YER SUMNER, Employee/Appellant, v. JIM LUPIENT INFINITI, SELF-INSURED/SFM RISK SOLUTIONS, Employer/Cross-Appellant, and MINN. DEP’T OF LABOR & INDUS./VRU, MERCY HOSP., MED. ADVANCED PAIN SPECIALISTS, MCCARRON LAKE CHIROPRACTIC, MAI SPINE CTR., HEALTHEAST ST. JOHN’S & BETHESDA HOSPS., HEALTHEAST PHYSICIAN SERVS., FAIRVIEW HEALTH SERVS., CIGNA HEALTH CARE, REHAB RESULTS, N. MEM’L HEALTH CARE, and NEUROLOGICAL ASSOCS. OF ST. PAUL, Intervenors.

The employee appeals the compensation judge’s finding that the employee’s date of recovery from her January 28, 2012, work injury was May 29, 2012, and therefore the employee was not entitled to additional temporary total disability benefits, medical treatment expenses, or rehabilitation expenses. The employee also appeals the compensation judge’s determination that the employee could not make direct claims for medical expenses for treatment from the intervenors and the judge’s finding denying payment to Rehab Results and McCarron Lake Chiropractic. The employer cross-appeals the compensation judge’s finding that the employee’s medical treatment expenses through May 29, 2012, were reasonable, necessary, and causally related to the employee’s work injury. We affirm in part and reverse in part.

This matter was the subject of previous decisions by the Workers’ Compensation Court of Appeals in Sumner v. Jim Lupient Infiniti, 75 W.C.D. 243 (W.C.C.A. 2014) and by the Minnesota Supreme Court in Sumner v. Jim Lupient Infiniti, 865 N.W.2d 706, 75 W.C.D. 263 (Minn. 2015), and we incorporate by reference previous final decisions by the Office of Administrative Hearings, this court, and the Minnesota Supreme Court in this matter.

On January 28, 2012, Yer Sumner, the employee, was injured while working as an internet sales director of automotive sales for Jim Lupient Infiniti, the employer, which was self-insured for workers’ compensation liability and administered by SFM Risk Solutions. Further background of the matter is detailed in this court’s earlier decision and will not be repeated here.

The employee filed a claim petition seeking temporary total disability benefits and payment of medical expenses, and the employer denied liability. The parties notified all potential intervenors of the claim. Eleven payers and providers submitted motions to intervene, most attaching billing records to their motions. The employer filed objections to all but two of the intervention motions, those of McCarron Lake Chiropractic and Rehab Results. The objections admitted that the intervenors were proper parties to the claim, denied that the treatment charges were reasonable, necessary, or causally related to the claimed work injury, and asserted the defense that any claim for medical reimbursement was limited to amounts payable under the fee schedule. Neither the record at hearing nor the Department of Labor and Industry (DOLI) file disclosed any objection to McCarron Lake Chiropractic’s or Rehab Results’ motions. No representative of any intervenor attended the initial hearing before the compensation judge on September 10, 2013.

The compensation judge found that the employee was temporarily totally disabled from January 28 through February 11, 2012, and awarded temporary total disability benefits for this period. The judge found that the employee had fully recovered from her work injury without the need for work restrictions or further treatment and with no residual disability by May 21, 2012. Holding that none of the intervenors’ rights to reimbursement were otherwise established prior to the hearing, the judge denied all of the intervenors’ claims for reimbursement due to their failure to personally attend the hearing.

The employee appealed the compensation judge’s findings that the employee had recovered from her work injury by May 21, 2012; the denial of temporary total disability benefits after February 11, 2012; the failure to determine whether certain medical treatment was reasonable, necessary, and causally related to the work injury; and the denial of reimbursement to intervenors. North Memorial Healthcare and Mercy Hospital cross-appealed from the denial of their claims for reimbursement. This court affirmed in part, reversed in part, vacated in part, and remanded in part.^[1] Specifically, the court reversed the judge’s order disallowing potential reimbursement for McCarron Lake Chiropractic and Rehab Results. North Memorial Health Care and Mercy Hospital petitioned the Minnesota Supreme Court for consideration of the intervention issue, which was affirmed. The Minnesota Supreme Court noted that there are two exceptions to the appearance requirement for intervenors, one being when the parties have filed a stipulation establishing the right to reimbursement and the other being when the employer and/or insurer do not object to the intervenor’s claim.^[2] The two intervenors involved in the supreme court decision, North Memorial Healthcare and Mercy Hospital, did not meet either exception.

The matter was returned to the compensation judge on remand based on this court’s earlier decision and a hearing was held on April 16, 2016. The issues on remand were the following: (1) the date of the employee’s recovery from the work injury, (2) the employee’s restrictions, (3) ability to work, (4) wage loss benefits, (5) which medical expenses were reasonable, necessary, and causally related to the employee’s work injury, and (6) whether Rehab Results and McCarron Lake Chiropractic were entitled to reimbursement of their intervention claims. At the hearing, the employee asserted a direct claim for all of the intervenors involved. In Findings and Order served and filed June 6, 2016, the compensation judge found that the employee had recovered from her work injury as of May 29, 2012, and was entitled to temporary total disability benefits from January 28 through May 29, 2012. He also found that medical treatment and rehabilitation expenses during that time period were reasonable and necessary. The judge denied the intervention claims of Rehab Results and McCarron Lake Chiropractic, the employee’s direct claims for treatment provided by the other intervenors, and treatment at Neurological Associates of St. Paul after May 29, 2012.

The employee appeals the date of recovery and the denial of temporary total disability benefits, medical expenses, and rehabilitation expenses through October 30, 2012, as well as the denial of her direct claims for treatment by the intervenors. The employee also appeals the finding denying payment to Rehab Results and McCarron Lake Chiropractic. The employer cross-appeals the finding that the employee’s medical treatment expenses through May 29, 2012, were reasonable, necessary, and causally related to the employee’s work injury.

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.”^[3] 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.”^[4] Where evidence conflicts or more than one inference may reasonably be drawn from the evidence, the findings are to be affirmed.^[5] Similarly, 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 evidence or not reasonably supported by the evidence as a whole.”^[6] 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.^[7]

The compensation judge denied all medical treatment expenses, rehabilitation expenses, and temporary total disability benefits after May 29, 2012. The employee appeals the denial of these benefits through October 30, 2012, claiming that the compensation judge’s finding that the employee had recovered from her work injury without residual disability or need for work restrictions or medical care as of May 29, 2012, is not supported by substantial evidence.^[8] The employee argues that the earliest possible recovery date was October 30, 2012, the date of independent medical examiner Dr. Allen’s supplemental report stating that the employee did not require any additional medical treatment or work restrictions.

On remand, the compensation judge found that the employee had fully recovered from the effects of the work injury, without residual disability or need for work restrictions, based on the opinions of Dr. Allen, the results of the neuropsychiatric assessment, and the multiple normal physical examinations and diagnostic imaging studies submitted into evidence at the hearing. On appeal, the employee asserts that the judge erred in accepting and relying on part of Dr. Allen’s opinion but ignoring or rejecting Dr. Allen’s recommendations for further treatment and a gradual return to work in May 2012. We are not persuaded by this argument. The compensation judge found that the employee was temporarily totally disabled from January 28 through May 29, 2012. The judge accepted Dr. Allen’s opinion that it was reasonable for the employee to be totally disabled for perhaps two weeks from the time of the injury on January 28, 2012, followed by a gradual return to full-time work. A compensation judge is not required to accept all parts of an expert opinion.^[9] Here, the judge did not restrict his review to Dr. Allen’s opinion, but considered the record as a whole in determining when the employee had recovered from her work injury.

On May 29, 2012, the employee underwent a neuropsychological consultation with Dr. Adams-Rieck, who diagnosed mild traumatic brain injury, resolved, and conversion disorder. The doctor also opined that the employee’s intense and unusual symptoms were not typically related to concussion, that these symptoms and her increase in anxiety, tearfulness, and overall emotional distress were not direct consequences of her concussion, and that her presentation suggested conversion disorder. Dr. Boardman also reported normal examination findings and opined that the employee had sustained a mild concussion, but that her symptoms indicated additional psychological factors.

The employee claims that the May 29, 2012, neuropsychological consultation date does not apply to the employee’s ongoing cervical and trapezius injuries and that she continued to have restrictions and need for rehabilitation and medical treatment through at least October 30, 2012. We are not persuaded by this argument. The judge listed several medical records indicating normal results of tests and scans in his findings. The judge specifically noted that the cervical spine CT scan on the day of injury as well as a head CT scan on March 3, 2012, were normal and that an examination at Mercy Hospital on April 9, 2012, indicated normal range of motion, no clear radiculopathy, and no neurologic deficits. The compensation judge found the employee fully recovered from the effects of the work injury by May 29, 2012. We find that substantial evidence in the record supports that conclusion, and we affirm.

The compensation judge awarded the employee’s medical treatment and rehabilitation expenses from January 28 through May 29, 2012. The employer cross-appealed the award of medical expenses, but did not appeal the judge’s award of rehabilitation expenses. The employer argues that much of the employee’s medical treatment expenses through May 29, 2012, were not causally related to the employee’s work injury but were caused by her anxiety and post-traumatic stress disorder, which were not causally related to the work injury. The employer relies on Dr. Allen’s opinion that only the employee’s initial treatment was reasonable and necessary, and argues that the employee received duplicative and unreasonable medical treatment after the injury such as six emergency room visits, five CT scans, two MRI scans, two x-rays, and an EKG within two months of a minor concussion and a soft tissue injury. The determination of whether medical treatment is reasonable and necessary is a question of fact to be determined by a compensation judge.^[10] Here, the employee sustained a mild concussion and a soft tissue strain of the cervical/trapezius musculature from her slip and fall. Initially, the significance or depth of each injury was not immediately known. There were a variety of diagnoses, including post-concussive syndrome with paresthesias, chest pain, neck pain, and post-traumatic headache. Based on the medical records, the compensation judge could reasonably conclude that the treatment through May 29, 2012, was reasonable and necessary for the work injury but that treatment after that date was not causally related to the work injury since the employee had recovered from the effects of the work injury by that date. Accordingly, we affirm the compensation judge’s findings regarding the medical treatment expenses awarded through May 29, 2012.

The employee asserts that she should be allowed to make direct claims for medical expenses paid by the intervenors before this court. The providers here had intervened and the employer had objected to their motions for intervention. The compensation judge noted that most of the intervenors’ claims had been previously extinguished, relying on Xayamongkhon v. Ind. Sch. Dist. No. 625^[11] to bar the employee from making direct claims for those intervenors. The employee argues that the Xayamongkhon decision does not apply to prevent the employee from making a direct claim for those intervenors, claiming that primary liability was the main issue in this case, not disputed medical treatment. We disagree. The Xayamongkhon decision is not distinguishable from this case on the basis of the type of objections made by the employer. We affirm the compensation judge’s denial of the employee’s direct claims for those intervenors’ expenses before this court, pursuant to the Xayamongkhon decision.

On remand, the compensation judge also extinguished the intervention claims of McCarron Lake Chiropractic and Rehab Results for failure to appear at the April 19, 2016, hearing, based on the supreme court’s decision in Sumner. This court, however, specifically held in its earlier decision that these two intervenors were not required to appear at the previous hearing since no objections were filed on their motions to intervene.^[12] The supreme court specifically noted in its affirmance that a situation where an employer does not object to an intervenor’s motion is one of the exceptions to the appearance requirement for intervenors.^[13] We therefore hold that the judge erred by extinguishing McCarron Lake Chiropractic’s and Rehab Results’ claims for nonappearance in light of the Minnesota Supreme Court’s decision. We therefore reverse the compensation judge’s determination that the intervention claims of McCarron Lake Chiropractic and Rehab Results are extinguished. Since the compensation judge’s award of medical treatment through May 29, 2012, was affirmed, and the award of rehabilitation benefits through that date was not appealed, McCarron Lake Chiropractic and Rehab Results are entitled to payment of their intervention claims for treatment through May 29, 2012, pursuant to the terms and conditions under the Workers’ Compensation Act.