Damon A. Ewing, Employee, vs. Print Craft, Inc., Self-Insured Employer/Relator, and Gallagher Bassett Services, Inc., Third Party Administrator/Relator, and Optimal Recovery, Inc./Ann Brown, QRC, Intervenor/Respondent, and Blue Cross Blue Shield of Minnesota/Blue Plus, et al., Intervenors.
A19-0534
STATE OF MINNESOTA IN SUPREME COURT
January 2, 2020
Hudson, J.
Workers’ Compensation Court of Appeals
Joshua E. Borken, Law Office of Joshua Borken, Saint Paul, Minnesota, for respondent.
The compensation judge correctly held that the employer was not liable for rehabilitation services provided after the date by which the employee‘s work-related injury had resolved, thus making those services neither reasonable nor necessary.
Reversed.
O P I N I O N
HUDSON, Justice.
This appeal from the Workers’ Compensation Court of Appeals (WCCA) requires that we determine whether an employer can be held liable for rehabilitation services provided after an employee‘s work-related injury has resolved. The compensation judge denied the qualified rehabilitation consultant‘s reimbursement claim for rehabilitation services provided during the period in which the employee was no longer suffering from a work-related injury. The WCCA reversed, concluding that the employer must pay for rehabilitation services until the employer files a rehabilitation request for assistance. Because we conclude that the WCCA erred by imposing liability on the employer for rehabilitation services provided after the date that the employee‘s injury had resolved, we reverse.
FACTS
Relator Print Craft, Inc. (Print Craft) is a commercial printer located in New Brighton. Respondent Ann Brown (Brown) is a qualified rehabilitation consultant (QRC) who provided rehabilitation services to one of Print Craft‘s employees, Damon
Ewing sprained his left ankle when he slipped on ice and fell while leaving work in December 2015. He first sought treatment at a local hospital, and over the months that followed, saw specialists at different clinics in the Twin Cities, in addition to several doctors at the Mayo Clinic. Ewing underwent assessments in the spring of 2016 to determine if he had developed complex regional pain syndrome (CRPS) as a result of his injury. Doctors at the Mayo Clinic concluded that Ewing did not have CRPS and that his work-related injury had resolved by no later than April 20, 2016. His primary care provider and his podiatrist, however, diagnosed him with CRPS related to the ankle injury.
Ewing first met with Brown on April 20, 2016. Brown prepared a rehabilitation consultation report after their meeting. She indicated in her report that Ewing was a “qualified employee” under
Over the summer of 2016, Ewing received further treatment for his left-ankle sprain, including physical therapy. At the beginning of August 2016, Ewing‘s self-reported symptoms included pain and twitching in his left arm, short-term memory loss, cognitive
In September 2016, Print Craft‘s insurance adjuster e-mailed Brown to inform her that the adjuster would not approve any further treatment for Ewing until the adjuster received the results of an independent medical examination of Ewing. Print Craft paid Brown‘s invoices up to September 8, 2016, but refused to pay for any of the services Brown provided after that point. Brown continued to provide rehabilitation services to Ewing and filed a plan amendment with the Department on October 14, 2016, extending the projected completion date to December 30, 2016. Print Craft did not submit a rehabilitation request for assistance to the Commissioner of the Department.1
Ewing appeared for an independent medical examination with Dr. Joel Gedan on November 7, 2016. Based on his physical examination of Ewing and review of Ewing‘s medical records, Dr. Gedan concluded that Ewing did not suffer from CRPS or any work-related injury resulting from his December 2015 fall other than a left-ankle sprain. Dr. Gedan identified a functional restoration program (i.e., physical therapy) as the only medical treatment that would likely improve Ewing‘s ankle condition.
Print Craft filed a Notice of Intention to Discontinue Workers’ Compensation Benefits (Notice) on December 7, 2016, stating that it would no longer pay Ewing‘s temporary total disability benefits. Ewing objected, which led to an administrative conference before a compensation judge. On January 4, 2017, the compensation judge granted Print Craft‘s request to discontinue Ewing‘s disability benefits, finding that Ewing no longer required work restrictions related to his ankle sprain. Brown received a copy of the decision by mail. Ewing filed an objection to this order.2
Meanwhile, Brown continued to provide rehabilitation services to Ewing through the end of 2016 and into the beginning of 2017. She filed a second rehabilitation plan amendment in late December 2016 that extended the projected completion date to April 30, 2017. Print Craft did not file a rehabilitation request for assistance at that time.
Print Craft filed a rehabilitation request with the Commissioner on April 6, 2017. Print Craft requested termination of Ewing‘s rehabilitation plan, while “maintaining a
After several continuances, a formal hearing occurred on April 6, 2018. The hearing consolidated Ewing‘s November 2016 claim petition, his February 2017 objection to the discontinuance of temporary total disability benefits, and Print Craft‘s request to terminate Ewing‘s rehabilitation plan. Brown intervened and testified at this hearing. In the interim, Brown continued to provide rehabilitation services to Ewing, filing at least two plan amendments that extended the projected completion date through July 31, 2018.
The compensation judge concluded that Ewing‘s work-related injury had resolved by April 20, 2016, and denied all claims for disability benefits, medical treatment, and rehabilitation services arising after that date. The judge also concluded that Ewing did not develop CRPS or “any other consequential injury” because of his work-related fall in December 2015.
Ewing did not appeal this decision. Brown, however, appealed to the Workers’ Compensation Court of Appeals (WCCA), asserting that the compensation judge erred in denying her claim for reimbursement for rehabilitation services provided from September 8, 2016 to April 6, 2018, the date of the last hearing before the compensation judge. The WCCA reversed, concluding that the compensation judge “erred as a matter of law in assigning the cutoff date for [rehabilitation] services” as April 20, 2016. Ewing v. Print Craft, Inc., No. WC18-6197, 2019 WL 1376844 (Minn. WCCA Mar. 12, 2019).
ANALYSIS
Neither Print Craft nor Ewing appealed the compensation judge‘s decision, and Brown challenged only the compensation judge‘s decision that denied her request for reimbursement for rehabilitation services. For this reason, it is undisputed that Ewing‘s work-related injury had resolved as of April 20, 2016.3 The question before us is whether the WCCA correctly concluded that Print Craft was required to show good cause to terminate Brown‘s rehabilitation services provided after the date that the employee‘s injury resolved.4 We review de novo the WCCA‘s interpretation of the law on this point. Hohlt v. Univ. of Minn., 897 N.W.2d 777, 780 (Minn. 2017).
Although the WCCA relied on
We begin with a brief review of the Minnesota workers’ compensation system and employer liability for rehabilitation services. See generally
[A]n employee who, because of the effects of a work-related injury or disease, whether or not combined with the effects of a prior injury or disability:
A. is permanently precluded or is likely to be permanently precluded from engaging in the employee‘s usual and customary occupation or from engaging in the job the employee held at the time of injury;
B. cannot reasonably be expected to return to suitable gainful employment with the date-of-injury employer; and
C. can reasonably be expected to return to suitable gainful employment through the provision of rehabilitation services, considering the treating physician‘s opinion of the employee‘s work ability.
We have said, however, that an employer‘s liability for compensation under chapter 176 ends when an employee is no longer disabled. See Kautz v. Setterlin Co., 410 N.W.2d 843, 845 (Minn. 1987) (holding that a non-disabled employee was “not entitled to compensation” beyond the date that benefits were allowed to be discontinued by administrative decision); see also Woelfel v. Plastics, Inc., 371 N.W.2d 215, 218 (Minn. 1985) (“The finding that employee‘s disability caused by the work injury continued only through [a certain date], determined the extent of the employer-insurer‘s liability, and employee was not entitled to compensation after that date.“). In Kautz, the compensation judge found that the employee had reached maximum medical improvement from a work-related injury, but ordered the employer to pay disability benefits for 90 days beyond that date. 410 N.W.2d at 844. The WCCA reversed, noting that “[i]t is inherent in the underlying purpose of workers’ compensation that benefits are available only to employees
Kautz involved employer liability for temporary total disability benefits, not rehabilitation services. Nonetheless, the principle remains the same: employers are only liable for reasonable and necessary rehabilitation services provided to a qualified employee. The WCCA seems to have adopted this principle as well. See, e.g., Najarro v. Minn. Minerals & Aggregates, Inc., 69 Minn. Workers’ Comp. Dec. 484, 493 (WCCA 2009) (noting that a QRC “bears the risk of an adverse determination as to primary liability and the related risk of non-payment” when there is a dispute over the employee‘s eligibility for services); Rios v. Nat‘l Coatings, 62 Minn. Workers’ Comp. Dec. 349, 365 (WCCA 2002) (citing Kautz and stating that reimbursement must be denied “[f]or any period during which the employee was, in the judge‘s estimation, unrestricted by his work injury“); Quitevis v. M.W. Ettinger Transfer, 2002 WL 31815010, at *9 (Minn. WCCA Nov. 12, 2002) (reversing an award reimbursing for QRC services provided during a time when the employee was ineligible for those services); Trossen v. Champion Int‘l, 62 Minn. Workers’ Comp. Dec. 14, 24 (WCCA 2001) (citing Kautz and stating that rehabilitation services are not reimbursable when “an employee is found medically able to return to work
The compensation judge found that Ewing‘s work-related injury had resolved by April 20, 2016, and that the treatment he received thereafter, including the rehabilitation services, was not “reasonable, necessary, or causally related to the December 1, 2015 date of injury.” Based on these findings, the compensation judge denied Brown‘s request for reimbursement of her outstanding rehabilitation bills as “not related to the December 1, 2015 date of injury.”
Ewing did not appeal these findings, and Brown‘s appeal asserted only that the compensation judge erred as a matter of law in concluding that she was not entitled to reimbursement. Brown did not challenge the compensation judge‘s factual findings regarding Ewing‘s ineligibility for treatment after April 20, 2016, and does not assert here that those findings lack substantial evidence. Instead, she argues that an employer is liable for rehabilitation services until the employer provides notice of its intention to terminate those services. The WCCA agreed with Brown, relying in part on our decision in Halvorson v. B&F Fastener Supply, 901 N.W.2d 425 (Minn. 2017).
In Halvorson, the employee suffered several work-related injuries for which the compensation judge awarded wage-loss benefits, medical treatment costs, and rehabilitation services, paid for by the employer. Id. at 426–27. The employer filed a request to terminate rehabilitation services once the employee had returned to work,
Despite its invocation of the good-cause standard, Halvorson does not stand for the proposition that employers remain liable for QRC services in all cases until the employer files a rehabilitation request for assistance. Although the employer in Halvorson paid the QRC until the compensation judge ordered an end to the rehabilitation services following a formal hearing, the compensation judge who presided at the administrative conference had previously denied the employer‘s request to terminate the services, which meant the employer had a continuing obligation to pay for the services. See Halvorson v. B&F Fastener Supply, No. WC15-5869, 2016 WL 3251720, at *3–4 (Minn. WCCA May 9, 2016). Here, in contrast, a compensation judge had already ordered an end to one category of Ewing‘s workers’ compensation benefits, the temporary total disability benefits, following the January 2017 administrative conference.
Nor are we persuaded by the WCCA‘s decision in Parker v. University of Minnesota, 64 Minn. Workers’ Comp. Dec. 134 (WCCA 2003). The QRC in Parker contacted the claims adjuster assigned to the employee‘s workers’ compensation case to request authorization to perform job-placement services under an existing rehabilitation plan. Id. at 137. The adjuster refused to authorize the services, and the QRC informed the adjuster in writing that she intended to provide the services irrespective of the adjuster‘s authorization. Id. Although the WCCA ultimately ruled in favor of the QRC because it
Unlike the undisputed findings here, the QRC in Parker prevailed on the reimbursement claim because the employee was “eligible for rehabilitation services” and the services provided by the QRC “were reasonable and necessary.” Id. at 140. The WCCA‘s acknowledgement in Parker that employers are only liable for “services to which the employee was otherwise entitled,” id. at 142, reinforces our conclusion that Print Craft cannot be liable for the rehabilitation services provided by Brown after Ewing‘s injury had resolved.6
Moreover, nothing in Parker clearly states that an employer assumes absolute liability for services provided up until the date of the employer‘s rehabilitation request for assistance. Instead, Parker shows that the question of reimbursement is one for the
Brown contends that, without a requirement for notice in the form of the employer‘s rehabilitation request for assistance whenever a dispute arises, QRCs will unfairly bear a risk of nonpayment.7 Neither our precedent nor the WCCA‘s precedent clearly designate the date of a rehabilitation request for assistance by the employer as the bright line for when a “dispute” arises under Parker, and thus when the QRC has notice. Furthermore, the
As early as September 2016, Brown knew that Print Craft denied primary liability for any injuries other than the sprain to Ewing‘s left ankle, and that Print Craft would not pay for any medical treatment or rehabilitation services provided for denied conditions. Not only did she have e-mails confirming Print Craft‘s denial of liability, Print Craft stopped paying her invoices. Brown also knew in November 2016 that Ewing was in litigation with Print Craft over his claim for additional workers’ compensation benefits, when he filed a claim petition asserting that he suffered consequential injuries (an alleged concussion, memory and cognitive troubles, and CRPS in various parts of his body) due to his fall at work. In December 2016, Print Craft filed a Notice of Intention to Discontinue Ewing‘s benefits for the left-ankle sprain based on an independent medical examination. A compensation judge reviewed Print Craft‘s Notice, concluded that Ewing was no longer suffering from a work-related injury, and served a copy of that decision on Brown by mail on January 5, 2017.
In short, Brown was on notice of the dispute over Ewing‘s eligibility for workers’ compensation benefits long before Print Craft filed a rehabilitation request for assistance in April 2017. By continuing to provide rehabilitation services rather than pursuing other options available to her, including filing her own rehabilitation request for assistance or discontinuing services,8 she assumed the risk of non-payment. See, e.g., Breeze v. FedEx
Freight, No. WC14-5687, 2014 WL 4491102, at *4 (Minn. WCCA Aug. 26, 2014) (“[I]n Parker, we clearly indicated that a QRC has no obligation to provide services during litigation on the question of the employee‘s eligibility for rehabilitation services.“).
Finally, Brown contends that the WCCA reached the correct decision because the administrative rules impose liability on an employer through the date of the employer‘s rehabilitation request for assistance. She specifically cites
Rule 5220.0410 governs the initial proposal of a rehabilitation plan.9 It does not apply in this case because Print Craft paid for QRC Brown‘s services at the time she initially proposed the rehabilitation plan and lodged no objection at the time of the
We therefore conclude that the WCCA erred in reversing the compensation judge‘s decision and ordering Print Craft to pay for rehabilitation services provided after Ewing‘s
CONCLUSION
For the foregoing reasons, we reverse the decision of the Workers’ Compensation Court of Appeals.
Reversed.