APRIL 26, 2018

No. WC17-6123

MEDICAL TREATMENT AND EXPENSE – MEDICATIONS. Substantial evidence, including medical records, lay testimony and expert medical opinion, substantially supports the compensation judge’s determination that certain medications were reasonable, necessary, and causally related.

    Determined by:
  1. David A. Stofferahn, Judge
  2. Patricia J. Milun, Chief Judge
  3. Sean M. Quinn, Judge

Compensation Judge: Stephen R. Daly

Attorneys: Charles M. Cochrane, Cochrane Law Office, P.A., Roseville, Minnesota, for the Respondent. James R. Waldhauser, Cousineau, Waldhauser & Kieselbach, P.A., Mendota Heights, Minnesota, for the Appellants.




The employer and insurer appeal the compensation judge’s decision ordering payment of prescription medication to intervening providers and ordering reimbursement to the employee for out-of-pocket medical expenses. We affirm.


Pamela Benson sustained a number of work-related injuries while in the employ of McQuay International. The employee had an injury to her left knee on May 3, 1990. On May 3, 2000, and July 10, 2001, there were injuries to her shoulders, wrists, and elbows. Liability for these injuries was admitted by the employer and its insurer and various benefits were paid.

In 2009, the parties entered into a stipulation for settlement in which the employee received a lump sum payment in return for a full and complete settlement of all past, present, and future claims with the exception of future reasonable, necessary, and related medical expenses. The Award on Stipulation was served and filed on April 13, 2009.

A hearing before a compensation judge was held on April 28, 2015, on the employee’s claim for payment of prescription medications. In an unappealed Findings and Order issued May 6, 2015, the compensation judge determined that medications prescribed by the treating physician for treatment of the employee’s chronic pain and depression were reasonable, necessary, and related to the employee’s work injuries.

The present matter originated with a claim petition filed by the employee. As presented at the hearing, the issues were: payment of medical claims by intervenors; payment of the employee’s out-of-pocket medical expenses; and whether the employee was required to use the pharmacy selected by the employer and insurer. The employee’s prescription medications were supplied by Injured Workers Pharmacy who had intervened for reimbursement of the cost of the prescriptions. At the outset of the hearing, the parties agreed the employer and insurer would pay prescription expenses that had been incurred for morphine and tramadol.

The employee was the only witness at the hearing. She testified that since the hearing in 2015, the only treatment for her work injuries had been medication prescribed by her treating doctor, Dr. Tamara Detert, at Allina Northfield. She testified how her medication alleviated her symptoms and assisted her in her daily activities. As medical support for her claim, the employee introduced records from her clinic, Allina Northfield, and reports from Dr. Robert Wengler and Dr. Gretchen Ehresmann that had been introduced in the 2015 hearing. She also presented reports from her current treating doctor, Dr. Tamara Detert.

In a number of letters and reports, Dr. Detert commented on the medications prescribed for the employee. Dr. Detert stated in letters of January 11 and February 3, 2017, that, in her opinion, the employee had developed chronic pain syndrome as a result of her work injuries and also had reactive depression. The employee was prescribed morphine and tramadol for pain relief, Cymbalta and lorazepam for depression and anxiety, Provigil to counteract the sedative effects of the pain medication, clonidine for high blood pressure, oxybutynin for an over-active bladder, and furosemide as a diuretic. Dr. Detert stated that the employee is stable on her medications and, in the opinion of Dr. Detert, the employee was compliant in her prescribed use of medication.

The employer and insurer relied on the opinion of Dr. Donald Starzinski, a board-certified neurologist, who reviewed the employee’s records and provided medical reports dated March 18, 2015, and July 11, 2017. It was his opinion that the employee’s medication usage “is quite suboptimal with regard to control of her chronic pain.” Dr. Starzinski concluded that the use of morphine was counterproductive because of potential dependency and tolerance as well as various side effects. He recommended pain-modulating agents such as Neurontin.

The compensation judge issued his Findings and Order on October 9, 2017. The compensation judge found the prescriptions supplied by Injured Workers Pharmacy to be reasonable, necessary, and causally related to the employee’s work injuries, and the medical services provided by Allina Northfield were reasonable, necessary, and related as well. The compensation judge determined that the services provided by District One Hospital were not causally related to the work injuries. Finally, the compensation judge determined that the employee was required to use the pharmacy selected by the employer and insurer pursuant to Minn. Stat. § 176.135, subd. 1(g).

The employer and insurer have appealed the compensation judge’s decision.


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(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.” 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, 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.” Northern States Power Co. v. Lyon Food Prods., Inc., 304 Minn. 196, 201, 229 N.W.2d 521, 524 (1975).

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 Oil Refinery, 48 W.C.D. 607, 608 (W.C.C.A. 1993), summarily aff’d (Minn. June 3, 1993).


An employer is obligated to provide medical treatment, including medicines, that “may reasonably be required” to “cure and relieve from the effects of the injury.” Minn. Stat. § 176.135, subd. 1. The reasonableness and necessity of medical treatment is a question of fact to be determined by the compensation judge. Hopp v. Grist Mill, 499 N.W.2d 812, 48 W.C.D. 450 (Minn. 1993); Willy v. Northwest Airlines Corp., 74 W.C.D. 669 (W.C.C.A. 2014). The question for the court in this appeal is whether the compensation judge’s factual determination is supported by substantial evidence in view of the entire record as submitted. Minn. Stat. § 176.421, subd. 1.

The employer and insurer in their appeal contend that the decision of the compensation judge is not supported by substantial evidence. Specifically, they argue that the medication usage by the employee has gone on for too long without adequate consideration of alternatives. The appellants acknowledge that alternatives are now being recommended by the employee’s treating physicians but argue that the prescriptions filled by Injured Workers Pharmacy which were in dispute at the hearing should not have been awarded by the compensation judge. They claim instead that the opinion of Dr. Starzinski as to appropriate medical usage should have been adopted. In this appeal they seek relief from the compensation judge’s decision by modifying the medical prescriptions in accordance with Dr. Starzinski’s opinion.

The compensation judge in this matter was presented with medical records detailing the employee’s treatment including medication prescriptions. The compensation judge also considered the employee’s testimony as to her symptoms and the relief provided by her medication. Finally, the compensation judge had competing opinions of Drs. Detert and Starzinski. The compensation judge, as fact finder, is to consider the totality of the evidence and reach a decision based upon the preponderance of the evidence. Minn. Stat. § 176.021, subd. 1a; Minn. Stat. § 176.371.

The compensation judge stated in his memorandum that he found Dr. Detert’s opinion as to reasonableness, necessity, and causal relationship to be “more persuasive.” Dr. Detert had treated the employee for a year before the hearing and she had reviewed the employee’s medical records. Dr. Detert had sufficient information to establish foundation for her opinion. See Grunst v. Immanuel-St. Joseph Hosp., 424 N.W.2d 66, 68, 40 W.C.D. 1130, 1132-33 (Minn. 1988); Niemi v. M.A. Mortenson, 74 W.C.D. 679 (W.C.C.A. 2014).

We have previously held in a number of decisions that we will generally affirm the compensation judge’s decision when that decision is based on a medical opinion with adequate foundation. Smith v. Quebecor, 63 W.C.D. 566 (W.C.C.A. 2003); Younghans v. Johnson Bros. Liquor, 77 W.C.D. 381 (W.C.C.A. 2017); Puffer v. Precision Tune, 76 W.C.D. 669 (W.C.C.A. 2016). We find no reason to depart from that general rule in the present case.

The decision of the compensation judge is affirmed.