William Johnson, et. al,

William Johnson, et. al, No. WC19-6325 (W.C.C.A. June 2020).

The Employer and Insurer appeal the compensation judge’s award of payment for opioid medication in which the judge found that the rare case exception to the treatment parameters applied.

The Employee sustained an injury in 2002, which was assessed as not treatable by surgery, other than by amputation. Dr. Monsein considered the Employee’s treatment to be reasonable, necessary, and causally related to the work injury, resulting in CRPS.  This included treatment for opioid medications.  The Employer and Insurer, years later, had the Employee undergo an IME with Dr. Wojciehoski.  Dr. Wojciehoski found the Employee was not experiencing CRPS and that the Employee should be weaned off opioid medications. The Employer and Insurer also asserted the use of ongoing opioid medications were not consistent with the treatment parameters.

The matter was heard in July 2017, where the judge found the CRPS had not resolved, and that the medications, including the use of opioids, were reasonable, necessary, and related to the work injury, and that the treatment parameters were not applicable.  The matter went up to the MN Supreme Court, where it was determined that the treatment parameters were applicable. Therefore, the only issue on appeal in this present case is whether or not the rare case exception applies.

The WCCA discussed that the rare case exception allows the compensation judge to retain flexibility to award proper medical treatment outside of the treatment parameters and depart from standards, in certain situations. The WCCA determined that there is no dispute that the Employee suffers from intractable pain, and the only alternative offered to the Employee was amputation of the affected limb. Further, while the Employer and Insurer noted the Employee’s treating physician was open to trying alternatives, those alternatives have not been proposed as treatments that will be paid for by Employer and Insurer. The WCCA also discussed the compensation judge’s note that the Employee’s pain was reduced by half and allowed the Employee to engage in activities of daily living with the use of opioid medications. Therefore, under these facts, the WCCA affirmed and found substantive evidence supported the compensation judge’s application of the rare case exception.

Takeaway: In certain situations, the compensation judge can depart from the treatment parameters.  When looking to depart from the parameters, the compensation judge retains some flexibility, and will look at and apply the facts unique and specific to the claim.