The employer and insurer appeal from the compensation judge’s finding that Minn. Stat. § 176.136, subd. 1b.(d), which limits an employer’s liability for the costs of medical treatment provided outside of Minnesota, cannot be applied because “[the statute] would effectively transfer liability from [the employer to the employee] and thus would be in conflict with Minn. Stat. § 176.135.”  Finding the statute at issue “clear and free from all ambiguity,” and perceiving no statutory conflict, we reverse.

This case was submitted to the compensation judge on stipulated facts.  On January 26, 2009, Andrea Schatz [the employee] sustained an admitted injury to her left shoulder while working for Interfaith Care Center [the employer].  Following her injury, the employee moved to the state of Wyoming, where she received medical treatment from Thunder Basin Orthopaedics, P.C., and from Wyoming Regional Anesthesia.  When she entered into treatment with Thunder Basin Orthopaedics, the employee initialed the provider’s financial policy form stating that out-of-state workers’ compensation patients would be responsible for any remaining balance not covered by their workers’ compensation.  Both medical providers submitted their charges to the employer’s workers’ compensation insurer, which made payment in accordance with Minn. Stat. § 176.136, subd. 1b.(d), a provision limiting an insurer’s liability for out-of-state medical care.  Pursuant to this Minnesota statute, the employer’s workers’ compensation insurer paid the providers the amounts they would have been paid under the workers’ compensation law of Wyoming.  Each provider then submitted its unpaid balances to the insurer, claiming that its entire charges had been within the usual and customary range for the same or similar treatment in its region and should be paid.  After the statutory payment, Thunder Basin Orthopaedics claimed an unpaid balance of $5,796.92, and Wyoming Regional Anesthesia claimed $1,401.44.  The employer and its insurer denied liability for the unpaid account balances.

The employee filed a medical request for the balance due the Wyoming providers, and her claim was heard by a compensation judge on November 10, 2010.  No witnesses were called, and the parties presented the case by oral argument, a stipulation of facts, and submission of several joint exhibits.  The exhibits included the Thunder Basin Orthopaedics “financial policy” that was initialed by the employee; a letter from Thunder Basin Orthopaedics attesting that charges for services provided to the employee were within the usual and customary range in their region; and documents evidencing payments made by the insurer within the parameters of Wyoming’s workers’ compensation law.

In a findings and order issued December 10, 2010, the judge noted that the reasonableness, necessity, and causal relationship of the employee’s medical treatment to her work injury were uncontested.  The judge then found that the charges for the medical treatment at Thunder Basin Orthopaedics were within the usual and customary ranges charged in that provider’s region.  And she found that the employee had personal liability for the unpaid balance of each Wyoming health care provider.  In light of those findings, and concluding that a finding relieving the employer of liability under Minn. Stat. § 176.136, subd. 1b.(d), would effectively transfer liability from the employer to the employee, “in conflict with Minn. Stat. § 176.135,” the judge held the employer and insurer liable for the employee’s unpaid medical expenses.  The employer and insurer appeal.

“[A] decision which rests upon the application of a statute or rule to essentially undisputed facts generally involves a question of law which [the Workers’ Compensation Court of Appeals] may consider de novo.”  Krovchuk v. Koch Refinery, 48 W.C.D. 607, 608 (W.C.C.A. 1993).

Minn. Stat. § 176.136, subd. 1b.(d) (2008), provides as follows:

The compensation judge determined that the employer and insurer were obligated to pay the unpaid balances of the employee’s Wyoming medical bills, despite the limitations of Minn. Stat. § 176.136, subd. 1b.(d).  In a memorandum accompanying her findings and order, the judge concluded as follows:

Minn. Stat. § 176.136, subd. 1b.(d) (2008), has not been previously applied by this court or the supreme court.^[1]  As with all statutory construction, our task is to “ascertain and effectuate the intention of the legislature.”  Minn. Stat. § 645.16.  If the words of the statute are “clear and free from all ambiguity,” further construction is neither necessary nor permitted.  Id.; see also State by Beaulieu v. RSJ, Inc., 552 N.W.2d 695, 701 (Minn. 1996).  A statute is ambiguous only if it is reasonably susceptible to more than one interpretation.  Phelps v. Commonwealth Land Title Ins. Co., 537 N.W.2d 271 (Minn. 1995).

The compensation judge perceived a conflict between the provisions of section 176.136, subd. 1b.(d), which places a limitation on an employer’s liability for the costs of out-of-state medical treatment, and section 176.135, subd. 1, which establishes an employer’s obligation to furnish medical treatment to an injured employee in the first instance.  However, the more recent cost containment statute does not limit the employee’s entitlement to treatment, articles, and supplies under the Act, only the amount an employer may be required to pay for those services.^[2]

We share the judge’s concern that the statute in question may potentially shift the cost of reasonable and necessary medical treatment to an injured employee.  Absent a statutory mandate, it is doubtful that health care providers located outside of Minnesota will accept less than their usual and customary charges in payment for treatment or services.  Further, it seems doubtful that our legislature intended to subject injured workers to actions in the courts for payment of the difference between the employer’s statutory obligation and the health care providers’ usual and customary charges.^[3]  In the present case, those amounts total over $7,000.  To be sure, the legislature has regularly adjusted and sometimes reduced the benefits available to employees for work-related injuries under our Workers’ Compensation Act.  But we can recall no adjustments to the Act that ultimately passed on to the employee the cost of his or her own workers’ compensation benefit.

In the end, however, whether the legislation directed toward containment of medical costs results in a better rule of law or is instead unfair is not for this court to decide.  We are obligated to interpret the statute according to the evident purpose of the legislature and our long-established rules of statutory construction.  If the statute unfairly burdens the injured employee, “[i]t is for the legislature, not the court, to judge the social utility of this statutory system, which has no common law counterpart, to balance the interests of employees and employers, and to make whatever adjustments and corrections it deems appropriate.”  Parson v. Holman Erection Co., Inc., 428 N.W.2d 72, 76, 41 W.C.D. 129, 135 (Minn. 1988).

Here, we find the provisions of the statute neither ambiguous nor susceptible to more than one interpretation.  The obvious purpose and intent of the law is to contain the cost of medical treatment to employers who are subject to the Act.  Cost containment is a legitimate legislative objective and one consistent with the purpose and intent of the Workers’ Compensation Act.  See Minn. Stat. § 176.001 (the purpose of the Workers’ Compensation Act as a whole is to “assure the quick and efficient delivery of indemnity and medical benefits to injured workers at a reasonable cost to the employers who are subject to [the Act]”); see also Gluba ex. rel. Gluba v. Bitzan & Ohren Masonry, 735 N.W.2d 713, 725, 67 W.C.D. 228, 243 (Minn. 2007).  We hold that the language of Minn. Stat. § 176.136, subd. 1b.(d), plainly limits an employer’s liability for the costs of medical treatment provided by a health care provider located outside of Minnesota.  Where, as here, the employer made appropriate payments within the parameters of the workers’ compensation law of the jurisdiction in which the treatment was provided, as is required under Minn. Stat. § 176.136, subd. 1b.(d), the judge’s award of full payment of the provider’s charges, beyond that required by the statute, was in error and must be reversed.

I dissent.  I would affirm the decision of the compensation judge.

We should be clear as to the result of this decision.  Two medical providers are seeking payment of an additional $7,200 for treatment that all parties agree is reasonable, necessary, and related to the employee’s work injury.  If the workers’ compensation insurer is not responsible for those charges, the providers will certainly look to the employee for payment.  Even if a health insurance policy is available to the employee in this case, such policies uniformly contain provisions which exclude coverage for work-related injuries.  The end result, then, is that Andrea Schatz will be responsible for over $7,000 in out-of-pocket costs for reasonable and necessary treatment of her work injury.

“A basic thought underlying the compensation act is that the business or industry shall in the first instance pay for accidental injuries as a business expense or a part of the cost of production.”  State ex rel. Chambers v. District Court, Hennepin County, 139 Minn. 205, 209, 166 N.W. 185, 187 (1918).  “Workers’ compensation . . . is social legislation providing a measure of security to workers injured on the job, with the burden of that expense considered a proportionate part of the expense of production.”  Botler v. Wagner Greenhouses, 754 N.W.2d 665, 667, 68 W.C.D. 470, 477 (Minn. 2008), quoting from Franke v Fabcon, 509 N.W.2d 373, 376, 49 W.C.D. 520, 524 (Minn. 1993).

Minn. Stat. § 176.135, subd. 1, provides that “the employer shall furnish” any medical treatment “as may reasonably be required at the time of the injury and at any time thereafter to cure and relieve from the effects of the injury.”  (Emphasis added.)  This provision has existed in the statute since the time of the initial enactment of the workers’ compensation law in 1913 and has changed only to impose additional obligations on the employer.  See General Statutes of Minnesota (1913), section 8212.  It has never been the law in Minnesota that an injured worker must pay for medical treatment that is related to the work injury and is necessary to “cure and relieve from the effects of the injury.”

As argued by the employer and insurer and as interpreted by the majority, Minn. Stat. § 176.136, subd. 1b.(d), reverses ninety-plus years of case law and conflicts with a fundamental provision of the workers’ compensation statute.  I would not interpret this section in that manner.

First, I think it not reasonable to conclude that the legislature meant to reverse a fundamental principle of the worker’s compensation law in such an offhand manner.  Second, imposition of liability for medical expenses on an employee is contrary to the even-handed approach which the legislature has stated to be its intention in the interpretation of the workers’ compensation statute.  Minn. Stat. § 176.001.  Third, this interpretation has a result that is “absurd, impossible of execution, or unreasonable” and is contrary to statutory language that “the legislature intends the entire statute to be effective and certain.”  Minn. Stat. § 645.17.

An employer’s obligation to pay a Minnesota medical provider for treatment of a work injury is limited to the amounts set out in the fee schedule promulgated by the Department of Labor and Industry.  Minn. Stat. § 176.136, subd. 1b.(b).  While the amount paid may be less than the usual and customary charges for those services, the employee is protected from collection by the provider for the balance of the bill under Minn. Stat. § 176.136, subd. 2, which prohibits any “attempt to collect from the injured worker.”  Surely the legislature was aware that Minnesota does not have jurisdiction to apply this provision to an out-of-state provider.  I do not believe that the legislature simply meant to limit the payment made by the insurer, leave an unpaid balance, and thereby subject the employee to a lawsuit from the provider with personal liability for medical expenses, a result which is contrary to almost 100 years of statute and case law.  It is also unreasonable to conclude that an employee who is injured in Minnesota and who later moves to another state would be penalized for the move by losing such an important right as coverage by the employer of medical care for a work injury.

Minn. Stat. § 176.136, subd.1b.(d), should be held to apply in those instances where an out-of-state provider has intervened in a workers’ compensation claim under Minn. Stat. § 176.361.  In that case, the provider is subject to Minnesota jurisdiction and its charges may be limited just as a Minnesota provider’s charges may be limited under Minn. Stat. § 176.136.  Minn. Stat. § 176.136, subd. 1b.(d), would then limit the payment to the amount an out-of-state provider would receive to the fee schedule for workers’ compensation claims in its own state.  In a case such as the present one, where the employee has received reasonable treatment out of state and the out-of-state provider does not intervene, Minn. Stat. § 176.136, subd. 1b.(d) does not apply.

There is no conflict between the provisions of Minn. Stat. § 176.136, subd. 1b.(d), and Minn. Stat. § 176.135.  There is no conflict because Minn. Stat. § 176.135, establishing the liability of an employer for medical treatment of a work injury, is fundamental to the workers’ compensation system and must be given primary consideration and effect in this case.