The employee sustained an ankle injury in 2002 that eventually led to a diagnosis of complex regional pain syndrome. Surgery was not an option to address his condition and his doctor noted that the employee’s options were essentially to be in extreme pain or endure the side-effects of opioid medication.
The employer and insurer obtained an IME with Dr. John Dowdle in 2004, who diagnosed reflex sympathetic dystrophy and noted that amputation was being considered to address the employee’s pain symptoms in the alternative to an open sympathectomy, which the employee was not a good candidate for according to two surgeons. The employee continued treatment with opioid medication, Endocet, and Neurontin, which was noted to be reasonable and necessary according to a medical record review of Dr. Matthew Monsein prepared at the request of the employer and insurer in 2009.
The employer and insurer then obtained another IME with Dr. Randal Wojciehoski in 2016. Dr. Wojciehoski opined that he was “not convinced” that the employee was suffering from CRPS/RSD and recommended weaning from opioid medications and benzodiazepines. The employee at that time was taking Lorazepam, nifedipine, and Neurontin, and Dr. Wojciehoski opined those medications were not reasonable or necessary to treat the employee’s pain condition and that his medication was not prescribed properly under the treatment parameters. In response, the employer and insurer wrote to the employee’s treating doctor requesting compliance with Minn. R. 5221.6110.
The employee then filed a Medical Request seeking payment of medication and the employer and insurer’s Medical Response stated the treatment was not reasonable or necessary and that the treatment parameters were not being followed. Both parties filed requests for formal hearing after a DOLI conference and a hearing was held on July 21, 2017. The issues included: 1) whether the employee’s CRPS had resolved; 2) whether Endocet and two other medications were reasonable and necessary to treat that condition; and 3) whether the treatment parameters applied to the Endocet prescription.
The compensation judge found that the CRPS condition had not resolved, the employee’s medications were reasonable and necessary, and that the treatment parameters were not applicable due to the employer and insurer’s denial of liability for the condition. The employer and insurer appealed.
The WCCA affirmed the compensation judge’s decision noting that Minn. R. 5221.6020, subp. 2 is unambiguous and states that the treatment parameters do not apply after denial of liability and in this case, the employer and insurer denied liability for the employee’s prescriptions by challenging the causation of the employee’s condition. The court noted that the employer and insurer argued that the employee had recovered from his CRPS condition which constitutes contesting liability and that is enough to preclude the application of the treatment parameters.