Articles Posted in Medical Care

The Iowa Workers’ Compensation Commissioner filed an Appeal Decision on November 3, 2020 in the case of Mary Coleman Duchesneau v. Wal-Mart Stores, Inc.  The claimant alleged injuries to her bilateral hands, bilateral wrists, bilateral elbows, bilateral shoulders and her neck.  The claimant was seen by a large number of physicians that gave differing opinions concerning the diagnosis of her injuries, the recommended treatment and the causes of her injuries.

Ultimately, the Workers’ Compensation Commissioner found that most of the claimed injuries were work related.  The Commissioner also found that the claimant had suffered 55% industrial disability and therefore was entitled to 275 weeks of permanent partial disability benefits at the claimant’s weekly rate of $338.36.

The claimant was 59 years old at the time of the workers’ compensation trial and had worked at Wal-Mart since 2003.  Over her life she had worked in a number of fields including carpentry, janitorial, retail sales, baking, dry cleaning, child care, cab driving, cashier, and photo manager.  At Hy-Vee she primarily had worked as a deli merchandise supervisor.  The claimant developed problems with both of her hands and arms which radiated up to her shoulders.  The claimant believed her problems were a result of using a handheld device to put prices on deli items for 3 to 4 hours a day.

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.

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.