Jimmy J. Loupe, Jr. v. McNeilus Steel, Inc., WCCA September 11, 2018, No. WC18-6175.
Summary:
Employee appeals from the compensation judge’s determination that payment for an x-ray administered four years after the employee underwent knee surgery due to a work-related injury was precluded under the medical treatment parameters. Affirmed.
Background Facts:
EE injured right knee while working for ER. ER admitted liability and paid benefits.
Following injury, EE moves to Luisiana. Dr. recommended partial knee replacement surgery. ER/IR approved. Knee replaced on August 21, 2013, no complications. Dr. saw EE each year thereafter for follow-up visits and had an x-ray done each year, which was paid for in 2014, 2015, and 2016. All came back normal.
In 2016 the parties stipulated to a settlement, full, final, and complete with the exception of medical treatment and expenses which were left open subject to defenses.
ER/IR decline to approve 2017 x-ray citing Minn. R. 5221.6100 i.e. the x-rays were “routine” under the rule and not indicated under the treatment parameters for radiographic parameters.
Lower Court’s Finding:
EE filed a medical request in July of 2017 and subsequently a March of 2018 narrative from the Dr. stating the medical necessity of the annual x-rays. This was the only evidence. The compensation judge found that the treatment parameters precluded payment for routine x-rays and denied EE’s claim.
Issue(s):
Whether the determination that the x-rays were routine, was clearly erroneous and unsupported by substantial evidence in view of the entire record as submitted.
EE argues that judge erred in applying treatment parameters regarding “routine” rather than “repeat” imaging. “repeat” imaging is allowed for follow up imaging to a surgery.
The court was not persuaded. B/c there were four unremarkable x-rays, judge was reasonable in concluding the x-rays were routine. Nothing in the rules requires an ER to pay for post-surgical x-rays every year in perpetuity.
ER also argues the judge erred as a matter of law by rejecting uncontroverted medical opinion. While unopposed medical opinions cannot be ignored, it isn’t binding on a trier of fact. Tuomela v. Reserve Mining Co., 299 Minn. 203, 204 (1974). The issue isn’t whether the medical record was ignored, but rather, whether the judge had substantial evidence in the record to support her finding.
Holding:
Substantial evidence in the record supports the judge’s finding. Accordingly, affirmed.