LARRY COSTELLO, Employee, v. CLAY COUNTY SHERIFF=S DEP=T, SELF-INSURED/MINNESOTA COUNTIES INS. TRUST, Employer/Appellant, BLUE CROSS/BLUE SHIELD OF MINN., MERITCARE HOSP. and MERITCARE MED. GROUP, Intervenors.
WORKERS= COMPENSATION COURT OF APPEALS
JUNE 7, 2007
PRACTICE & PROCEDURE - REMAND. Where the compensation judge failed to address the issue of the reasonableness and necessity of a surgical procedure and nonetheless ordered reimbursement of the associated expenses, the order for reimbursement is vacated and the case is remanded for determination of the issue.
Vacated and remanded.
Determined by: Stofferahn, J., Pederson, J., and Rykken, J.
Compensation Judge: William R. Johnson
Attorneys: Norbert Cuellar, Minneapolis, MN, for the Respondent. David L. Christianson, Cronan Pearson Quinlivan, Minneapolis, MN, for the Appellant.
DAVID A. STOFFERAHN, Judge
The employer appeals from the compensation judge=s order for reimbursement of medical expenses associated with surgery performed on December 20, 2005, on the basis that the compensation judge failed to make any findings as to the underlying reasonableness and necessity of that surgery. We remand that issue for reconsideration.
The employee, Larry Costello, sustained an injury to his low back on May 1, 1980, while working as a detective for the employer, the Clay County Sheriff=s Department. A proposed IDET procedure was found reasonable and necessary in prior Findings and Order served and filed on June 14, 2005. The employee underwent the IDET procedure in November 2005.
The employee experienced increasing pain and a right L3-4 laminectomy and microdiscectomy was performed on December 20, 2005, without authorization by the insurer. The self-insured employer continues to dispute the reasonableness and necessity of this second surgery.
Following this procedure, the employee continued to experience back pain and fusion surgery was recommended by Dr. Manuel Pinto. The employer also disputed the necessity for this proposed surgery.
The employee filed a claim petition on May 19, 2006, seeking approval of the recommended fusion surgery and payment of certain prior medical expenses paid for or treatment provided by intervenors, primarily including the expenses for treatment associated with the December 20, 2005, surgery.
At the hearing below, the parties specifically noted in their preliminary arguments that the reasonableness and necessity of the December 20, 2005, procedure was at issue and required determination by the compensation judge.
Following the hearing, the compensation judge found that the proposed fusion surgery was reasonable and necessary. No appeal has been taken from the order that the employer pay for the proposed surgery.
The compensation judge also awarded reimbursement to the intervenors of the medical expenses which include expenses associated with the disputed December 20, 2005, surgery. No findings were made, however, as to whether that surgery was reasonable and necessary.
The employee argues, essentially, that such a finding is implicit in the award of reimbursement. We note, however, that the only issue listed under a AStatement of Issue@ paragraph in the Findings and Order is the reasonableness and necessity of the proposed fusion. Similarly, the compensation judge=s memorandum erroneously states that A[t]he only issue in the case is whether the proposed fusion surgery is reasonable and or necessary.@ It is apparent that the compensation judge simply failed to address the issue of whether the December 20, 2005, surgery was reasonable and necessary.
Accordingly, we vacate orders 3 and 4, providing for reimbursement to the intervenors, and remand the case to the compensation judge for reconsideration on the issue of the reasonableness and necessity of the December 20, 2005, surgery.