William H. Johnson, Respondent,
Darchuks Fabrication, Inc. and Harleysville Insurance Company, Relators, and Injured Workers Pharmacy, Intervenor.
Workers' Compensation Court of Appeals Office of
Charles M. Cochrane, Cochrane Law Office, P.A., Roseville,
Minnesota, for respondent.
A. LaCourse, Christine L. Tuft, Arthur, Chapman, Kettering,
Smetak & Pikala, P.A., Minneapolis, Minnesota, for
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.
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.
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
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.
his injury, Johnson has consulted with numerous physicians
and medical specialists. Early on, he was prescribed physical
therapy and sympathetic blocks,  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.
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.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
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.
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.
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. See Minn. R. 5221.6110, subp. 7
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 ...