In the latest decision in the Gamble series, the WCCA addressed the issue of whether the compensation judge erred in ordering Lakeview to reimburse the self-insured employer for payment the employer made with respect to the employee’s unreasonable and unnecessary surgery. By way of review, the Minnesota Laborers Health & Welfare Fund previously paid for a surgery for the employee, the compensation judge then found the employee’s injury to be compensable and thus ordered the self-insured employer to reimburse the Fund for all payments made, including that surgery. However, the compensation judge also found that the surgery was not reasonable and necessary and thus ordered Lakeview to reimburse the self-insured employer for payments made to the Fund for that surgery. The WCCA affirmed the compensation judge’s decision that the surgery was not reasonable and necessary and Lakeview petitioned for further determination about whether they are required to reimburse the self-insured employer.
The WCCA affirmed the compensation judge’s determination that Lakeview must reimburse the self-insured employer for the cost of the surgery under Minn. R. 5221.0600, subp.6 since the payment for the surgery was excessive since the surgery was not reasonable or necessary.