The Iowa legislature enacted a number of new work comp laws that took effect on July 1, 2017. See here for a summary of the new laws. These new laws apply to injuries that occur on and after July 1, 2017.
A number of cases in which the new laws apply have been tried at the Deputy Commissioner level. The case of Reiter v. Incorporated City of Remsen and EMC Insurance involves a stipulated shoulder injury. The Reiter case interprets and applies two of the legal changes.
The first change is Iowa Code Section 85.34(2)(x) which provides:
“In all cases of permanent partial disability described in paragraphs ‘a’ through ‘u’, or paragraph ‘v’ when determining functional disability and not loss of earning capacity, the extent of loss or percentage of permanent impairment shall be determined solely by utilizing the guides to the evaluation of permanent impairment, published by the American Medical Association, as adopted by the workers’ compensation commissioner by rule pursuant to chapter 17A. Lay testimony or agency expertise shall not be utilized in determining loss or percentage of permanent impairment pursuant to paragraphs ‘a’ through ‘u’, or paragraph ‘v’ when determining functional disability and not loss of earning capacity.”
Prior to the new laws, the extent of impairment could be proven through a wide variety of means. Iowa Code Section 85.34(2)(x) changes the law so that in cases involving scheduled injuries the impairment can only be proven by a rating calculated pursuant to the AMA Guides.
The parties each presented impairment ratings in the Reiter case, and the issue was which rating should be accepted. In the Reiter case the doctor authorized by the insurance company found a 10% impairment of the upper extremity based on the stipulated shoulder injury. The insurance company doctor did not use the AMA Guides.
The claimant’s independent medical exam doctor gave the opinion the shoulder injury caused a 13% impairment of the upper extremity. The IME physician expressly based his impairment rating on the AMA Guides to the Evaluation of Permanent Impairment, 5th Edition.
The Deputy Commissioner that heard the Reiter case found that based on the new Section 85.34(2)(x) the higher IME rating should be used because it was pursuant the AMA Guides.
The second issue related to the new Iowa Code Section 85.34(2)(n) that changed a shoulder injury from an unscheduled injury to a scheduled member injury and also provided that permanent partial disability compensation for a shoulder injury should be based on a maximum of 400 weeks.
The AMA Guides do not have a specific rating for shoulder injuries. Instead, the AMA Guides are set up to rate shoulder injuries as an impairment of the upper extremity. Additionally, impairment to the upper extremity can also be translated into impairment of the whole person under the AMA Guides. The IME doctor’s opinion that the claimant suffered a 13% impairment of the upper extremity translates to an 8% impairment of the whole person. The claimant argued that the 13% impairment of the upper extremity should be used. 13% of 400 weeks would work out to 52 weeks of permanent partial disability benefits.
The defense argued that the 8% whole person impairment rating should be used. 8% of 400 weeks would work out to be 32 weeks of permanent partial disability benefits. In other words, there is a difference of 20 weeks of permanent partial disability benefits.
Deputy Commissioner Erin Pals reasoned that:
- The rules for evaluating impairments to shoulders are contained in Chapter 16 of the AMA Guides which is entitled, “Upper Extremities.”
- Although any AMA Guides impairment rating for a body part can be converted to a whole person impairment rating, the Workers’ Compensation Commissioner has historically not utilized whole person impairment ratings for scheduled membered injuries.
- Therefore, Deputy Pals found it appropriate that the upper extremity rating, and not the whole person impairment rating, should be applied to determine the amount of compensation for the shoulder injury.
- Consequently, Deputy Pals found that the 13% upper extremity impairment rating should be applied to the maximum of 400 weeks for a shoulder injury resulting in an award of 52 weeks of permanent partial disability benefits.
Decisions by the head Workers’ Compensation Commissioner or Appellate Courts down the road could come to a different result. However, I believe that Deputy Pals’ analysis is very reasonable, and I believe it will continue to be followed.