LLOYD L. FINKE, Employee/Appellant,
v.
MIDWEST COAST TRANSP. and ST. PAUL FIRE & MARINE INS. CO., Employer-Insurer.
Minnesota Workers Compensation
Workers' Compensation Court of Appeals
February 3, 1999
HEADNOTES
MEDICAL
TREATMENT & EXPENSE - OUT-OF-STATE PROVIDER. Where
the record contained no evidence whatever as to whether the
out-of-state provider's charges were or were not
consistent with the usual and customary charges for similar
treatment in the Sioux Falls, South Dakota, community, and
the compensation judge erred in reaching a determination on
the issue through misapplication of the South Dakota
workers' compensation medical fee schedules, we vacate
and remand to afford the parties an opportunity to submit
evidence on the issue of whether the provider's charges
were within the usual and customary charges for similar
treatment in the treatment community.
Vacated
and remanded.
Determined
by Johnson, J., Pederson, J., and Wheeler, C.J.
Compensation Judge: Harold W. Schultz
OPINION
STEVEN
D. WHEELER, Judge
The
employee appeals from the compensation judge's finding
that certain medical charges billed by a South Dakota medical
provider were excessive. We vacate and remand.
BACKGROUND
On
September 10, 1974, the employee, Lloyd L. Finke, a Minnesota
resident, sustained a work-related heart attack arising out
of and in the course of his employment with Midwest Coast
Transportation, a South Dakota employer, while he was
unloading one of the employer's trucks in
Wisconsin. The employer and its insurer, St. Paul Fire
& Marine Insurance Company, accepted liability and paid
various Minnesota workers' compensation
benefits. (Court Exh. 1: Stipulated Facts; DOLI file:
First Report of Injury.)
From
September 24, 1996 to November 19, 1996, the employee, then
age 63, was treated medically for his heart condition at the
North Central Heart Institute in Sioux Falls, South
Dakota. A nuclear stress test on September 24, 1996
suggested reversible inferior wall ischemia. Dr. Donald
T. Bishop, a cardiologist at the North Central Institute,
recommended that the employee undergo cardiac
catheterization. On November 19, 1996, Dr. Bishop
performed both left and right heart catheterization. The
parties have stipulated that the treatment received at the
North Central Heart Institute was reasonable, necessary and
causally related to the work injury. (Exh. A: Medical
Records; Court Exh. 1: Stipulated Facts.)
The
North Central Heart Institute billed charges amounting to
$6,716.00 for the treatment rendered to the employee during
the period in question. St. Paul Fire and Marine
Insurance Company sent the bill to a company known as Forté
for a review of the bill. The review, performed by Susan
R. Kurysh, R.N., resulted in a Medical Bill Review Report,
dated December 31, 1996, which stated that the fees charged
exceeded those provided in South...
