The Mach matter is a long gestating case dealing with recommended medical treatment that had been denied by a compensation judge previously and was, years later, recommended again. The Employee suffered an admitted injury from which he sought workers’ compensation benefits in August 2010. The Employee contended that, due to the injury, he developed a complex regional pain syndrome and he was entitled to medical benefits. At hearing, it was determined that the employee failed to show that he suffered from complex regional pain syndrome and that the recommended neurostimulator was not reasonable and necessary. Consequently, all of the Employee’s medical claims up to January of 2011 dealing with complex regional pain syndrome and the neurostimulator were denied.
In 2012, the neuro stimulator was once again recommended to treat the employee’s work injury. The Employee filed a Medical Request for this treatment, the compensation judge determined that, as a matter of law, the employee was barred from receiving medical benefits related to treatment for complex regional pain syndrome and the neurostimulator based upon the decision of the Judge in early 2011.
When this case reached the Minnesota Supreme Court, the two issues to determine were whether or not this claim for medical benefits could be precluded by the legal doctrines of res judicata or collateral estoppel.
The application of res judicata, in this case, would be that the employee’s claim for benefits would be barred because it is the exact same claim on which he had a right to be heard previously. The Supreme Court, because this is a temporally separate medical recommendation, declines to apply res judicata in this matter. The Court notes that the employee’s medical expenses in the previous hearing were denied until January of 2011, and these new medical expenses occurred afterward. The medical expenses occurred at a later date, and therefore, the new claim is not the same claim as before and cannot be barred by res judicata.
The second and arguably more important decision made by the Minnesota Supreme Court, is the determination on whether the employee’s claims can be barred by the doctrine of collateral estoppel. Collateral estoppel could occur if the facts surrounding a previous decision are not substantially different from the facts occurring and creating an issue at a later date. In other words, the court would need to make a determination on if there was a substantial change in circumstances occurring that would necessitate a need to approve treatment where it was previously denied.
The Minnesota Supreme Court would apply the “substantial change in condition” test to determine if the Employee could be approved for the neurostimulator even though it was previously denied as not reasonable or necessary. The Supreme Court states, “collateral estoppel does not apply to bar a claim for reimbursement of medical expenses for treatment received when an employee’s medical condition has changed.”
The employee is claiming that his medical condition has changed since the January 2011 decision, and would therefore not be barred from making a future claim for identical treatment. The Supreme Court then sends this case back to a compensation judge to make a determination on if the employee’s condition changed.