The Minnesota Supreme Court reversed the WCCA’s decision and in doing so clarified that employers are not liable for rehabilitation services provided after the date by which the Employee’s work-related injury had resolved, since those services were neither reasonable nor necessary.
This case involved an Employee who sprained his ankle while leaving work in December 2015. He underwent assessments to determine if he had developed complex regional pain syndrome as a result of his injury, and doctors at Mayo Clinic concluded that he did not, and that his injury had resolved by April 20, 2016. His primary care provider did diagnose him with CRPS related to the ankle injury. In September 2016, Print Craft’s Insurer emailed the QRC to inform her that they would not approve further treatment for Ewing. The QRC continued to provide services from October 2016 into the beginning of 2017. Print Craft did not submit a rehabilitation request until April 6, 2017. The Employee filed a claim petition alleging that he did have CRPS. Neither the claim petition nor Print Craft’s answer mentioned rehabilitation services.
A formal hearing occurred on April 6, 2018. The compensation judge concluded that the work-related injury had resolved by April 20, 2016 and denied all claims for benefits, including rehabilitation services arising after that date. Neither the Employee nor Employer appealed this decision, which means it was undisputed that the Employee’s injury resolved by April 20, 2016. The QRC challenged only the compensation judge’s decision that denied her request for reimbursement of rehabilitation services.
A fundamental principle is that employers are liable only for reasonable and necessary rehabilitation services provided to a qualified Employee. The Court noted that an employer’s liability for compensation under chapter 176 ends when an Employee is no longer disabled. Here, because the compensation judge found that the rehabilitation services provided to the Employee after his injury resolved were not reasonable, necessary, or causally related to his date of injury, the Employer was not liable for them.
The QRC argued that the Employer is liable for rehabilitation services until it provides notice of its intention to terminate those services, in the form of a rehabilitation request for assistance. However, the Supreme Court pointed out that she did have notice because the Insurer had emailed her its intent to stop paying for rehabilitation services, and subsequently stopped paying her invoices. At that time, she had the option to file her own rehabilitation request or discontinue services. The Court noted that a QRC who continues to provide rehabilitation services during the pendency of a dispute over rehabilitation eligibility runs the risk of non-payment in the event the Employer prevails in the eventual hearing.
Takeaway: As long as Insurers notify QRC’s that there is a dispute, they can simply deny bills for rehabilitation services, and do not have to file a rehabilitation request. Email notice is sufficient.