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Johnson v. Darchuks Fabrication, Inc.

Supreme Court of Minnesota

April 24, 2019

William H. Johnson, Respondent,
v.
Darchuks Fabrication, Inc. and Harleysville Insurance Company, Relators, and Injured Workers Pharmacy, Intervenor.

          Workers' Compensation Court of Appeals Office of Appellate Courts

          Charles M. Cochrane, Cochrane Law Office, P.A., Roseville, Minnesota, for respondent.

          Emily A. LaCourse, Christine L. Tuft, Arthur, Chapman, Kettering, Smetak & Pikala, P.A., Minneapolis, Minnesota, for relators.

         SYLLABUS

         1. The treatment parameters established under the workers' compensation act in Minnesota Rule 5221.6020, subpart 2 (2017), apply to treatment of an injury afterliability has been established but do not apply when liability for the compensation benefits owed for an injury has been denied.

         2. An employer that contests its obligation to pay for medical treatment for an employee injury that the employer admits is covered by the workers' compensation act has not "denied liability for the injury" within the meaning of Minnesota Rule 5221.6020, subpart 2.

          OPINION

          CHUTICH, JUSTICE.

         This case considers whether the medical treatment parameters established under the workers' compensation act apply to an employee's claim for reimbursement of medical expenses that the employer contends are not reasonably necessary. Minnesota Rule 5221.6020, subpart 2 (2017), states that the treatment parameters "do not apply to treatment of an injury after an insurer has denied liability for the injury." Relying on this rule, the Workers' Compensation Court of Appeals concluded that the treatment parameters do not apply when an employer contests its obligation under the workers' compensation act to pay for an employee's particular medical treatment. We disagree. Accordingly, we reverse the Workers' Compensation Court of Appeals and remand the case to the workers' compensation judge for further proceedings consistent with this opinion.

         FACTS

         In September 2002, employee William Johnson suffered a right ankle injury when he stepped on a piece of scrap metal while working for Darchuks Fabrication, Inc. Within a short period, Johnson developed sharp pain and burning sensations that progressed up his right leg. These symptoms persisted and, eventually, Johnson was diagnosed with a condition known as "complex regional pain syndrome," which is recognized and governed by the workers' compensation treatment parameters. See Minn. R. 5221.6305 (2017). The condition is characterized by a number of symptoms affecting a person's extremities, including reduced range of motion, swelling, changes in skin texture or color, sensitivity to touch or cold, and abnormal skin temperature regulation. See id., subp. 1.[1]

         Since his injury, Johnson has consulted with numerous physicians and medical specialists. Early on, he was prescribed physical therapy and sympathetic blocks, [2] but these treatments did not provide lasting relief. By July 2004, Johnson had developed severe depression that, in addition to his chronic pain, negatively affected his ability to concentrate and focus in his day-to-day life. A 2004 report by one of Johnson's treating physicians concluded that Johnson was "not capable of gainful occupation" and had "not yet reached Maximum Medical Improvement for his work injury." The report recommended consultations with a pain clinic and a program that tried a variety of medications to manage his pain and improve his quality of life. The report also noted that Johnson's condition may be a lifetime disorder. The record shows that Johnson's symptoms have consistently included paresthesias, hypersensitivity, intolerance to heat and cold, skin atrophy, and pain with physical activity. His pain is always present, and he experiences difficulty sleeping without medication. Johnson has not been able to return to work since his injury.

         After his injury, Johnson sought workers' compensation benefits. In 2004, the parties reached an agreement and entered into a stipulation to settle Johnson's claim for benefits. Under the agreement, Darchuks accepted workers' compensation liability for the ankle injury and, in addition to making a lump-sum payment, agreed to pay ongoing medical expenses that were reasonably required to cure and relieve Johnson's symptoms.[3]In accord with the stipulation, Darchuks paid for Johnson's medical treatment until the dispute at issue here arose, when Darchuks determined in July 2016 that Johnson's current treatment was no longer reasonable or necessary.

         Since 2005, Johnson has received treatment from his current physician, a general practitioner. He has not consulted with a pain specialist, as was previously recommended by a former treating physician. Over the years, Johnson's physician has prescribed a combination of medications that include muscle relaxers, calcium channel blockers, nerve medications, sleep medications, opioid analgesics, and anti-anxiety medications. With these medications, Johnson appears to have achieved some measure of control over his symptoms-but has never been able to eliminate the symptoms altogether.

         Despite the stability of Johnson's symptoms, his ability to manage daily life has slowly declined. According to his medical records, for example, Johnson's capacity to do household chores and outside housework diminished between 2013 and 2015. During this period he also reported increased difficulty with daily exercise because of the pain. In October 2016, Johnson told his physician that his pain completely interferes with his general activity and sleep on a regular basis.

         Presently, Johnson's treatment regime consists of five medications: Endocet (an opioid for pain), lorazepam (an anti-anxiety medication), nifedipine (to reduce contractions in his blood vessels in his leg), Neurontin (a brand-name medication for nerve pain), and cyclobenzaprine (to treat muscle spasms). Aside from changes in dosage prescribed by Johnson's physician, this treatment regime has remained unchanged for more than ten years. Johnson has a check-up with his physician every three months. As required by the treatment parameters, Johnson has signed and complied with a narcotic medication contract for his opioid prescription.[4] See Minn. R. 5221.6110, subp. 7 (2017).

         In May 2016, Darchuks requested that Johnson undergo an independent medical examination. It was the fourth independent medical examination conducted since Johnson's initial injury in 2002. Until then, every physician who had examined Johnson agreed with his complex regional pain syndrome diagnosis and agreed that the condition is causally related to Johnson's workplace ankle injury. The May 2016 ...


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