid while the Employee was gainfully employed.

 

Res Judicata Effect of § 176.106 Decisions

 

Abbett, Jr. v. Georgia-Pacific Corp.

WCCA, filed October 11, 2012 ~ Reviewed by Jennifer Augustin

 

The WCCA reiterated its prior decisions acknowledging the potential for res judicata effect by unappealed Minn. Stat. § 176.106 decisions from the Department of Labor and Industry, but only for those issues specifically decided in the prior proceeding. Problems exist in using administrative decisions to bar future claims and defenses since there is no record of the administrative conference, no sworn testimony, and no formal exhibits. Giving res judicata effect to an administrative decision concerning future treatment may be particularly inappropriate.

 

Independent Contractor v. Employee

 

Price v. David Fox

WCCA, filed October 15, 2012 ~ Reviewed by Jennifer Augustin

 

Where a homeowner hired Price to mow the lawn, remove leaves, and shovel snow, Price was paid a guaranteed salary based upon 16 hours per week with payment on an hourly basis for any time expended in excess of 16 hours, where Price decided what days and hours he worked, where the homeowner provided 90% of the tools and equipment, where Price was allowed to hire whomever he wished to assist him, and those assistants were paid based upon the hours Price billed to the homeowner, the WCCA concluded that Price substantially met all of the safe harbor criteria for an independent contractor pursuant to Minn. R. 5224.0110, subp. 1, and reversed the decision of the compensation judge.  Even had they not concluded he met all of the safe harbor criteria, they would nevertheless have concluded he was not an employee under the general rules, where the right to control the means and manner of the performance of the work is the most significant factor to consider. The court pointed out that the homeowner may control the quality or description of the work without controlling the means or manner by which the person performs the work.

 

 

 

 

 

Traveling Employee

 

Eide v. Award Const. Co.

W.C.C.A., filed Oct. 16, 2012 ~ Reviewed by Jennifer Augustin

 

The Employee was required to travel to California for work. While in California and after his work shift, he died from a heart attack in his hotel room. The WCCA affirmed the Compensation Judge’s denial of dependency benefits holding that, while the death occurred “in the course of employment” under the traveling employee doctrine, it did not “arise out of the employment,” because there was no causal connection between the Employee’s work and his fatal heart attack.  In other words, there was no increased risk or hazard with its origin or source in the employment and beyond the exposure of the general public.

 

Milbrat v. The MarketPlace, Inc.

W.C.C.A., filed Oct. 22, 2012 ~ Reviewed by Jennifer Augustin

 

The Employee sustained a work-related injury. While traveling from her treating physician’s office to her usual and customary pharmacy to fill prescriptions related to her injury, she was involved in a motor vehicle accident, sustaining further injury. The WCCA concluded that coverage shall be granted for this injury that occurred during travel to obtain medication for a work injury. They cite prior case law extending coverage to those employees injured during travel to or from a doctor for treatment of a work injury, which says the employer has an obligation to provide medical treatment and the employee has an obligation to receive such treatment and thereby avoid further medical complications.  The proper treatment of an employee’s injury is in the interests of both the employee and employer.  This same rationale is equally applicable to cases in which an employee is traveling to obtain medication prescribed to cure and relive her from the effects of the work injury.

 Thomas P. Kieselbach
1550 Utica Ave. South, Ste. 600
Minneapolis, MN 55416
Phone: 952.525.6955
E-mail: tpk@cousineaulaw.com

2011 Minnesota Legislative Update

On May 22, 2011, the Minnesota Legislature passed Senate Bill 1159 by a vote of 126 – 4. It will enact various Workers’ Compensation Advisory Council recommendations.

Case Law Updates

Roraff Fees

Parales-Rodriguez v. ERMC, WCCA, 4/1/11 ~ Reviewed by Nicole Kampa

The WCCA affirmed in part and vacated in part the findings of the Compensation Judge on Roraff Fees. The Compensation Judge awarded Roraff fees and determined it was not premature despite continued payment of wage loss benefits from which contingent attorney fees were being withheld.  The WCCA agreed with the employer and insurer that Roraff fees were premature as it was impossible to determine at the time of hearing either the amount of benefits ultimately to be recovered for the employee or the exact amount of any contingent fee since the employee continued to receive wage loss benefits from which contingent fees were being withheld. The Court reminded the parties that an Irwin analysis requires parties to know of the amount involved, results obtained and amount of the contingent fee at the time of hearing.

Chronic Pain Program

Griffin v. Kindred Hospitals, WCCA, 4/4/11 ~ Reviewed by Nicole Kampa

The WCCA held that the Compensation Judge erred in finding treatment received at a pain center was closed out under a prior stipulation for settlement. In the present case a prior stipulation for settlement closed out medical expenses in the nature of “multi-dimensional in-patient and out-patient chronic pain treatment programs.” The WCCA held that the treatment received in the present case did not meet all mandatory requirements of Minnesota Rules 5221.6600, subpart 2.E. defining multidisciplinary chronic pain management programs. Careful attention to language in a stipulation for settlement may help ensure a complete close-out of all desired medical expenses.

Joinder

Johnson v. McDowall Companies,WCCA, 4/12/11 ~ Reviewed by Nicole Kampa

The WCCA affirmed the Compensation Judge’s denial of a motion for joinder on grounds it would delay an expedited hearing and was not necessary for resolution of the claims. The WCCA held a motion to join a subsequent employer and insurer that was filed the week before an expedited hearing would have delayed the hearing. The employer was not prejudiced since the Court found it could assert a contribution claim in a subsequent proceeding. The WCCA also held the Compensation Judge’s factual conclusions concerning competing medical opinions was not clearly erroneous as a matter of law.

Thomas P. Kieselbach,
1550 Utica Ave. South, Ste. 600
Minneapolis, MN 55416
Phone: 952.525.6955
E-mail: tpk@cousineaulaw.com

Case Law Updates

Jurisdiction

Brian K. Martin, Employee, vs. Morrison Trucking, Inc., Respondent, and Travelers Insurance Company, Relator, and Minnesota Department of Labor and Industry, Special Claims Section, f/k/a Special Compensation Fund, Respondent, Minnesota Supreme Court, filed August 3, 2011.

Minnesota Statutes § 175A.01, subd. 5 (2010), provides jurisdiction to the Workers’ Compensation Court of Appeals to decide only questions of law and fact arising under the workers’ compensation laws of Minnesota.

The Workers’ Compensation Court of Appeals has jurisdiction to determine whether an insurance contract provides Minnesota workers’ compensation insurance.

The Workers’ Compensation Court of Appeals did not have jurisdiction to declare an unambiguous exclusion of Minnesota coverage in the insurance contract held by the employer in this case to be invalid and unenforceable because the exclusion conflicted with Wisconsin statutory provisions and public policy.

Reversed. Justice G. Barry Anderson. Concurring, Justice Paul H. Anderson. Took no part, Justice Alan C. Page.

Age 67 Presumption

Frandsen v. Ford Motor Company, A11-0126, Minnesota Supreme Court, filed August 10, 2011

The Minnesota Supreme Court determined the age 67 retirement presumption, codified in Minn. Stat. § 176.101 subd. 4, applies unless the employee rebuts the presumption or proves the employer and insurer knowingly and intentionally waived the statutory right to assert the presumption.

The Workers’ Compensation Court of Appeals (WCCA) held the employer waived its right to later assert the retirement presumption in a to-date stipulation for settlement.  The WCCA reviewed the to-date settlement and concluded the employer waived the retirement presumption because “the parties did not incorporate into the settlement agreement the presumptive retirement provision.”

The Minnesota Supreme Court reversed the WCCA.  The Court criticized the WCCA’s decision as it required an employer to expressly reserve the retirement presumption and such requirement improperly relieves the employee of his or her burden to rebut the presumption by a preponderance of the evidence or to prove the employer knowingly and intentionally waived the presumption.  The Court clarified for there to be waiver, two elements must exist: (1) knowledge of a right; and (2) intent to waive that right.  Waiver can be expressed or implied, but either type requires an expression of intent to relinquish the right.  Employee must prove waiver by producing evidence of knowledge and intent in the form of:

(1)    language in a stipulation for settlement between the parties;
(2)    affirmative conduct on the part of the employer; or
(3)    circumstances that would ascribe meaning to the employer’s silence.

The Minnesota Supreme Court held the retirement presumption shall apply unless the employee rebuts the presumption or affirmatively proves waiver.  Simple absence of specific language reserving the retirement presumption in a stipulation for settlement is not enough, standing alone, to support a finding the employer and insurer waived their right to assert the age 67 retirement presumption.

Medical Expenses

Troyer v Vertlu Management Co., Minnesota Supreme Court, filed August 17, 2011 ~ Reviewed by Craig A. Larsen

The Supreme Court affirmed the Compensation judge and the WCCA’s decision that a hospital can charge directly for implant hardware, and that a compensation judge has no authority to determine a reasonable price for the hardware to be less than 85% of a hospital’s usual and customary price.

The employee had a spinal cord stimulator implanted at HealthEast St. Josephs Hospital.  HealthEast billed $73,320, its usual and customary charge, for the hardware along with other charges for the surgery. This charge included a significant mark up over what it actually paid the manufacturer. The insurer paid the other charges, but paid only a portion of the amount billed for the hardware, less than 85% of the charge. HealthEast filed a medical Request for the difference between the amount paid and 85% of their usual charge.

The employer and insurer argued that HealthEast did not “furnish” the hardware, but that the manufacturer was the entity that “furnished” the hardware. Consequently, the manufacturer should be the entity billing for the hardware pursuant to Minn. R. 5221.0700, subp.2A. The Supreme Court held, after going through a tedious construction of the rules regarding payment of medical expenses, that when more than one health care provider is responsible for the creation or transmission of a service, article or supply, the provider that provides it in its final usable form has “furnished” it, and is the one to properly charge for it.

The employer and insurer also argued that the compensation judge has authority to determine a reasonable value for a service, article, or supply at less than 85% of the usual and customary charge, or prevailing charge, in accordance with Minn. Stat. 176.136. After discussing the language contained in Minn. Stat. 176.136, and specifically Minn. Stat.176.136, subd. 1b(b) the Court held that a compensation judge does not have authority to determine a reasonable value of medical services at less than 85% of usual and customary or prevailing charges.

Given the outcome of this case, it will be difficult to contain future medical costs for implantable devices associated with workers’ compensation claims.

Covered Employees

Francisco Vargas-Velasquez v. Hernandez Expert Roofing, WCCA, filed June 23, 2011 ~ Reviwed by Joshua Borken

The WCCA affirmed the Compensation Judge’s conclusion that Vargas-Velasquez was not an employee of Hernandez Expert Roofing and was not covered by that company’s workers’ compensation insurance policy because the Articles of Incorporation and the certificates of workers’ compensation insurance clearly identified the petitioner as a stockholding executive officer of the corporation who had not expressly opted for personal insurance coverage as required under the statute.

Expansion of Issues Upon Appeal

Ellingboe v. Lowes, WCCA, filed May 13, 2011 ~ Reviewed by Jennifer Augustin

The Employer and Insurer filed a NOID based on an IME report opining that the Employee’s left foot condition was a result of his genetic makeup, not his work injury.  An administrative conference was held, whereby the issue of causation was addressed and the compensation judge found for the Employee.  The Employer and Insurer appeal and argue the Employee did not engage in a diligent job search.  The WCCA held this was an improper expansion of the issues beyond those addressed at the hearing.  The Employer and Insurer argued that when the Employee’s attorney failed to object to questions about job search asked of the Employee during cross-examination and made no objection to the employer and insurer’s attorney raising the issue in her closing argument, the Employee’s attorney consented to the job search as an issue.  The WCCA held an agreement to the expansion of the issues could not be construed in any way on these facts.

Mental Injuries

Quijada v. Heikes Farms, Inc.,  WCCA, filed May 4, 2011 ~ Reviewed by Jennifer Augustin

The Employee appealed the compensation judge’s finding that this psychological condition was unrelated to his personal injury.  The WCCA affirmed, stating that, in cases involving mental injury, the fact that there exists a temporal relationship between the injury and the onset of a mental condition, standing alone, is insufficient to establish causation.  It does not necessarily follow that because the depression came after the injury that the injury caused the depression.  Rather, some medical opinion causally relating the mental condition to the physical injury is required before the depression can be found compensable.  The Employee further argued that his personal injury caused him to be unemployed which, in turn, resulted in financial and family problems.  The WCCA found this to be an intervening non-medical factor which separated the personal injury from the claimed psychological consequence.

Payments to Out-of-State Intervenors

Schatz v. Interfaith Care Center
,  WCCA, filed June 16, 2011 ~ Reviwed by Joshua Borken

Minn. Stat. §176.136, subd. 1b(d), which limits an employer’s liability for the cost of medical treatment provided outside of Minnesota, is not in conflict with Minn. Stat. §176.135. The Court reversed the compensation judge’s finding that relieving the employer of liability under Minn. Stat. §176.136, subd. 1b(d)would effectively transfer liability from the employer to the employee in conflict with Minn. Stat. §176.135.  The Employee was injured in Minnesota and then moved to Wyoming and received treatment for her injury in Wyoming.  The statute at issue has a provision that limits an insurer’s liability for out-of-state medical care to the amounts the providers would have received under the workers-compensation law of the state where the treatment occurs.  The Wyoming provider’s financial policy form, initialed by the Employee, provided that the Employee was responsible for any remaining balance not covered by workers’ compensation.  This is the first application of the statute by the WCCA.  The dissenting opinion believes the statute reverses 90+ years of case law and conflicts with a fundamental provision of the workers’ compensation statute, specifically requiring an injured work to pay for medical treatment that is related to the work injury and is necessary to cure and relieve the effects of the injury.

Physical-Mental Injuries

Kim v. Moneygram International, Inc.,  WCCA, filed June 14, 2011

The WCCA affirmed the Compensation Judge’s finding that a claimed unwanted sexual contact during an IME was not a substantial contributing factor to the employee’s psychological or mental symptoms. The employee attended an IME for a claimed low back injury.  During the examination, the IME doctor placed his hands on the employee’s breasts as part of the exam.  The employee claimed, as a result of the unwanted sexual contact she developed PTSD and panic disorder.  The Compensation Judge found no physical injury, and therefore any psychological injury was not compensable under Lockwood v. ISD #877.  The Compensation Judge adopted the independent psychological evalutor’s opinion that the events at the IME  were not a substantial contributing cause of any psychological symptoms.  Finding the psychological evaulator’s opinion to be well founded, the WCCA affirmed.

Removal from Job Market

Schweder v. Covalence Specialty Materials Corp., WCCA, filed May 26, 2011 ~ Reviewed by Jennifer Augustin

The Employee appealed the compensation judge’s conclusion that his move from the Twin Cities to Hoyt Lakes constituted a withdrawal from the labor market so as to preclude the receipt of temporary total disability benefits.  The WCCA reversed, holding that, while the labor market in St. Louis County is smaller than the labor market in the Twin Cities, the evidence did not support a determination that the employee would be able to obtain only sporadic, short-term employment resulting in grossly insubstantial income or that employment opportunities were virtually nonexistent in St. Louis County.

Chronic Pain Program

Griffin v. Kindred Hospitals
,  WCCA, 4/4/11 ~ Reviewed by Nicole Kampa
The WCCA held that the Compensation Judge erred in finding treatment received at a pain center was closed out under a prior stipulation for settlement. In the present case a prior stipulation for settlement closed out medical expenses in the nature of “multi-dimensional in-patient and out-patient chronic pain treatment programs.” The WCCA held that the treatment received in the present case did not meet all mandatory requirements of Minnesota Rules 5221.6600, subpart 2.E. defining multidisciplinary chronic pain management programs. Careful attention to language in a stipulation for settlement may help ensure a complete close-out of all desired medical expenses.

Joinder

Johnson v. McDowall Companies,  WCCA, 4/12/11 ~ Reviewed by Nicole Kampa
The WCCA affirmed the Compensation Judge’s denial of a motion for joinder on grounds it would delay an expedited hearing and was not necessary for resolution of the claims. The WCCA held a motion to join a subsequent employer and insurer that was filed the week before an expedited hearing would have delayed the hearing. The employer was not prejudiced since the Court found it could assert a contribution claim in a subsequent proceeding. The WCCA also held the Compensation Judge’s factual conclusions concerning competing medical opinions was not clearly erroneous as a matter of law.