An employer paying the medical expenses of an employee in institutional care can be required to pay the costs of transfer to a residential setting, even if it is not medically necessary.
“Bowman asserts there is no conflict between the Department’s authority and an individual’s right to be placed in the least restrictive environment under Wis. Stat. ch. 55. Bowman claims that when an injured employee’s needs are being met in an institutional setting and he or she cannot show that transfer to a residential setting is medically necessary, the individual-not the employer-should be on the hook for the additional cost of care. This is plainly inconsistent with the legislature’s stated purpose in enacting chapter 55. A protectively placed individual whose employer has conceded liability for worker’s compensation purposes should not have liberty conditioned on his or her ability to pay for medical treatment.”
“We agree with the circuit court’s resolution of the issue. The Department’s authority under Wis. Stat. ch. 102 is subordinate to the circuit court’s determination as to the least restrictive placement under Wis. Stat. ch. 55. Accordingly, the Commission exceeded its authority by evaluating the medical necessity of LaBeree’s home placement. On remand, the Department may exercise its authority to determine which expenses associated with LaBeree’s placement are reasonable and medically necessary, but may not determine the necessity of the placement itself.”
Affirmed and Remanded.
Recommended for publication in the official reports.
2009AP1628 LaBaree v. LIRC
Dist. III, Dunn County, Smeltzer, J., Brunner, J.
Attorneys: For Appellant: Biegert, Matthew A., New Richmond; Schmiege, Anne E., New Richmond; For Respondent: Topczewski, Peter L., Brookfield; Rice, David C., Madison