CHRIS M. PRIGLMEIER, Employee/Appellant,
v.
STELLAR CONCRETE & MASONRY and LUMBERMEN'S UNDERWRITING ALLIANCE, Employer-Insurer,
and
STELLAR CONCRETE & MASONRY and CONSTITUTION SERVS. GROUP/BERKLEY RISK ADM'RS CO., Employer-Insurer/Cross-Appellants,
and
MN DEP'T OF HUMAN SERVS. and INSTITUTE FOR LOW BACK & NECK CARE, Intervenors.
No. WC04-228
Minnesota Workers Compensation
Workers' Compensation Court of Appeals
April 25, 2005
HEADNOTES
CAUSATION
- SUBSTANTIAL EVIDENCE. Where, for two years following
his 2000 work injury, the employee was subject to no work
restrictions, missed no work time, and sought no further
medical treatment, and where the judge's decision was
otherwise supported not only by a medical opinion but also by
the testimony of the employee and other medical records in
evidence, the compensation judge's conclusion, in
reliance on the medical opinion, that the employee's 2000
work injury was not a substantial contributing factor in the
employee's physical condition following his 2002 work
injury was not clearly erroneous and unsupported by
substantial evidence.
MEDICAL
TREATMENT & EXPENSE; EVIDENCE - ADMISSION; PRACTICE &
PROCEDURE - REMAND. Where the employee submitted into
evidence the records from his chiropractic provider but where
his exhibit summarizing the related outstanding expenses did
not include the actual bills, where it was unclear whether
this failure occurred because of some oversight by the
employee or because of some misunderstanding at trial, and
where the judge ostensibly based her denial of payment for
the treatment expenses on the absence of the actual billings
and did not address either the reasonableness and necessity
of the treatment or the merits of the employer/insurer's
defenses under the treatment parameters, the compensation
judge's denial of payment for the treatment expenses was
reversed, and the issue was remanded to the compensation
judge for further consideration and findings.
TEMPORARY
TOTAL DISABILITY - SUBSTANTIAL EVIDENCE. Where the
employee's QRC testified that the employee fully
cooperated with rehabilitation efforts during the period in
question, where, although he did not search for other work,
the employee did attempt the full-time job offered by the
employer and did request amendments to his rehabilitation
plan to allow a second surgical opinion and exploration of
alternative job goals, and where the proposed amendments to
the rehabilitation plan were rejected by the
employer/insurer, the compensation judge's award of
temporary total disability benefits was not clearly erroneous
and unsupported by substantial evidence.
JOB
SEARCH; TEMPORARY TOTAL DISABILITY. Where, having been
fully advised that rehabilitation services had been
suspended, the employee evidently did not submit a single job
application anywhere once he had stopped working for the
employer, the compensation judge's denial of temporary
total disability benefits was not clearly erroneous and
unsupported by substantial evidence, notwithstanding the fact
that the employee was without rehabilitation assistance
during the period at issue.
PERMANENT
PARTIAL DISABILITY - SUBSTANTIAL EVIDENCE. Where it was
clear from the record that the judge's permanency rating
was supported by the opinions of at least three doctors, the
compensation judge's award of compensation for a 7% whole
body impairment instead of for a 12% whole body impairment
was not clearly erroneous and unsupported by substantial
evidence, notwithstanding the fact that the judge did not
specify in her opinion which doctor's opinion she was
relying upon.
MAXIMUM
MEDICAL IMPROVEMENT - SUBSTANTIAL EVIDENCE. Where the
employee's treating doctor had testified that the
employee had not reached MMI, where that doctor had
recommended a facet injection as a treatment less invasive
than fusion or the installation of an artificial disc, where
the employer/insurer had not authorized the facet injection
until just before trial, where at least one other doctor had
opined that the employee remained a surgical candidate,
and where even the independent medical examiner had conceded
that the facet injection "may obviate the need for
surgical intervention," the compensation judge's
conclusion that the employee was not yet at MMI was not
clearly erroneous and unsupported by substantial evidence,
notwithstanding the fact that there remained some uncertainty
as to whether or not the proposed facet injection might
result in significant lasting improvement in the
employee's condition.
Affirmed
in part, reversed in part, and remanded
Determined by: Pederson, J., Stofferahn, J. and Rykken, J.
Compensation Judge:Kathleen Behounek
OPINION
WILLIAM R. PEDERSON, Judge
The
employee appeals from the compensation judge's
determination that the employee's October 24, 2000, work
injury is not a substantial contributing factor in the
employee's disability subsequent to the November 5, 2002,
work injury; from the judge's denial of outstanding
treatment expenses at Integracare/Williams Clinic; from her
denial of temporary total disability benefits from December
3, 2003, through the date of hearing; and from her denial of
his claim to compensation for a 12% whole body
impairment. The employer and Constitution Services
Group/Berkley Risk Administrators Company cross appeal from
the judge's award of temporary total disability benefits
from June 20, 2003, through December 2, 2003; from the
judge's award of further rehabilitation benefits; and
from her conclusion that the employee has not reached maximum
medical improvement from his work injury of November 5,
2002. We reverse and remand for reconsideration and
further findings the judge's denial of payment for the
treatment expenses at Integracare/Williams Clinic, and we
affirm on all other issues.
BACKGROUND
Chris
Priglmeier [the employee] resides with his wife and three
children in Rice, Minnesota, a community located about ten
miles north of St. Cloud. He was born on March 31, 1965,
and is a 1983 graduate of Sauk Rapids/Rice High
School. He has had no additional formal
education. The employee's employment history has
included work as a laborer for a wood trim manufacturer, work
opening and closing pools for a swimming pool company,
general construction work, and work as a cement
finisher. The employee began working for Stellar
Concrete & Masonry [the employer] as a cement finisher in
1999. He had experienced no reported injuries or
treatment to his low back prior to starting work for the
employer.
On
October 24, 2000, the employee sustained an injury to his low
back while removing asphalt at a job site in Hibbing,
Minnesota. On the date of the injury, the employee was
thirty-five years old, and the employer was insured against
workers' compensation liability by Lumbermen's
Underwriting Alliance [Lumbermen's]. The employee
reported the incident to his foreman but did not miss any
time at work. Two days later, on October 26, 2000, the
employee sought medical treatment with Dr. Basil LeBlanc at
St. Cloud Medical Group. The employee told Dr. LeBlanc
about lifting heavy pieces of asphalt over the past few days,
and he complained to the doctor of discomfort in his mid
lumbar region. Dr. LeBlanc diagnosed a lumbar strain,
prescribed Celebrex, and released the employee to work
without restrictions. The employee subsequently
continued to have mild low back complaints, and he did
self-limit his job activities, but he continued also to work
as a cement finisher, missed no work time, and sought no
further treatment for low back pain for over two years.
In the
late summer of 2002, the employee started experiencing pain
in his right hip when he would try to bend down. On
November 5, 2002, that pain was very severe, and the employee
was unable to continue working. The following day, he
was seen by Dr. Steven Danielson, who diagnosed low back pain
with a possible radicular component and ordered an MRI scan
of the lumbar spine. On November 12, 2002, the employee
reviewed his MRI scan with Dr. Philip Bachman, who described
the findings as "scant" and revealing only a
contained disc herniation at L5-S1. Dr. Bachman
diagnosed discogenic pain with right radicular symptoms and
recommended a Medrol Dose Pak and physical therapy. On
November 5, 2002, the employer had been self-insured against
workers' compensation liability, with claims administered
by Berkley Risk Administrators Co. [Berkley].
On
November 19, 2002, the employee began treating at
Integracare/Williams Clinic [Integracare]. His primary
treating doctor at Integracare was chiropractor Dr. Michael
Balfanz, although he was occasionally treated...
