The employer and insurer appeal from the compensation judge’s determination that the medical treatment parameters do not apply as a defense to the MedX Program recommended by Physicians’ Diagnostics and Rehabilitation (PDR), and they argue that the treatment parameters bar the compensation judge’s award of the MedX program.  We affirm.

The facts of this case are largely undisputed, and the compensation judge’s factual findings regarding the history of this case have not been appealed.

The employee, Miralda De La Cruz, worked for the employer, Sunrise of Edina, as a case manager.  Her duties included assisting residents with showering, feeding, dressing, and daily personal care.

On December 6, 2011, the employee was waiting for assistance in order to perform a two-person transfer of a female resident weighing approximately 180 to 190 pounds.  The resident, however, became agitated and began to stand up.  The employee attempted to help the resident in order to avoid a fall.  As the employee tried to hold the resident, she felt some slight pain in her back.  The pain got worse as her shift continued, and the employee informed her supervisor.  She finished her shift.  The employer and insurer admitted that on December 6, 2011, the employee sustained a low back injury.

The employee initially tried chiropractic care before reporting to see Dr. Ben Trappey at Community University Health Clinic on December 19, 2011.  At that time, the doctor noted that the employee was having back, neck, and shoulder pain over the past two to three weeks, which was associated with lifting patients at work.  The employee was given some initial restrictions to avoid lifting heavy patients for two weeks.

The employee began treating with Dr. Thomas Jetzer at Occupational Medicine Consultants on December 21, 2011.  Dr. Jetzer noted pain in the employee’s thoracic region with no radicular symptoms, but she did have pain when she bent and flexed.  The employee was assessed with a lumbosacral strain, and Dr. Jetzer recommended physical therapy.  The employee was given light-duty work restrictions.

The employee started physical therapy at NovaCare Rehabilitation on December 22, 2011, and she continued treating with Occupational Medicine Consultants.  She was complaining of back pain, which was improving, but she did note radicular symptoms into both legs.  The employee continued to treat with Occupational Medicine Consultants through December 2011 and January 2012.

The employee underwent a lumbar MRI on February 2, 2012.  It showed a mild disc bulge at L4-5, but it was otherwise unremarkable.

By February 29, 2012, Dr. Gerald Peterson, with Occupational Medicine Consultants, noted that a work-hardening program had not worked.  He referred the employee to PDR because of non-improving back pain.  The employee was discharged from physical therapy in early April 2012 with a fair prognosis, pending referral to PDR.

The employee saw Dr. Thomas Kraemer at PDR on April 6, 2012.  The doctor noted the employee’s history of low back pain.  She was continuing to have achiness in her low back with numbness and sharp pains into her left thoracolumbar region, buttock, and anterolateral thigh.  Dr. Kraemer suspected deconditioning involving the paralumbar musculature due to the employee’s chronic pain and activity modification.  He recommended spinal rehabilitation in the form of their MedX Program, beginning with a modified protocol.  This recommended treatment program would run twice a week for eight to twelve weeks, depending on the employee’s progress.

In May 2012, the employee filed a medical request seeking approval of the MedX Program as recommended at PDR.  The employer and insurer filed a medical response denying the employee’s request to participate in the MedX Program.  The employer and insurer stated the following reason for the denial:  “The employee has already received 12 weeks of passive treatment in this case.  Further passive treatment is barred by treatment parameters.”  The employer and insurer specifically cited Minn. R. 5221.6200, subp. 3, as the reason for their denial under the treatment parameters.

At the employer and insurer’s request, Dr. Paul Wicklund conducted an independent medical examination of the employee on August 6, 2012.  Dr. Wicklund opined that the employee had subjective low back pain without objective findings.  He opined that the December 6, 2011, injury was a temporary strain and no longer a substantial contributing cause to the employee’s subjective complaints of pain.  He also opined that no further treatment was recommended.

The case came on for hearing before Compensation Judge Marshall on October 11, 2012.  The compensation judge was asked to determine the following issues:

At the hearing, the compensation judge heard testimony from the employee.  There were no other witnesses.  The parties did not give opening statements.  Rather, they summarized their positions in closing arguments.  Counsel for the employer and insurer cited Minn. R. 5221.6205, subp. 3, arguing that any additional passive treatment would not be permitted beyond 12 weeks.  Counsel for the employer and insurer also argued that the MedX program was not reasonable and necessary, stating, “[s]pecifically, I’d point you to the IME that was referenced and the testimony that the employee underwent with Dr. Paul Wicklund who concludes that the employee needs no further treatment for her work injury.”  Counsel for the employer and insurer stated, “in light of the lack of MRI findings and other objective findings Dr. Wicklund has stated that while the employee may have ongoing subjective complaints they’re not due to any ongoing soft tissue injury.”  Counsel for the employer and insurer went on to argue that “the treatment the employee received at NovaCare was adequate and there’s no need for the MED-X Program.”  Counsel for the employer and insurer also argued that “in addition to Dr. Wicklund’s opinion on reasonableness and necessity the treatment parameters would also bar any additional physical therapy such as - - or passive treatment modality such as the MED-X Program in this matter.”

The compensation judge determined that Dr. Wicklund had opined that the employee’s injury was a temporary back strain that had resolved.  The compensation judge then determined that because the employer and insurer used Dr. Wicklund’s IME report as a basis for denying ongoing treatment, they had also taken the position that the employee’s injuries had resolved.  Therefore, he concluded, pursuant to Bryant v. Honeywell, Inc., slip op. (W.C.C.A. Apr. 25, 2003), that the treatment parameters were not applicable as a defense to the requested medical treatment.  The compensation judge then went on to find that the preponderance of the evidence established that the MedX Program recommended by PDR was reasonable, necessary, and causally related to the work injury of December 6, 2011.  The employer and insurer appeal.

The question of reasonableness of medical treatment is one of fact for the compensation judge.  See Hopp v. Grist Mill, 499 N.W.2d 812, 48 W.C.D. 450 (Minn. 1993).  The issue for this court is whether substantial evidence supports the compensation judge’s determination.  Hengemuhle v. Long Prairie Jaycees, 358 N.W.2d 54, 37 W.C.D. 235 (Minn. 1984).  The treatment parameters were promulgated to establish guidelines for compensation judges in determining reasonable, medically necessary treatment of employees with compensable workers’ compensation injuries.  See Minn. R. 5221.6020, subp. 1.  The parameters were designed to assist the compensation judge in “identifying reasonable and appropriate medical treatment.”  Jacka v. Coca-Cola Bottling Co., 580 N.W.2d 27, 35, 58 W.C.D. 395, 407 (Minn. 1998).

On appeal, the employer and insurer do not challenge the compensation judge’s ultimate determination that the treatment at issue was reasonable and necessary.  Rather, they challenge the compensation judge’s determination that the treatment parameters do not apply as a defense to the treatment at issue and then whether the parameters bar the treatment at issue.

The treatment parameters “do not apply to treatment of an injury after an insurer has denied liability for the injury.”  Minn. R. 5221.6020, subp. 2.  This denial includes both a primary liability denial as well as denial of medical causation.  See Bryant, slip op.; Oldenburg v. Phillips & Temro Corp., 60 W.C.D. 8 (W.C.C.A. 1999), summarily aff’d (Minn. Feb. 15, 2000).

The treatment parameters were intended to foster communication between the parties and providers on treatment issues, to avoid unnecessary disputes over proposed treatment, and to minimize undue delay in the provision of reasonable and necessary care.  See Oldenburg, 60 W.C.D. at 13 (citing Jacka, 580 N.W.2d 27, 58 W.C.D. 395 (Minn. 1998); Olson v. Allina Health Systems, slip op. (W.C.C.A. Feb. 5, 1999)).  Therefore, “the parameters are inapplicable, by rule, when an employer and insurer deny liability for a work injury because, under those circumstances, the employer and insurer have no real interest in information about the course of the employee’s care and no legitimate expectation of influencing or limiting the employee’s treatment options.”  Oldenburg, 60 W.C.D. at 13 (citation omitted).  “The same may be said where the employer and insurer are denying that an ‘admitted’ injury has any continuing effects.”  Id.  Consequently, “an employer and insurer alleging that an injury is merely temporary may not reasonably rely on the parameters to deny payment for treatment rendered after the alleged resolution of the injury.”  Id.

The employer and insurer argue that at the time the employee filed her medical request, the employer and insurer denied the requested MedX Program based solely on the treatment parameters and not based on causation.  In addition, the independent medical examination report was not issued until after the administrative conference.  Therefore, they argue that the facts in this case are similar with those in Hausladen v. Egan Mech., No. WC08-136 (W.C.C.A. July 7, 2008).

In Hausladen, this court held that substantial evidence supported the compensation judge’s conclusion that the treatment parameters were applicable as a defense because the employer and insurer had only raised the treatment parameters as a defense and not causation.  The independent medical examiner in that case concluded that the employee’s condition was not related to the work injury involved.  As this court explained, however, the only indication that the employer and insurer could have been denying causation was a single statement on the first page of the medical response.  Then, the employer and insurer went on to clarify, later in the medical response, that they were denying the treatment at issue because they felt that the employee had not been compliant with her treatment recommendations.  Otherwise, the employer and insurer did not raise causation as a defense, and they relied solely on the treatment parameters in defense against the employee’s claim for medical treatment.  On review, this court noted the seemingly conflicted information on the medical response, but concluded that the employer and insurer’s actions could not be viewed as a denial of causation.  As such, in Hausladen, this court concluded that substantial evidence supported the compensation judge’s determination that only the treatment parameters had been raised as a defense and, therefore, that the treatment parameters were applicable as a defense.

Here, the employer and insurer did raise the treatment parameters as a defense at hearing.  However, in contrast to Hausladen, the employer and insurer also relied on Dr. Wicklund’s opinion that the employee’s ongoing “subjective symptoms” were no longer related to the work injury and that the employee needed no further treatment for her work injury.  At the hearing, counsel for the employer and insurer referenced Dr. Wicklund’s opinion and stated that “while the employee may have ongoing subjective complaints they’re not due to any ongoing soft tissue injury.”  Counsel for the employer and insurer also argued, based on Dr. Wicklund’s opinion, that “the treatment the employee received at NovaCare was adequate and there’s no need for the MED-X Program.”  Ultimately, counsel for the employer and insurer argued that “in addition to Dr. Wicklund’s opinion on reasonableness and necessity the treatment parameters would also bar any additional physical therapy such as - - or passive treatment modality such as the MED-X Program in this matter.”

As such, there is substantial evidence to support the compensation judge’s conclusion that the employer and insurer were also relying on Dr. Wicklund’s IME report and his opinion that the employee’s injury was no longer a substantial contributing factor in the employee’s ongoing symptoms and need for treatment.  As indicated in Oldenburg, once the employer and insurer deny ongoing liability for the effects of a work injury, they have “no real interest in information about the course of the employee’s care and no legitimate expectation of influencing or limiting the employee’s treatment options.”  60 W.C.D. at 13.  Therefore, we affirm the compensation judge’s determination that the treatment parameters were inapplicable as a defense to the treatment at issue.^[1]