Articles Posted in Medical Care

The Supreme Court filed a very interesting decision on May 31, 2019 in the case of Robert W. Milas, M.D. v. Society Insurance and Angela Bonlander.

Dr. Milas brought a lawsuit against a workers’ compensation insurance company and one of its adjusters alleging that they went back on a promise to pay Dr. Milas $14,325.87 for a complex neck surgery, and that those actions constituted both breach of contract and fraudulent misrepresentation.

Dr. Milas is a board-certified neurosurgeon in the Quad Cities.  The disputes began when Society Insurance hired Dr. Milas to perform a neck surgery for an injured worker.

Under Iowa workers’ compensation law the insurance company and employer cannot interfere with the medical judgment of their own treating physician.  Schwers v. Nordstrom Distribution Center is a December 17, 2018 Alternate Medical Care Decision from the Workers’ Compensation Commissioner that deals with this rule.

The Claimant injured her back on August 10, 2017.  Nordstrom Distribution Center is self-insured for work comp injuries.  Nordstrom accepted the injury and provided medical care.  Dr. Michael Chapman performed a low back fusion surgery on the Claimant.

Unfortunately, the Claimant continued to have low back pain.  Dr. Chapman referred the Claimant to pain doctor #1 who performed a number of tests and a diagnostic medial branch block, and gave the opinion that a medial branch problem and facet disease could be ruled out as a cause of the Claimant’s back pain.

The Iowa Workers’ Compensation Commissioner filed an Appeal Decision on November 30, 2018 in the case of Clay v. Bridgestone Americas and Old Republic Insurance Co.  The case involved a hernia claim with an injury date of October 25, 2013 and a low back claim with an injury date of June 27, 2014.  In this blog post I am going to first talk about hernia injuries, and then talk about the importance of maximum medical improvement in Iowa work comp cases.

  1. HERNIA INJURIES IN IOWA WORK COMP CASES

The Claimant had some abdominal pain in May and June of 2013.  The doctors were not able to find any explanation for the pain.  On October 25, 2013 the Claimant lifted a 50-pound bag as part of her job and felt a twinge in her stomach.  The October 25, 2013 pain continued and the Claimant saw several physicians before she was diagnosed with a hernia on December 27, 2013.

In this blog post I am going to talk about two recent Iowa work comp alternate medical care decisions, and some related strategy advice.

  1. Be polite. The recent October 2, 2018 Alternate Medical Care Decision in the case of Stewart v. Hy-Vee, Inc. and EMC Property and Casualty Company involved an accepted left knee injury.  During the course of the case the claimant moved from Iowa to Lake Charles, Louisiana. The Defendants arranged care with an orthopedic surgeon at the Imperial Health Center located in Lake Charles, Louisiana.

 
The claimant was late for her first appointment with the orthopedic surgeon.  The claimant said she was 30 minutes late, and the doctor’s office said she was 90 minutes late.  The appointment had to be rescheduled.

Under Iowa law the Defendants in workers’ compensation cases are required to provide reasonable medical care for work-related injuries.  An injured worker who is unhappy with the medical care they are receiving can bring what is called an application for alternate medical care to attempt to get his medical care changed.  An application for alternate medical care is not automatically approved, and it is not enough that the injured worker is dissatisfied with the care that he has been receiving.  The Iowa rules require that the injured worker must show that the care was not offered promptly, was not reasonably suited to treat the injury, or that the care was unduly inconvenient.

Additionally, the Iowa Workers’ Compensation Commissioner can order alternate medical care when the employer-authorized care has not helped, and the injured worker can show that the authorized care is inferior or less extensive than the care requested by the injured worker.

Another important rule in Iowa workers’ compensation is that the employer’s right to select the provider of medical treatment for an injured worker does not include the right to choose how the injured worker should be diagnosed, evaluated, treated or other matters of professional medical judgment.  In other words, work comp defendants are not entitled to interfere with the medical judgment of their own treating doctors.

In Iowa workers’ compensation cases the employer and insurance company have the right to choose the medical care providers for the injured worker.

If the worker is unhappy with the medical care they can file a Petition for Alternate Medical Care to have the care changed.  The employer’s obligation is to provide reasonable care.  The Claimant has the burden of proof to show that the authorized care is unreasonable.  Determining what care is reasonable is a question of fact.  As a general matter when the evidence shows that the employer-authorized medical care has not been effective, and that the authorized care is inferior to the requested care, the Petition for Alternate Medical Care will be granted.

On April 4, 2018 the Commissioner issued an alternate medical care decision in the case of Bushbaum v. Custom Wood Products which involves a worker’s request for alternate medical care, and also a complaint that the defendants had abandoned providing any medical care.  If the Commissioner finds that the defendants have abandoned medical care in a case, then the Commissioner will allow the worker to choose his future medical care.

I.  MEDICAL BACKGROUND OF COMPLEX REGIONAL PAIN SYNDROME

The cause of Complex Regional Pain Syndrome (CRPS) is not well understood.  The current theories are that CRPS is caused by an injury or an abnormality of the peripheral and central nervous systems.  CRPS generally occurs as the result of a physical injury or trauma such as infections, surgery and heart attacks.

There are two main types of CRPS.  Type 1 is also known as Reflex Sympathetic Dystrophy Syndrome (RSD).  Type 1 CRPS develops after an injury or illness that does not directly damage the nerves in the affected limb.

The Iowa Workers’ Compensation Commissioner recently issued an Appeal Decision in the case of McDonald v. Sedona Staffing and Ace American Insurance Co.  The McDonald case is factually very complex, and deals with the issue of whether an employer can cut off medical care for a worker who was injured on the job, and then injured the same body part in a later non-work accident.

The claimant was working at a manufacturing company through Sedona Staffing where he primarily was a welder.  The claimant injured his low back when he slipped and fell on the job.

The claimant was treated conservatively for several months, but ultimately underwent low back surgery by Dr. Abernathey from Cedar Rapids, Iowa.

Under Iowa law a worker who is injured on the job is entitled to receive lifetime medical care for the work injury. The Iowa work comp system has an alternate medical care procedure to deal with many of the disputes that can develop over the medical care benefits.

Iowa workers’ comp law also allows both the insurance company and the injured worker the opportunity to obtain medical examinations to address disputes over causation and the severity of an injury.

We have added a new section to our website that explains all of these medical care issues. You can find this new section here.

Sometimes an employer will fail to purchase Iowa workers’ compensation insurance. If you end up getting hurt on the job when your employer does not have workers’ compensation insurance there is a procedure for suing the employer in a civil action. I will write about the strategies for dealing with an uninsured employer in the future.

Today I am going to write about the situation in which an employer does have workers’ compensation insurance, but the employer has a very high deductible. This is similar to the situation in which you can get collision coverage as part of your auto insurance, and choose the amount of the deductible you want. You can get a very low deductible like $100 or a very high deductible like $5,000. Your auto insurance company does not have to chip in until you have paid the amount of your deductible. When an Iowa employer has a high deductible workers’ compensation insurance policy this means that the insurance company does not have to pay towards your work comp benefits until the employer has paid the amount of the deductible.

Recently we have run into a number of cases in which employers have deductibles in the area of $250,000 per injury. This means the employer has to pay for the first $250,000 of workers’ comp benefits for each injured worker before the insurance company is required to start paying. This is not a problem as long as the employer has the money to pay for the medical care and the weekly checks for the work injury.