Employer and insurer appeal the compensation judge’s decision ordering payment of prescription medication to intervening providers and ordering reimbursement to the employee for out-of-pocket medical expenses.
The employee in this case suffered several injuries with the employer. These injuries were admitted and benefits were paid. In 2009, the parties entered into a Stipulation for Settlement, leaving future reasonable, necessary, and related medical expenses open. The first hearing was held before a compensation judge in April 2015, when it was ordered that medications prescribed for chronic pain and depression were reasonable, necessary, and related to the work injuries. That decision was not appealed. The present matter originated with a claim petition, filed by the employee, presenting issues of payment of medical claims by intervenors, payment of out-of-pocket medical expenses, and deciding whether the employee was required to use the pharmacy selected by the employer and insurer.
The employee’s treating physician, Dr. Detert, opined that the employee is stable on her medications and compliant in her prescribed use of the medications. On the other hand, Dr. Starzinski, for the employer and insurer, opined that the employee’s usage of her medications “is quite suboptimal with regard to control of her chronic pain” and some medications were counterproductive. Alternatives were recommended.
On October 9, 2017, the compensation judge held that the prescriptions supplied were reasonable, necessary, and causally related to the work injuries, while other services provided were not related. Further, the judge found that the employee was required to use the pharmacy selected by the employer and insurer, pursuant to Minn. Stat. § 176.135, subd. 1(g).
Upon appeal, the employer and insurer argued that the medication usage has gone on too long, without adequate consideration of alternatives. Instead, the employer and insurer argued the opinions of Dr. Starzinski in modifying the prescriptions should be adopted.
The WCCA restated the rule that an employer is obligated to provide medical treatment, including medicines, that “may reasonably be required” to “cure and relive from the effects of the injury.” Minn. Stat. § 176.135, subd. 1. After review of the matter, the WCCA affirmed, reasoning that the compensation judge was presented with medical records detailing the employee’s treatment, including prescriptions. Further, the compensation judge, as fact finder, found Dr. Detert’s opinion more compelling, as Dr. Detert treated the employee for a year before the hearing and reviewed the medical records, establishing sufficient foundation for her opinion. As such, it has been previously held that decisions will generally be affirmed based on medical opinions when there is adequate foundation.