NEWS / Legal News - August 2021
Minnesota Supreme Court Reverses WCCA Decision on Rare Case Exception in Treatment Parameters
Rare Case Exception to Opioid Treatment Parameters
The employee had a work-related ankle injury and claimed he eventually developed complex regional pain syndrome (CRPS). The employer and insurer admitted the injury but denied CRPS. The employee had long-term narcotics prescribed for his work injury, and the employer and insurer denied payment based on non-compliance with narcotic treatment parameters.
The Workers' Compensation Court of Appeals (WCCA) stated that the employee did not have to comply with treatment parameters because CRPS was denied.
The Supreme Court reversed the WCCA's decision, stating that treatment parameters only do not apply if all liability for the work injury is denied. The Supreme Court specifically pointed out that the treatment parameters still apply if primary liability for the work injury has been admitted, but certain conditions are denied and remanded the case back down to the compensation judge.
After the trial on remand the court said that although the employee did not comply with treatment parameters for long-term narcotics and did not qualify for departure from those treatment parameters, the employer and insurer were still liable for the narcotics because this was a "rare case exception" to having to follow the treatment parameters based on the fact that treatment was reasonable and necessary. The WCCA affirmed.
SUPREME COURT DECISON
The Supreme Court reversed the decision stating that an employee cannot simply avoid the treatment parameters by showing that medical treatment is reasonable and necessary. In order for an employee to prove that the medical treatment being requested qualifies as a "rare case exception" to having to comply with the treatment parameters, the employee needs to demonstrate why the treatment parameters should not apply. The Supreme Court explained that in order for medical treatment to qualify as a "rare case exception," the employee must prove that not following the treatment parameters better achieves the objectives of the work comp system to cure and relieve the effects of the work injury than could be achieved by complying with the treatment parameters. The employee in this case, however, offered no reason why treatment parameters could not be complied with other than saying that the employee and his medical provider found the treatment parameter requirements such as completing an opioid risk assessment tool, discussing the side-effects of narcotics, and putting a signed opioid agreement in the medical records to be "onerous, cumbersome, and draconian."
TAKE AWAY MESSAGE
The Court has now made clear that if a medical provider is not complying with all the requirements of the long-term narcotic treatment parameters that the employer and insurer are under no obligation to pay for the narcotics.
View the decision here.
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