William H. Johnson,

1
STATE OF MINNESOTA

IN SUPREME COURT

A20-0963

Workers’ Compensation Court of Appeals Moore, III, J.

William H. Johnson,

Respondent,

vs. Filed: August 18, 2021
Office of Appellate Courts
Darchuks Fabrications, Inc.
and Harleysville Insurance,

Relators.

________________________

Dana L. Gerber, Atkinson Gerber Law Office, Arden Hills, Minnesota, for respondent.

Emily A. LaCourse and Christine L. Tuft, Arthur, Chapman, Kettering, Smetak & Pikala,
P.A., Minneapolis, Minnesota, for relators.

________________________

S Y L L A B U S
Respondent’s treatment with opioid medication, which is non-compliant with the
long-term opioid treatment parameter promulgated by the Department of Labor & Industry,
does not qualif y as a rare exception to the treatment parameters and is, therefore, not
compensable treatment under Minnesota’s workers’ compensation system.
Reversed.
2
O P I N I O N
MOORE, III, Justice.
This case asks us to decide whether the facts establish that Respondent William
Johnson’s treatment with opioid medication, which is non-compliant with the long- term
opioid medication treatment parameter, is compensable under the workers’ compensation
laws as a “rare case” exception. We must determine whether the Workers’ Compensation
Court of Appeals (WCCA) erred in affirming the compensation judge’s determination that
Johnson’s treatment with opioid medication for a work-related ankle injury that resulted in
an intractable pain condition is compensable as a rare case exception despite its non-
compliance with the parameter promulgated by the Department of Labor & Industry for
that form of treatment. Because the circumstances of this case, as presented by the record
before us, are not exceptional, the rare case exception to the treatment parameters does not
apply. Therefore, we reverse.
FACTS
This is the second appeal to our court concerning respondent William Johnson’s
work-related injury and the proper application of the treatment parameters to his injury.
See Johnson v. Darchuks Fabrication, Inc., 926 N.W.2d 414 (Minn. 2019). Before we turn
to the facts of this case, we provide a brief overview of the function of the treatment
parameters in determining compensation for a work-related injury.
Minnesota’s workers’ compensation system requires employer s to furnish such
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.” Minn. Stat. § 176.135, subd. 1 (2020).
3
“[T]he compensation judge is responsible for determining whether medical treatment is
‘reasonably required’ ” within the scope of section 176.135, subdivision 1. Jacka v.
Coca-Cola Bottling Co., 580 N.W.2d 27, 32 (Minn. 1998) (quoting Minn. Stat. § 176.135,
subd. 1).
At the direction of the Legislature, the Minnesota Department of Labor & Industry
developed rules—treatment parameters—that set standards for particular types of
treatment of workers’ compensation injuries. See Minn. Stat. § 176.83 (2020); Minn. R.
5221.0200 (2019). These parameters are “used to determine whether a provider . . . is
performing procedures or providing services at a level or with a frequency that is excessive,
unnecessary, or inappropriate.” Minn. Stat. § 176.83, subd. 5. Because the parameters
establish standards for reasonable treatment, see Jacka , 580 N.W.2d at 34, treatment that
is inconsistent with an applicable parameter may be excessive, Minn. R. 5221.6050,
subp. 7(A) (2019), and, therefore, no longer reasonable. Treatment that is not reasonable
and necessary is not compensable. Minn. R. 5221.0500, subp. 1D (2019).
Minnesota Rule 5221.6110 (2019), the parameter that governs treatment through
long-term use of opioid medication, requires detailed medical records, assessment s, and
evaluations to establish that the patient cannot function in daily living activities given the
level of pain without long-term use of opioid medications. See id., subps. 3–6 (describing
assessment tools, selection criteria, contraindications, and treatment program
requirements).
1 Rule 5221.6110 states that long-term opioid treatment is “not indicated

1 Rule 5221.6110 was adopted in 2015 at the Legislature’s express direction, amidst
growing awareness of the opioid epidemic and the risks associated with excessive and
4
for treatment of workers’ compensation injuries” unless the requirements of the parameter
are met. Minn. R. 5221.6110, subp. 2. The rule explicitly requires the provider to
“document in the medical record” the patient selection criteria, assessments performed, any
potential contraindications, the elements of the treatment program, the written treatment
contract, an objective assessment of the success of the treatment, and the results of periodic
monitoring and testing. Id. Further, these requirements must be completed pursuant to
specified standards, as laid out in other subparts of the rule. For example, subpart 6B
requires the provider to complete an opioid risk assessment using a tool validated in the
peer-reviewed scientific literature, subpart 6H requires the provider to discuss the risks and
possible side effects with the patient, and subpart 7 requires the patient to enter into a
written contract, to be made part of the medical record, that includes the goals of the
treatment, the treatment program, and the monitoring that will be done.
Subpart 10 specifically addresses patients who were receiving long-term opioid
treatment on the date that Rule 5221.6110 went into effect. It requires the prescribing
healthcare provider to, upon receipt of written notice of the rule from the employer’s

inappropriate use of these drugs. Minn. Stat. § 176.83, subd. 5(b)(7); Act of May 16, 2013,
ch. 70, art. II, § 11, 2013 Minn. Laws 1, 12. The Statement of Need & Reasonableness for
the rule noted that opioid overdose was a “leading cause of injury-related mortality in the
United States” and that “[p]rescription opioids were involved in 67.8% of all overdoses.”
Minn. Dep’t of Lab. & Indus., Statement of Need & Reasonableness (Mar. 12, 2015), at
17; see also id. at 23 (“The rules proposed . . . incorporate the accepted medical
standards . . . for long-term treatment with opioid analgesic medication.”). The detailed
requirements in this rule directly correlate to the level of detail expected in the standards
of care applicable to all patients receiving long-term opioid treatment. Id. at 24. Treatment
that meets the requirement of the parameter “will improve the quality of the injured
workers’ life by improving function, reducing pain and minimizing risk.” Id.

5
insurer, come into compliance with certain requirements of the parameter within 3 months
after receipt of the notice to comply. Minn. R. 5221.6110, subp. 10.
Treatment parameters provide certainty as to treatment and serve as a “yardstick”
to measure whether treatment is reasonable and appropriate. Jacka, 580 N.W.2d at 35. For
the cases that do not fit fully within a particular parameter, a departure from a parameter
that limits the duration or type of treatment may be appropriate under four circumstances
outlined in Rule 5221.6050, subpart 8.2 But if a departure is not warranted under subpart
8, the treatment is not compensable unless the commissioner or a compensation judge
determines that the level, frequency , or cost is reasonable and not excessive. Minn. Stat.
§ 176.83, subd. 5(c).
In Jacka v. Coca-Cola Bottling Co., we recognized that “the treatment parameters
cannot anticipate every exceptional circumstance,” and, thus, compensation judges “may
depart from the rules in those rare cases in which departure is necessary to obtain proper
treatment.” 580 N.W.2d at 35‒36. This language from Jacka has been interpreted as
creating an exception to the parameters under which treatment is compensable in “rare
cases” even where that treatment neither complies with applicable treatment parameters
nor meets the requirements for a departure under Rule 5221.6050, subpart 8. See, e.g., Asti
v. Nw. Airlines, 588 N.W.2d 737, 740 (Minn. 1999) (“We thus conclude that this is indeed
one of those rare cases where a departure from the treatment parameter rules is

2 Johnson made no argument before the compensation judge for a departure under
subpart 8, and the compensation judge expressly found that none of the four circumstances
under the rule applied. Neither party appealed this finding.

6
necessary.”); Martin v. Xerox Corp., 59 Minn. Workers’ Comp. Dec. 509, 515 (WCCA
1999) (discussing “the ‘rare case’ departure contemplated by Jacka”).
This appeal concerns whether our reference in Jacka to a departure in “rare cases”
applies to Johnson’s long-term opioid medication treatment. We turn now to the facts of
this case.3
In September 2002, long before the opioid treatment parameter was promulgated,
Johnson suffered a severe right ankle sprain when he stepped on a piece of scrap metal
while working for the relator in this appeal, Darchuks Fabrication, Inc. 4 His ankle was
casted for a brief time and then placed in a controlled-ankle-motion walking boot. Johnson
experienced considerable pain, and soon afterwards, began to show signs of complex
regional pain syndrome. The condition is characterized by several symptoms, including
reduced range of motion, swelling, changes in skin texture or color, blistering, and
abnormal skin temperature regulation. See Minn. R. 5221.6305, subp. 1A(2) (2019).
In an effort to control the pain, Johnson’s providers tried a number of different
treatment regimens, including OxyContin, narcotic patches, steroid injections, physical
therapy, and sympathetic blocks. Johnson’s pain did not respond to these forms of
conservative treatment, he did not obtain relief from a pain clinic, and surgical treatment

3 The underlying facts concerning Johnson’s injury, diagnosis, and medical care are
undisputed. The parties contest only whether the ongoing opioid medication treatment is
compensable as a rare case exception to the treatment parameters.

4 Darchuks accepted liability for this injury, including responsibility for on-going
medical expenses reasonably required to treat the injury, under a settlement agreement the
parties reached in 2004. Johnson, 926 N.W.2d at 416.

7
was ruled out. 5 Johnson has not been able to return to work since his injury and has
consistently reported numerous symptoms, including painful tingling or pricking
sensations, hypersensitivity, intolerance to heat and cold, skin atrophy, an d pain that is
always present.
With no lasting relief from other treatment methods, by 2004 Johnson began treating
with Endocet, a pain medication containing the opioid oxycodone. He has continued to
use Endocet as part of his pain management regimen since that time. As recently as 2016,
Johnson’s pain was present twenty -four hours a day, limited his physical activity , and
interfered with his sleep. Medical records note, however, that there “might be alternatives
to his current treatment regimen,” including a new referral to a pain clinic if Johnson is
willing, but that his condition is likely to be of “longstanding duration.”
Johnson’s opioid treatment does not compl y with all the requirements of the
long-term opioid medication treatment parameter. The compensation judge found that
Johnson’s provider did not complete an opioid risk assessment using a tool validated in the
peer-reviewed scientific literature and did not discuss the risks and possible side effects of
long-term opioid use with Johnson. Minn. R. 5221.6110, subp. 6B, H. In addition,
although Johnson’s medical records indicate that he signed an opioid treatment agreement
on April 22, 2016, that agreement is not contained in his medical records. Minn. R.
5221.6110, subps. 2, 7 (requiring the written contract to be made part of the patient’s

5 Our 2019 opinion in the first appeal states that Johnson did not consult with a pain
specialist. Johnson, 926 N.W.2d at 416. Th e record before us in this appeal, however,
contains medical records from pain clinic visits.

8
medical record).6 On the other hand, Johnson’s provider monitored, to some degree, his
use of Endocet and its impact on his pain, occasionally verified with Johnson that he was
not receiving prescriptions from other providers, and sometimes monitored whether
Johnson was seeking earl y refill of his medications. It also appears from the medical
records that the provider conducted a risk assessment in April 2016 and Johnson scored a
3, or a moderate/severe risk.
Johnson has undergone several independent medical examinations at the request of
Darchuks, the most recent occurring in May 2016. The report from this exam was the first
to doubt Johnson’s diagnosis of complex regional pain syndrome; until this point, every
physician who had examined Johnson agreed with this diagnosis. After the May 2016
report, Darchuks asked Johnson’s provider to bring his opioid medication treatment into
compliance with the long-term opioid medication treatment parameter. When the provider
did not do so, Darchuks denied payment for treatment related to the complex regional pain
syndrome diagnosis, including Johnson’s Endocet prescription.
This denial of payment prompted the first round of proceedings in this matter after
both parties requested a hearing under Minn. Stat. § 176.83, subd. 5(c), to determine if the
treatment was excessive, unnecessary, or inappropriate. At the hearing, Johnson testified

6 Minnesota Statutes § 176.83, subd. 5(b)(7), specifically requires the Department of
Labor & Industry to incorporate “the use of written contracts between the injured worker
and the health care provider” into the long-term opioid medication treatment parameter.
Darchuks has not challenged, in the two appeals taken in this case, the compensation
judge’s finding that a treatment agreement has been signed but continues to argue that the
agreement is not contained in Johnson’s medical records as required by the parameter.

9
that his normal Endocet use is tw o pills taken three times a day, and sometimes one pill
during the night if his pain is severe enough. He described the effect of the Endocet as
cutting the pain by about half “so it’s tolerable so I can try to be normal with my life.” He
also stated that “sometimes the pain level is at a thirteen out of ten, I mean it’s just
unbearable.” The compensation judge found that Johnson had signed an opioid medication
contract and, apart from one isolated incident, did not use more Endocet than the prescribed
amount. The judge also specifically found that Johnson’s complex regional pain syndrome
diagnosis has not resolved and that the treatment with Endocet is reasonable and necessary
to cure and relieve the effects of Johnson’s work injury. The judge ordered Darchuks to
continue paying for the Endocet, concluding that the long-term opioid medication
treatment parameter did not apply because Darchuks had disputed Johnson’s complex
regional pain syndrome diagnosis. See Minn. R. 5221.6020, subp. 2 (2019) (stating the
parameters do not apply if an insurer denies liability for the injury).
On appeal, we reversed, concluding that Darchuks disputed only the complex
regional pain syndrome diagnosis, not liability for the injury or the treatment reasonably
necessary to cure and relieve that injury. Johnson, 926 N.W.2d at 421–22. Therefore, we
remanded to the compensation judge to address Darchuks’s assertion that the treatment
prescribed by Johnson’s provider was not reasonable and necessary because the regimen
did not comply with the long-term opioid medication treatment parameter. Id. at 422.
On remand, the compensation judge held a second hearing, which consisted of only
argument from counsel and did not include additional testimony or exhibits. The order
from that hearing incorporated a number of the findings made in the previous proceeding,
10
including that Johnson’s Endocet treatment was reasonable and necessary. 7 The
compensation judge also found that Johnson’s Endocet use was not compliant with the
long-term opioid medication treatment parameter. Specifically, the judge noted the
absence of documentation that an opioid risk assessment was performed, or that the risks
and possible side effects were discussed with Johnson, and the lack of the written contract
in Johnson’s medical record. The judge also found that none of the departures from the
parameters that are authorized by Rule 5221.6050, subpart 8, applied.
Nevertheless, the judge determined that the Endocet treatment was compensable as
a rare case under our decision in Jacka because Johnson experienced unbearable pain
without the Endocet and that medication reduced his pain by half, allowing him to engage
more fully in the activities of daily living. The judge concluded that without the relief
provided b y the Endoc et treatment, Johnson would be left with “virtually no quality of
life.” Therefore, the judge ordered Darchuks to continue paying for the treatment.
Darchuks appealed and the WCCA affirmed, concluding that substantial evidence
supported the co mpensation judge’s determination that a rare case exception was
warranted. Johnson v. Darchuks Fabrication, Inc., No. WC19-6325, 2020 WL 4429009
(Minn. WCCA June 18, 2020). Darchuks petitioned for review by writ of certiorari to our
court.

7 Darchuks appealed this finding in the first appeal, but none of the subsequent
proceedings have addressed that finding. The compensation judge specifically
incorporated the finding that the Endocet was reasonable and necessary into the remand
order. Darchuks did not challenge this finding in the appeal now before us.
11
ANALYSIS
The sole issue in this appeal is a legal one: whether the facts before us are sufficient
to establish a rare case exception to the long-term opioid medication treatment parameter
so that Johnson’s Endocet treatment is compensable under the workers’ compensation
system. We review issues of law de novo. Gamble v. Twin Cities Concrete Prods., 852
N.W.2d 245, 248 (Minn. 2014).
The compensation judge concluded, and the WCCA agreed, that Johnson’s
work-related injury presents a rare case that excuses the lack of compliance with the
applicable treatment parameter. The treatment parameters draw on “medical standards for
quality health care,” Minn. Stat. § 176.83, subd. 5(a), and establish standards for reasonable
medical care for work-related injuries. Leuthard v. Indep. Sch. Dist. 912- Milaca,
958 N.W.2d 640, 646 (Minn. 2021). Rather than prohibiting treatment, the parameters
serve to control medical costs by suggesting when a change in treatment may be
appropriate. Jacka, 580 N.W.2d at 35. Treatment that is inconsistent with an applicable
parameter may be excessive, Minn. R. 5221.6050, subp. 7A, would no longer be
reasonable, and thus would not be compensable. Minn. R. 5221.0500, subp. 1D.
We have explained that there are two possible departures from the treatment
parameters: the departures the Department of Labor & Industry has authorized from
parameters “that limit the duration or type of treatment,” Leuthard, 958 N.W.2d at 648
(discussing Minn. R. 5221.6050, subp. 8); and, a judicial recognition that the parameters
“cannot anticipate every exceptional circumstance,” thereby warranting a departure from
the parameter requirements in a rare case. Jacka, 580 N.W.2d at 35–36. Jacka did not,
12
however, address whether the treatment at issue in that case presented exceptional
circumstances that warranted a rare exception to the parameters.8
The first—and only —time we have substantively addressed the concept of a rare
case exception was in Asti v. Northwest Airlines. 588 N.W.2d 737 (Minn. 1999). In Asti,
the treatment at issue, a health club membership that allowed for an on-going exercise
regimen to treat a back injury , was authorized under the relevant treatment parameter for
up to 13 weeks. Id. at 739– 40. When the employer refused to pay for an on-going
membership beyond that period, the compensation judge found that the treatment was
reasonable and necessary because the exercise regimen at the health club was necessary to
cure and relieve the effects of Asti’s work injuries and without that treatment he would
have been unable to continue his employment. Id. at 739. Therefore, the judge concluded
that a departure under Rule 5221.6050, subpart 8, was warranted. Id. The WCCA reversed,
holding that Asti failed to satisfy the requirements for a departure under the rule. Id.
On appeal, we agreed with the WCCA’s determination that Asti had not satisfied
the requirements for a departure under Rule 5221.6050, subpart 8, but we nonetheless
reversed because we determined that it was “one of those rare cases” where a departure
from the treatment parameters was necessary. Id. at 740. We noted that Asti’s ongoing
exercise regimen was an inexpensive treatment that enabled him to continue his
employment, and that the alternative —permitting his health to decline to the point of

8 In Jacka, we addressed questions certified by the chief administrative law judge,
specifically, the Department of Labor & Industry’s authority to promulgate the treatment
parameters, how the treatment parameters are applied by compensation judges, and the
effective date for the parameter rules. Id. at 30–31.
13
inability to work despite the availability of treatment that would allow him to return to
work—could not have been the result intended by the drafters of the treatment parameters.
Id. Thus, we agreed that the specific circumstances presented—a treatment regimen
consisting of a health club membership that continued beyond 13 weeks and that was
necessary “to maintaining employment” —were exceptional and this was a rare case that
warranted a departure from the 13-week parameter limit. Id. at 740–41. In other words,
compliance with the parameter in Asti would have undermined the objectives of the
workers’ compensation system while non-compliance, through a departure, achieved those
objectives.
Darchuks argues that the compensation judge erred in concluding that Johnson’s
case is compensable as a rare case exception because neither Johnson nor his provider have
tried to comply with the treatment parameters. Darchuks asserts that no evidence in the
record establishes that Johnson’s failure to comply with the long- term opioid medication
treatment parameter is necessary for him to obtain treatment that cures and relieves the
effects of his injury. Finally, Darchuks maintains that Johnson’s ongoing use of opioid
medication, even without gaining substantial relief or progress, is “exactly the type of
situation anticipated by the Treatment Parameters” and, therefore, not an exceptional case.
Darchuks contends that allowing a departure in this case will eviscerate the treatment
parameters and render them meaningless.
Johnson argues that any treatment that is reasonable and necessary satisfies the
threshold requirement for compensation and that, therefore, the rare case exception
necessarily applies when the treatment is found to be reasonable and necessary even if it
14
exceeds the treatment parameters and regardless of whether that regimen qualifies for a
departure under Rule 5221.6050. But Johnson does not offer any well-founded explanation
for why h e could not comply with the long-term opioid medication treatment parameter
with regard to his Endocet treatment—specifically, why an opioid risk assessment still has
not been completed, why there is no evidence that the risks and possible side effects have
been discussed, or why a written contract has not been made part of his medical record.
Nor does he offer any factual reason why his treatment cannot become compliant with the
parameter. Before the compensation judge, Johnson relied on amorphous assertions that
the long-term opioid medication treatment parameter is “onerous” and “cumbersome” and
that his Endocet treatment regimen has adhered to the “spirit” of the parameter because
there is no evidence indicating that he has misused the opioid medication.
We conclude that merely demonstrating that the treatment at issue is reasonable and
necessary to cure and relieve the effects of a work-related injury is not sufficient to warrant
a rare case exception to the treatment parameters. We reach this conclusion for the
following reasons.
First, we reject Johnson’s contention that the only showing necessary for the rare
case exception to apply is a finding that the treatment at issue is reasonable and necessary.
A conclusion that treatment is reasonable and necessary is required for every injury subject
to workers’ compensation liability. Indeed, employer liability for the treatment required
for a work-related injury is always, and only, that which is “reasonably . . . required . . . to
cure and relieve from the effects of the injury.” Minn. Stat. § 176.135, subd. 1(a).
Johnson’s argument, which would entitle any injured worker who shows that treatment is
15
reasonable and necessary to compensation regardless of whether that treatment complies
with an applicable parameter or warrants a departure under Rule 5221.6050, subpart 8 ,
would eviscerate the treatment parameters. Compliance with the parameters would be
irrelevant in every case so long as the employee could show that the treatment at issue was
reasonable and necessary. We cannot adopt an interpretation of the law that would so
completely undermine the clear legislative intent to establish standards for medical care
that describe what is —and, therefore, also what is not —reasonable medical care. See
Minn. Stat. § 176.83, subd. 5 (instructing the Department of Labor & Industry to adopt
standards that “apply uniformly to all providers” to determine the reasonableness and
necessity of the proposed care).
Second, Asti does not support a different conclusion. It was clear there that
continuation of the health club membership beyond 13 weeks was necessary to allow Asti
to continue to work. 588 N.W.2d at 740. We assumed that the drafters of the treatment
parameters did not consider “every possible scenario,” that is, whether a 13-week limit is
preferable to some other, shorter or longer, limit that might cure or relieve a workplace
injury to a degree sufficient enough to allow continued employment. Id. Thus, Asti
establishes only that exceptional circumstances may exist when the employee demonstrates
that the particular parameter requirements at issue prevent the employee from obtaining
the treatment that is necessary to cure and relieve the effects of the injury . It was under
these exceptional circumstances that we determined that some degree of non-compliance—
i.e., a health club membership exceeding 13 weeks—better achieved the objectives of the
workers’ compensation system than strict compliance with the parameter. Id.
16
Third, the very purpose of the parameter at issue here, Minn. R. 5221.6110, is to
address when long-term use of opioid medication is reasonable and necessary and when
that particular treatment plan—long-term use that extends beyond 90 days, id., subp. 1—
is no longer reasonable or necessary. Multiple provisions in the rule guide the assessment
of whether long-term opioid medication treatment is reasonable and necessary and require
the provider to regularly revisit that assessment. See id., subp. 2 (stating that long-term use
of opioid treatment is not indicated “unless the requirements of” the rule “are met”); id.,
subp. 5 (providing “potential contraindications” to long-term use of opioid medication);
id., subp. 6A (requiring long-term u se of opioid medication to “be part of an integrated
program of treatment”); id., subp. 8B (requiring an assessment of “the success of the
program treatment,” with success defined as “improvement in both pain and function
within six months” after the treatment is initiated). We cannot conclude as a matter of law
that exceptional circumstances exist to justify a departure from the parameters when there
is no explanation for non-compliance with the requirements that establish whether the
treatment is reasonable and necessary.
Accordingly, this case is different from Asti. The reason for Asti’s
non-compliance—he had already used the allotted 13-weeks of the health club
membership—and the impact of allowing Asti’s treatment to exceed the parameter —he
was able to return to work and “remain gainfully employed”—were clear. 588 N.W.2d at
740. The record here does not establish that Johnson’s non-compliance with the opioid
treatment parameter is an exceptional circumstance not contemplated by the parameter.
Nor does the record show that Johnson’s non-compliance with the parameter better
17
achieves the objectives of the workers’ compensation system — to cure and relieve the
effects of his injury. The review and assessment requirements of Rule 5221.6110 provide
guidance as to when long-term opioid medication treatment is reasonable and necessary.
Despite non-compliance with the parameter, nothing in the record establishes why Johnson
(or his provider) has not complied with the parameter or why compliance is not obtainable.
In reaching this conclusion, we offer two other observations that we find relevant
on the facts of this case, though neither are essential to our decision . Johnson’s provider
noted that there may be alternative treatment options available to Johnson, but there is no
indication that these a lternatives were pursued, evaluated, and eliminated. The record
before the compensation judge also suggests that Johnson or his provider found the
requirements of the opioid treatment parameters to be onerous and draconian, and that this
view was an acceptable justification for non-compliance. But an unwillingness to comply
with the parameters based on individual disagreement with or dislike of a particular
parameter cannot justify a departure from the parameter. To condone non-compliance with
the parameters in a situation when alternative treatment is an option noted by the
employee’s treating physician and the reason for non-compliance appears to simply be a
disagreement with the parameters would certainly undermine the treatment parameters.
In addition, promulgation of a parameter to address long-term opioid medication
treatment was expressly required by the Legislature when an epidemic of opioid use was
underway across the country, and workers’ compensation systems, in particular, were
struggling with how to respond. See Debra L. Doby, Forcing Compliance with National
Standards: Opioids— Reducing Exposure in State Workers’ Compensation Claims, For
18
Def., Dec. 2018, at 50, 51. The rise of opioid prescriptions and associated increase of
excessive opioid use was acknowledged at length by the Department of Labor & Industry
when the long-term opioid medication treatment parameter was promulgated. Minn. Dep’t
of Lab. & Indus., Statement of Need & Reasonableness (Mar. 12, 2015), at 17‒23. And
the risk of injured employees becoming dependent on opioids when they receive
inadequate monitoring is serious. Tekesha R. Brown & J.C. Roper, Jr., The Solution is
Evidence-Based Medicine: Overuse of Addictive Narcotics in Treating Injuries, For Def.,
June 2010, at 59. T he argument offered by Johnson would render meaningless this
parameter, which is intended to specifically address these significant and serious concerns.
Second-guessing the merits of a policy decision made by the Legislature and the
Department of Labor & Industry under these circumstances is not an appropriate role for
this court. See Minn. Stat. § 176.83, subd. 5(b)(7); Minn. R. 5221.6110. See also In re
Welfare of M.L.M., 813 N.W.2d 26, 35 (Minn. 2012); Boedingheimer v. Lake Country
Transp., 485 N.W.2d 917, 922 (Minn. 1992) (noting that the Legislature has “entrusted”
the Department with promulgating the necessary rules that govern workers’ compensation
benefits).
We made clear in Jacka that a departure from the parameters that is not authorized
by existing rules is reserved for “exceptio nal” circumstances that the drafters of the
treatment parameters did not and could not anticipate when establishing standards for
reasonable and necessary treatment. 580 N.W.2d at 35‒36. The treatment parameters
represent the standards of medical care for various treatment modalities. Minn. Stat.
§ 176.83, subd. 5. In all but the most exceptional circumstances, these parameters will best
19
achieve the objectives of the workers’ compensation system . See Jacka, 580 N.W.2d at
35‒36. A case in which non-compliance with the treatment parameters will serve the
objectives of the workers’ compensation system better than strict compliance with the
parameters must be rare. And that non-compliance must be justified by some reason
beyond an unwillingness to comply with the applicable parameter.
Johnson has provided no justification for why his treatment is not compliant with
the long-term opioid medication treatment parameter, and, therefore, the compensation
judge and the WCCA erred as a matter of law in concluding that his non-compliance could
be excused under the rare case exception recognized in Jacka. Consequently, we hold that
the facts before us do not present exceptional circumstances that warrant a rare case
exception to the requirements of the treatment parameter for long-term use of opioid
medication.9
CONCLUSION
For the foregoing reasons, we reverse the decision of the Workers’ Compensation
Court of Appeals.
Reversed.

9 We note, however, as Darchuks’s counsel conceded at oral argument, that Johnson
is not necessarily barred from pursuing compensation for future Endocet use.