Can an employee, who has a history of diabetes, get his insulin covered by his employer and insurer when the recommended treatment is for surgical repair of a hernia? The short answer in Minnesota is “yes,” especially taking into account Rivera v. Cargill Kitchen Solutions, Inc., et al., No. WC14-5726 (W.C.C.A. Mar. 17, 2015). The WCCA framed the issue as “not whether the employee’s diabetic condition is causally related to his work injury, but whether medical treatment for the employee’s diabetic condition is reasonably required to cure and relieve the employee from the effects of his work injury.” Did the legislature truly intend for an employer/insurer to be on the hook for direct treatment of a pre-existing condition totally unrelated to an employee’s work injury?
The portion of the Workers’ Compensation Act in question here is Minn. Stat. § 176.135 subd. 1(a), which provides that “The employer shall furnish any medical…treatment…as may reasonably be required at the time of the injury and any time thereafter to cure and relieve from the effects of the injury.” The WCCA, in Rivera, interpreted Minn. Stat. § 176.135 subd. 1(a) to include insulin treatment for pre-existing diabetes, which the employee needed in order to undergo a hernia surgery.
In Rivera, the employee suffered a work-related umbilical hernia injury. The recommendation from the treating physician was a hernia repair surgery. The employee was not cleared for the recommended surgery, however, due to his uncontrolled diabetes. The employee alleged that he could not afford the insulin necessary to control his diabetes. The compensation judge found that treatment relating only to control of the diabetes was not related to the work injury and denied it. The WCCA reversed, however, interpreting Minn. Stat. § 176.135 subd. 1(a) to mean that the employer was responsible for covering the insulin treatment.
In two instances, the WCCA interpreted the statute to mean that a procedure was compensable if it was a prerequisite to receiving a procedure recommended to treat the effects of the work injury. The requirement, as per the statute, is for employers to pay for “medical…treatment…reasonably…required…to cure and relieve from the effects of the injury.” In the first instance, the WCCA interpreted that passage to mean an employer must pay for “treatment…reasonably required toeffectuate the recommended [treatment]” (emphasis added). In the second instance, the WCCA interpreted it to mean “treatment…reasonably required in order for the employee’s work injury to be…treated as recommended” (emphasis added). In both instances, the WCCA extended the notion of reasonably required to cover a prerequisite treatment for diabetes, which would have no direct impact on relieving the employee from his hernia symptoms. Specifically, the WCCA held that treatment of the diabetes should be covered because it is necessary in order for the actual treatment of the “effects of the injury” to begin.
In Rivera, the WCCA relied on its previous recent decision, Bauer v. FedEx Freight East, 72. W.C.D. 197 (W.C.C.A. 2011), to justify its present decision to award the employee insulin. Specifically, the WCCA framed the holding in Bauer as follows: “where the employee needed weight loss surgery in order to treat her knee injury, this court reversed the compensation judge’s denial of payment for the surgery” Rivera (emphasis added). In Bauer, however, the facts involved a morbidly obese woman who needed to receive knee surgery in order to treat the effects of a work-related knee injury, namely, knee pain and dysfunction. The facts of that case clearly show that the employee’s obesity aggravated her knee symptoms and, in turn, that the knee symptoms impacted the obesity. These facts thus supported the finding that “weight loss surgery is reasonably required to cure and relieve the employee from the effects of that condition.” 72 W.C.D. 207-08. The WCCA inBauer acknowledged the fact that the obesity pertained to the effects of her knee injury, not simply as a prerequisite to the real knee treatment.
In this case, however, the diabetes did not aggravate the effects of the hernia; it was actually recommended as a prerequisite in order to “effectuate” the employee’s ability to receive the recommended hernia repair surgery. The WCCA seems to have expanded beyond the original holding of Bauer when it chose to use a new test that differs from the language of the statute. By requiring that employers must now pay for “treatment…reasonably required to effectuate…recommended [treatment],” the WCCA has possibly opened the door to a multitude of required treatments. For example, could this decision be interpreted to require payment for smoking or substance abuse cessation programs?
Future cases may clarify this holding. In the meantime, if you have any questions about covered medical benefits, or any other workers’ compensation matter, please feel free to call or e-mail any one of our many experienced attorneys –www.hansendordell.com / 651-482-8900.