SCOTT ROUX, Employee/Appellant,
v.
R.J. REYNOLDS TOBACCO and ACE USA/ESIS, Employer-Insurer/Cross-Appellants
and
IMPACT PHYSICAL MED., ALLINA MED. CLINIC, UNITED HOSP., MED. HEALTH PLANS, and ABBOTT NW. HOSP., Intervenors.
No. WC18-6174
Minnesota Workers Compensation
Workers’ Compensation Court of Appeals
November 28, 2018
MEDICAL
TREATMENT AND EXPENSE – REASONABLE AND NECESSARY.
Substantial evidence in the record supports the compensation
judge’s award of some, and denial of other, claimed
medical treatment according to whether the claimed medical
treatment was reasonable and necessary.
James
Michael Gallagher, James Michael Gallagher & Associates,
Minneapolis, Minnesota, for the Appellant.
Christine L. Tuft and Alicia J. Smith, Arthur, Chapman,
Kettering, Smetak & Pikala, P.A., Minneapolis, Minnesota,
for the Cross-Appellants.
Deborah K. Sundquist, Judge, David A. Stofferahn, Judge, Sean
M. Quinn, Judge.
Compensation Judge: Stephen R. Daly.
OPINION
DEBORAH K. SUNDQUIST, Judge.
The
compensation judge awarded some, and denied other, claims for
medical treatment and mileage. The employee appeals and the
employer and insurer cross-appeal.
BACKGROUND
On June
20, 2011, while working for the employer R.J. Reynolds, Scott
Roux was injured in a motor vehicle accident. The employer
and its insurer admitted liability and paid medical benefits,
including right ankle surgery, vocational rehabilitation
benefits, and wage loss benefits. The parties entered into a
Stipulation for Settlement in June 2013 in which the employee
settled his claims on a full, final and complete basis. The
stipulation closed out all medical expenses of any type or
nature related to the employee’s claimed injuries to
the left eye, neck, back, head/brain, traumatic brain injury,
and mental health treatment. Only medical expenses related to
the injured right ankle remained open.
Following
the 2013 settlement, the employee’s condition required
ongoing treatment which was extensive and resulted in
piecemeal litigation. As such, the medical and procedural
background in this matter is complicated.
In
January 2014, the employee sought treatment with Dr. John N.
Dunne of Park Nicollet who recommended that the employee
continue to treat with MAPS for pain management, continue
pool therapy, and continue medications including Lyrica,
Vicodin, and trazadone. In December 2014, the employee filed
a medical request seeking approval of pool therapy at Courage
Center, a referral to MAPS, a referral to Dr. Chris Coetzee,
and approval of prescription medications hydrocodone and
trazadone. These issues were ultimately heard at a formal
hearing, and in an unappealed Findings and Order of April 15,
2015, the compensation judge awarded treatment with Dr.
Dunne, some treatment at MAPS, and prescription medications
hydrocodone and trazadone, concluding these treatments were
reasonable, necessary, and causally related to the
employee’s right ankle injury. The judge denied the
pool therapy and the referral to Dr. Coetzee.
The
employee continued to experience burning right ankle pain
throughout 2015 and 2016. He was ultimately diagnosed with
chronic regional pain syndrome (CRPS) by several doctors,
including Dr. Barbara Seizert, Dr. Raghavendra Nayak, and Dr.
Orlando Charry all with Courage Kenny, as well as by Dr. Todd
Hess and Dr. Coetzee. (Exs. C, D, and 8.) Both Dr. Charry and
Dr. Hess recommended treatment plans to include topical
ointments, injections, and acupuncture. The employer and
insurer retained Dr. Nolan Segal who conducted independent
medical examinations of the employee. He opined that there
was no evidence of CRPS and the employee’s current
complaints of pain were unrelated to the work injury. The
issue of whether Dr. Charry’s treatment and expenses
were reasonable, necessary and causally related to the
employee’s work...
