Workersâ Compensation Court of Appeals Office of Appellate
Benjamin J. Heimerl, Heimerl & Lammers, Minneapolis,
Minnesota, for respondent.
Kleffman, Beth A. Butler, Peterson, Logren, & Kilbury,
P.A., Saint Paul, Minnesota, for
A. Frederickson, Katie H. Storms, João C.J.G. de
Medeiros, Lind, Jensen, Sullivan & Peterson, P.A.,
Minneapolis, Minnesota, for respondent/cross-appellant.
Lillehaug, J. Took no part, Chutich, J.
compensation judge did not abuse her discretion in concluding
that respondent's work-related silica exposure was a
substantial contributing factor to his kidney failure.
Under 42 C.F.R. § 447.15 (2016), a provider cannot
recover payment from third parties for any services billed to
Medicaid after the provider has accepted payment from
Medicaid for those services.
Respondent/appellant's 30-day period for filing a notice
of appeal to the Workers' Compensation Court of Appeals
had not expired at the time of filing the appeal because the
findings and order of the compensation judge were not served
directly on respondent/appellant.
Workers' Compensation Court of Appeals did not err by
reviewing and modifying the compensation judge's order
instructing appellants to make workers' compensation
payments "in accordance with all other state and federal
question of whether Minnesota's workers' compensation
fee schedules apply to medical bills for treatment incurred
prior to a finding of primary liability is remanded to the
Workers' Compensation Court of Appeals.
after leaving his job at Atlas Staffing, Inc.
("Atlas"), respondent Anthony Gist was diagnosed
with end stage renal disease ("ESRD")-kidney
failure. His job with Atlas exposed him to silica, a known
cause of ESRD. Gist sought workers' compensation benefits
from Atlas and its insurer, Meadowbrook Claims Services
(collectively, "appellants"). Appellants denied
coverage, and Gist began receiving treatment from
respondent/cross-appellant Fresenius Medical Care
("Fresenius"). Fresenius billed Medicaid, Medicare,
and private insurer Medica for the costs of Gist's
treatment, and accepted payments from each.
hearing, the compensation judge found that Gist's silica
exposure was a substantial contributing factor to his kidney
disease, and ordered that appellants pay workers'
compensation benefits. After dismissing Fresenius's
cross-appeal as untimely, the Workers' Compensation Court
of Appeals ("WCCA") largely upheld the compensation
judge's decision. In the consolidated appeals brought by
appellants and Fresenius, we affirm in part, reverse in part,
and remand to the WCCA.
worked for Atlas, a temporary staffing agency, from September
2011 through June 2013. Atlas assigned him to Waltek Casting
Company, which creates casting molds for boats, planes, and
farming equipment engines. Gist's job at Waltek involved
placing wax figures on a rack and then a conveyor, after
which a robot would drop the figures into a silica-sand tank.
He was also required to fill and clean the silica-sand tanks.
Filling occurred 8 to 10 times per 8-hour shift, and the
tanks were cleaned at least once per day.
exposure to silica sand is hazardous, Gist wore ear plugs,
safety glasses, gloves, and a paper mask. Gist described the
2-hour cleaning process as hot, wet, and muddy. Silica sand
got inside his pants and stuck to his skin.
left the job on June 28, 2013, at age 50. About a month
later, he was seen at Mercy Hospital "for evaluation of
kidney concerns after being informed by his clinic that his
blood work had evidence for kidney failure." Thereafter,
Gist saw a number of doctors. In November 2014, he filed a
claim petition seeking workers' compensation benefits
compensation judge held a hearing in August 2016, at which
the sole issue relevant to this appeal was whether silica
exposure was a "substantial contributing factor to
[Gist's] kidney failure." The parties stipulated that
"[a]ll medical treatment to date has been reasonable and
necessary" and that Gist was "permanently and
total[ly] disabled." At the time of the hearing,
approximately $1.5 million in medical bills and indemnity
benefits were at issue.
deal of evidence regarding Gist's medical history was
presented at the hearing. We summarize that history as
• In February 2008, Gist was diagnosed "as having a
left foot wound with cellulitis and elevated blood sugar,
most likely diabetic."
• In June 2011, Gist was "diagnosed with
hypertension, left-sided chest pain, mild anemia, and
• In July 2013, Gist was evaluated by Dr. James Lee and
then hospitalized for acute renal failure. Gist told Dr. Lee
that he believed that his kidney failure was due to silica
• An August 2013 biopsy showed that Gist had a condition
"globally interpreted as irreversible, non-salvageable
• A week after his biopsy, Gist saw Dr. James Rusin, a
family physician. Dr. Rusin "did not feel silica had
anything to do with [Gist's] kidney problem."
• On August 27, 2013, Gist saw Stephanie Gordon, a nurse
practitioner. Gordon told Gist that "the kidney biopsy
results were not consistent with findings of some type of
• On November 4, 2013, Gist was evaluated by Dr. Arthur
Ney, a surgeon. Dr. Ney noted that Gist had "a history
of ESRD . . . possibly hypertension" and deemed him a
"reasonable candidate for transplant." Gist ...