TIMOTHY AALDERKS, Employee, v. NORTHERN STATES POWER CO., SELF-INSURED, Employer/Appellant.

WORKERS’ COMPENSATION COURT OF APPEALS
DECEMBER 5, 1995

HEADNOTES

MEDICAL EXPENSE - REASONABLE & NECESSARY. Substantial evidence supports the compensation judge’s findings that the expense of a home exercise gym was reasonable and necessary to cure and relieve the effects of the employee’s low back injury where the employee provided medical evidence to support his claim including: the treatment regimen to be followed, the benefits to be gained by use of the equipment, the cost of the specific equipment recommended, and whether there are reasonable alternatives which could accomplish the same benefits without the purchase of expensive equipment.

Affirmed.

Determined by: Johnson, J., Wilson, J., and Olsen, J.
Compensation Judge: Karen C. Shimon

 

OPINION

THOMAS L. JOHNSON, Judge

Northern States Power Company (the employer), self insured, appeals from the compensation judge’s findings and order ordering the employer to reimburse the employee in the sum of $2,812.50 for the cost of home exercise equipment as a reasonable and necessary medical expense. We affirm.

BACKGROUND

Timothy Aalderks (the employee) has worked as a laborer and pipe fitter for the employer since 1979. In March 1989, the employee sustained an admitted injury to his low back and sought treatment with Dr. John A. Benassi, D.C. After a few treatments, Dr. Benassi recommended an exercise program. The employer began paying annual health club membership dues for the employee starting in May 1990. The employee testified that the use of Nautilus equipment at the health club helped him “immensely” in that he had very little pain and he did not need chiropractic care. (T. 37.)

On January 14, 1994, the employee sustained a second admitted low back injury and again sought chiropractic treatment with Dr. Benassi. He saw Dr. Benassi eleven times from January 24, 1994, through August 3, 1994. Treatment notes dated April 6, 1994, state the employee was “working out and doing better.” (Pet. Ex. A.) At that time, the employee was attending a health club where he used Nautilus equipment approximately four times per week. (Unappealed Finding #4.) Treatment notes dated August 3, 1994, state that exercise helped the employee’s symptoms. (Pet. Ex. A.)

Sometime in the spring of 1994, the employer advised the employee that it would authorize payment for only three more months of health club membership dues. The employer ceased paying for the employee’s health club membership in August 1994, and the employee did not attend a health club thereafter. The employee testified that after he was no longer able to use the Nautilus equipment at the health club, his pain symptoms increased. (T. 75-76.)

On August 30, 1994, Dr. Benassi prescribed home gym equipment for the employee. Specifically, Dr. Benassi stated:

Because of the type of condition [the employee] has and his recurring relapses we feel it imperative that he purchase a Vetra 1270 home gym equipment to maintain stability, flexibility, and endurance thus avoiding future need of care.

(Pet. Ex. A.) By letter dated September 15, 1994, the employer wrote to Dr. Benassi inquiring as to what specific exercises the doctor was recommending for the employee. Dr. Benassi responded by letter dated September 29, 1994, stating:

[The employee] was prescribed home exercise equipment to stay fit for his job and prevent any further reinjury or possible disabling effects which could jeopardize his gainful employment.

Dr. Benassi also listed 12 specific exercises that he recommended for the employee. (Pet. Ex. A.)

By letter dated October 14, 1994, the employer informed the employee, that it would not pay for home exercise equipment as prescribed by Dr. Benassi. The employer’s refusal was based on its belief that the purpose of the exercises prescribed by Dr. Benassi was to maintain “general fitness” and “prevent reinjury.” On October 20, 1994, the employee purchased a Multisports-3200 home gym system at a total cost of $2,812.50. (Pet. Ex. B.)[1]

The employee filed a medical request seeking reimbursement for payment of the home exercise equipment. After a hearing, the compensation judge found that the need for the home gym equipment was essentially caused by the work injury and use of the equipment was a reasonable and necessary form of medical treatment for the cure and/or relief of the effects of the work injury. Thus, the compensation judge ordered the employer to reimburse the employee in the amount of $2,812.50 for the cost of the home exercise equipment. The employer appeals, arguing that the compensation judge’s findings are not supported by substantial evidence. We affirm.

STANDARD OF REVIEW

In reviewing cases on appeal, the Workers’ Compensation Court of Appeals must determine whether “the findings of fact and order [are] clearly erroneous and unsupported by substantial evidence in view of the entire record as submitted.” Minn. Stat.§ 176.421, subd. 1 (1992). Substantial evidence supports the findings if, in the context of the entire record, “they are supported by evidence that a reasonable mind might accept as adequate.” Hengemuhle v. Long Prairie Jaycees, 358 N.W.2d 54, 59, 37 W.C.D. 235, 239 (Minn. 1984). Where evidence conflicts or more than one inference may reasonably be drawn from the evidence, the findings are to be affirmed. Id. At 60, 37 W.C.D. at 240. Similarly, “[f]actfindings are clearly erroneous only if the reviewing court on the entire evidence is left with a definite and firm conviction that a mistake has been committed.” Northern States Power Co. V. Lyon Food Prods., Inc., 304 Minn. 196, 201, 229 N.W.2d 521, 524 (1975). Findings of fact should not be disturbed, even though the reviewing court might disagree with them, “unless they are clearly erroneous in the sense that they are manifestly contrary to the weight of the evidence or not reasonably supported by the evidence as a whole.” Id.

DECISION

It is well established that the employee bears the burden of proving that any claimed medical expenses are reasonable and necessary to cure or relieve the effects of a work-related injury. Peterson v. Kandi Kourts, 45 W.C.D. 528, 533 (1991). In Peterson, this Court outlined the medical evidence necessary for an employee to meet his burden of proof in establishing the reasonableness and necessity of exercise equipment, including:

[T]he treatment regimen to be followed, the benefits to be gained by use of the machine, the cost and specific machine recommended, and whether there are reasonable alternatives which could accomplish the same benefits without the purchase of expensive hardware.

Id.

Regarding the treatment regimen to be followed, Dr. Benassi stated that the prescription for the home exercise equipment was necessary for the care of the work injury. Dr. Benassi also stated that the purpose of the home gym equipment was to allow the employee to maintain strength in his lower back through exercise in order to prevent exacerbation of his lumbar condition. (See Pet. Ex. A.) Dr. Benassi’s letter to the employer dated September 29, 1994, listed 12 specific exercises that he recommended. (Pet. Ex. A.) The employee testified in detail regarding the various exercises he is able to and does regularly perform using the equipment.

Regarding the benefits to be gained, the employee testified that he uses the equipment at least three times a week, for over one hour each time. (T. 73.) He stated that the use of the equipment keeps him strong enough to perform his physically demanding work duties. (T. 73). The employee also testified that from the time his health club membership expired to when he purchased and began using the exercise equipment, his pain was a five, on a scale of zero to ten, with ten being the greatest amount of pain. With the consistent use of the equipment, however, he rated his pain as zero to one. (T. 76-77.)

The employee also testified that with the consistent use of the exercise equipment he is able to reduce his symptoms and avoid the need for chiropractic care. (T. 74.) The last time the employee felt the need to treat with Dr. Benassi was in August of 1994. (T. 7; Pet. Ex. A.) Dr. Benassi opined that the use of the equipment will prevent continual exacerbation of the employee’s condition, thereby reducing the need for further medical care and expense. (Pet. Ex. A.) The employer submitted the opinion of Dr. Thomas C. Jetzer. After reviewing only the employee’s request for reimbursement and the exercises recommended by Dr. Benassi as listed in his letter dated September 29, 1994, Dr. Jetzer opined that the activities recommended by Dr. Benassi could “significantly aggravate” the employee’s low back condition and that home exercise equipment would be contraindicated. (Resp. Ex. 1). The compensation judge was not persuaded by Dr. Jetzer’s opinion. (Finding #8). We note that it is the compensation judge’s responsibility, as trier of fact, to resolve conflicts in expert testimony. Nord v. City of Cook, 360 N.W.2d 337, 342, 37 W.C.D. 364, 371 (Minn. 1985).

Regarding the cost and the specific machine recommended, Dr. Benassi opined that the purchase of home exercise equipment was the most cost efficient approach to caring for the employee’s back injury. (Pet. Ex. A.) The particular equipment recommended by Dr. Benassi was a Vetra-1270 at a cost of approximately $3800. (T. 56). The employee testified that he shopped at various locations throughout the metropolitan area, researching different equipment regarding cost, brand, quality, versatility, and warranty. (T. 56-61). The price range of the various equipment the employee considered ran from $600 to $3800. The employee testified that he chose the Multisports-3200, priced at $2,812.50, because it was the best value for the price, taking into consideration various factors including the employee’s needs, quality, brand, versatility, and warranty (T. 60-71.) Moreover, the employee testified that he did not chose the particular model recommended by his treating doctor because he felt he could get comparable equipment at a lower price. (T. 57-58.) The compensation judge found that the employee credibly testified regarding his approach to choosing which equipment to purchase and that his approach was reasonable. (Finding #10.) Assessment of witness credibility and probative value of witness testimony is the unique function of the trier of fact. Krotzer v. Browning-Ferris/Woodlake Sanitation Serv., 459 N.W.2d 509, 513, 43 W.C.D. 254, 260-61 (Minn. 1990); Redgate v. Sroga’s Standard Serv., 421 N.W.2d 729, 734, 40 W.C.D. 948, 957 (Minn. 1988).

Regarding alternatives to purchasing home exercise equipment, the employee could have chosen to continuing exercising at a health club. However, the annual membership dues at the different health clubs the employee attended ranged from $248.04 to $383.40. (T. 143-44.) To continue to pay annual membership dues for a number of years might eventually be more costly than the one time purchase of home exercise equipment which the employee could use to get the same type of workout. The employer refused, however, to continue to pay dues for such.

After considering the factors listed in Peterson, 45 W.C.D. at 533, we find substantial evidence in the record to support the compensation judge’s findings that the employee’s need for home exercise equipment was essentially caused by the work injury and that the cost of the equipment was reasonable and necessary to cure and relieve the effects of the employee’s low back injury. Accordingly, we affirm the compensation judge’s order that the employer pay to the employee the sum of $2,812.50 for reimbursement of the expense of the exercise equipment.



[1] In an unappealed finding, the compensation judge found that the employee did not receive the employer’s letter dated October 14, 1994, wherein it informed the employee that it would not reimburse for the purchase of home gym equipment, until after the employee purchased the equipment on October 20, 1994. (Finding #7.)