PRACTICE & PROCEDURE – REMAND. Where additional fact finding is necessary to address the employee’s direct claim for medical expenses, we remand the matter to the Office of Administrative Hearings.
Compensation Judge: Adam S. Wolkoff
Attorneys: James A. Batchelor, Mottaz & Sisk Injury Law, Coon Rapids, Minnesota, for the Employee/Respondent. Christine L. Tuft and Hannah Mohs, Arthur, Chapman, Kettering, Smetak & Pikala, P.A., Minneapolis, Minnesota, for the Employer-Insurer/Appellants. M. Elizabeth Giebel, Lynn, Scharfenberg & Hollick, Minneapolis, Minnesota, for the Employer-Insurer/Respondents.
Vacated in part and Remanded.
THOMAS J. CHRISTENSON, Judge
On remand from the Minnesota Supreme Court, we have determined that additional fact finding is necessary to resolve the remaining issues in this case. We vacate in part and remand the matter to a compensation judge at the Office of Administrative Hearings for further findings.
The employee, Daniel Johnson, filed a claim petition against employer Concrete Treatments, Inc., and its insurer Technology Insurance Company (Concrete Treatments), and employer Furniture & Things, Inc., and its insurer SFM Mutual Insurance Company (Furniture & Things) on May 13, 2021. The matter was heard before Compensation Judge Adam S. Wolkoff on April 29, 2022, and his Findings and Order was served and filed on July 13, 2022.
On August 10, 2022, Concrete Treatments appealed the compensation judge’s finding that the employee sustained a work injury on October 1, 2018, which was a substantial contributing factor to his low back disability and need for medical treatment, including surgery. Concrete Treatments also appealed from an apportionment determination and from an order for reimbursement to the intervenors. The matter was considered without oral argument and this court issued a decision affirming in part and reversing in part the judge’s findings and order. Johnson v. Concrete Treatments, Inc., No. WC22-6484 (W.C.C.A. Mar. 14, 2023).
Appeals from this court’s decision were taken by the employee and by Concrete Treatments to the Minnesota Supreme Court on April 12, 2023. The employee appealed this court’s majority decision that he could not bring a direct claim for unpaid medical bills owed to Twin Cities Orthopedics (TCO) and Power Within Chiropractic (PWC) because the interests of TCO and PWC had been extinguished pursuant to Minn. Stat. § 176.361. Concrete Treatments appealed our decision affirming the judge’s factual findings that the employee sustained a permanent injury on October 1, 2018, and apportioned 60 percent responsibility for the employee’s low back disability from that injury. On November 3, 2023, the Minnesota Supreme Court consolidated the appeals for oral argument, which was held on January 8, 2024.
In an opinion issued on May 29, 2024, the Minnesota Supreme Court affirmed this court’s decision upholding the judge’s factual findings relating to the October 1, 2018, work injury as not manifestly contrary to the evidence. Regarding the issue on a direct claim, the supreme court reversed the majority decision of this court and held that the employee was entitled to bring a direct claim for medical expenses, regardless of the extinguishment of TCO and PWC’s intervention interests under Minn. Stat. § 176.361. In its opinion, the court further remanded the case to the WCCA “to determine whether additional factual findings are necessary regarding [the employee’s] direct claim for his unpaid medical expenses.” Johnson v. Concrete Treatments, Inc., No. A23-0543, A23-0544 (Minn. May 29, 2024).
As directed by the May 29, 2024, opinion of the Minnesota Supreme Court, we have considered whether additional findings are necessary to resolve the issues regarding the employee’s direct claim for medical expenses. While the compensation judge found that the employee was entitled to make a direct claim for his medical expenses, he did not consider whether the employers and insurers were prejudiced by the assertion of these claims under the legal analysis of Adams v. DSR Sales, Inc., 64 W.C.D. 396 (W.C.C.A. 2004). The question of prejudice against Furniture & Things and Concrete Treatments is a factual issue and requires a record sufficient for review. This court has stressed the importance of creating a reviewable record when questions of fact are in dispute. See, e.g., Mettner v. Brush Masters, Inc., slip op. (W.C.C.A. Nov. 1, 2002); Zuehlke v. Penrose Oil Co., slip op. (W.C.C.A. Jan. 24, 2001). Because the employers’ arguments regarding undue prejudice have not yet been addressed, the matter must be remanded for additional findings.
Therefore, in accordance with Findings 52 and 53 and the opinion of the supreme court, we vacate order 2 of the July 13, 2022, Findings and Order of Compensation Judge Adam S. Wolkoff and remand the matter to a compensation judge at the Office of Administrative Hearings for factual findings[1] on the remaining issues as to (1) whether Furniture & Things and Concrete Treatments have been unduly prejudiced as a result of the employee bringing a direct claim for medical expenses incurred at TCO (Ex. O) and PWC (Ex. N) and whether undue prejudice, if any, was sufficient to deny the employee’s direct claim for payment of the TCO and PWC bills; (2) whether any payments to TCO and PWC have been made by the employee, and, if so, the monetary amount each employer is required to reimburse the employee based upon apportionment set forth in Finding 55; (3) the amount to be paid, if any, to the employee for out-of-pocket medical expenses (Ex. S) that are to be paid by each employer based upon apportionment set forth in Finding 55; and (4) the amount, if payable, that each employer is required to pay as a result of the employee’s direct claim for medical expenses incurred at TCO and PWC, per the medical fee schedule and apportionment set forth in Finding 55.
[1] This court does not have statutory authority to make factual findings and a remand is required pursuant to Minn. Stat. § 176.421, subd. 6(5), which divests this court of jurisdiction.