The employee in this matter sustained an injury to his right knee on July 29, 2015 when he slipped on ice in a freezer while working for the self-insured employer. The employee underwent an MRI that revealed a meniscus tear and a complete tear of his ACL. He subsequently treated with Dr. Eckstrom who opined that the employee’s meniscus tear was related to the work injury, but his ACL tear was pre-existing, due to the history the employee provided.
As a result, Dr. Eckstrom requested pre-approval for surgery, noting “that the ACL repair would be billed to the employee’s personal insurance.”
The employee eventually hired an attorney, and requested a rehabilitation consult. The employer approved the rehab consult.
The employee received a referral to Dr. Kirsch, which the employer approved. At his appointment, the employee inquired as to whether his ACL injury was work-related, stating that he had a partial ACL tear 11 year prior, but continued to be active. Dr. Kirsch opined the ACL tear was work related, and so was the ACL surgery. The employer approved the ACL surgery.
The employee’s attorney filed a Claim Petition on December 14, 2015 for temporary total disability and temporary partial disability benefits, reserving PPD, claiming payment of medical bills, retraining, and QRC services. The employer admitted the TTD and TPD claims, asserted the PPD claim was premature, and indicated it was “unknown if any medical bills were outstanding.” The Employee’s Claim Petition was subsequently dismissed on August 10, 2016.
The Employee’s attorney filed a statement of attorney’s fees on August 3, 2016, claiming contingency, Roraff, and Heaton fees. After a telephone hearing on October 31, 2016, the compensation judge awarded contingency fees and denied the employee’s claims for Roraff and Heaton fees, as there was not a genuine medical dispute, and rehabilitation benefits were voluntarily paid. The employee appealed the compensation judge’s denial of Roraff and Heaton fees, but failed to include the claim for Heaton fees in the appellate brief, thus waiving this claim.
The WCCA notes that the standard of review on appeal is whether the compensation judge’s determination is supported by substantial evidence; findings of fact are to be upheld unless clearly erroneous. Further, the WCCA may review questions of law de novo.
The WCCA indicated that “whether there has been a genuine dispute is a question of fact for the compensation judge,” concluding that substantial evidence supported the compensation judge’s denial of Roraff fees, as the employer did not delay or refuse to pay for medical treatment, and followed the recommendations of the employee’s treating providers. The WCCA further denied the employee’s request to supplement the record, indicating nothing in Minn. Stat. § 176.421, subd. 1 allows parties to submit additional evidence that was not considered by the compensation judge at hearing.