JAMES M. DAWSON, Employee/Appellant,
v.
UNIVERSITY OF MINN., SELF-INSURED/SEDGWICK CLAIMS MGMT. SERVS., Employer,
and
MARSDEN BLDG. MAINTENANCE and RELIANCE INS. CO./ALEXSIS, INC., Employer-Insurer,
and
MEDICA CHOICE/HEALTHCARE RECOVERIES, INC., and HOLMBERG CHIROPRACTIC SERVS., Intervenors.
Minnesota Workers Compensation
Workers' Compensation Court of Appeals
May 6, 1999
HEADNOTES
PERMANENT
PARTIAL DISABILITY - SUBSTANTIAL EVIDENCE. Substantial
evidence, including expert opinion, supported the
compensation judge's denial of the employee's claim
for permanent partial disability benefits related to his
cervical condition.
MEDICAL
TREATMENT & EXPENSE - CHANGE OF PHYSICIAN; MEDICAL
TREATMENT & EXPENSE - TREATMENT
PARAMETERS. Prior approval of a request to
change physicians is not determinative of the compensability
of medical treatment, and neither the change-of-physicians
rules nor the permanent treatment parameters are applicable
where an employer and insurer have denied primary liability
for a work injury. Because the compensation judge erred
in denying the claimed treatment expenses on
change-of-physician and treatment parameters grounds under
the circumstances of this case, the matter is remanded for
reconsideration and additional findings.
Affirmed
in part, reversed in part, and remanded.
Determined by Wilson, J., Johnson, J., and Hefte, J.
Compensation Judge: James R. Otto.
OPINION
DEBRA
A. WILSON, Judge
The
employee appeals from the compensation judge's denial of
permanent partial disability benefits and treatment
expenses. We affirm in part, reverse in part, and remand
for further proceedings.
BACKGROUND
On
March 23, 1994, the employee slipped and fell several feet
while descending a ladder in the course and scope of his
employment as a pipe fitter for the University of Minnesota
[the employer], self-insured. He landed stiff-legged on
a cement floor; whether he then fell further, landing on his
left side, is disputed. He reported the incident to the
employer the following day and began seeing Dr. James
Anderson, on referral from the employer, and Dr. Dean Evans,
D.C., on his own initiative, for treatment of low back and
leg pain. By late April of 1994, the employee had begun
reporting additional symptoms, including facial numbness and
tingling pain into his left arm and left leg.
In
October of 1994, the employee began seeing Dr. Gregory
Holmberg, D.C., for symptoms which by this time included low
back pain, neck pain, headaches, facial numbness, and partial
loss of taste. The employee indicated that he had
transferred his care from Dr. Evans to Dr. Holmberg for
convenience due to clinic location.
On
October 26, 1994, Dr. Evans filed a medical request seeking
payment for several weeks of treatment rendered after the
March 1994 injury. The employer responded that Dr.
Anderson, not Dr. Evans, was the employee's primary
treating physician and that Dr. Evans' treatment was in
any event duplicative of the treatment the employee had
received from Dr. Anderson. In a decision issued on
November 28, 1994, a representative of the commissioner
indicated that the employee was entitled, under applicable
rules, to change physicians once within the first sixty days
of treatment, and that the care rendered by Dr. Evans was
otherwise reasonable, necessary, and compensable. In
response, the employer filed a request for formal hearing.
The
employee continued to treat intermittently with Dr. Holmberg
and eventually saw several other health care providers,
including Dr. Crispin See, of the Minneapolis Clinic of
Neurology. Diagnostic tests included at least two
cervical MRI scans and a lumber MRI.
On
March 12, 1996, the employee aggravated his low back
condition while working in a second, part-time job with
Marsden Building Maintenance [Marsden]. He continued to
treat with Dr. Holmberg after this incident.
The
employee filed a claim petition alleging entitlement to
permanent partial disability benefits, for cervical and
lumbar injuries, from the employer and Marsden. The
petition also listed claims for treatment expenses in
connection with the care rendered by several
providers. In its answer, the employer admitted that the
employee had sustained a temporary lumbar injury, denied that
the employee had injured his cervical spine, denied that the
employee had sustained any permanent partial disability, and
denied liability for the disputed treatment expenses on
grounds of causation, reasonableness and necessity...
