Articles Posted in Strategy Advice

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.

If an injured worker in an Iowa workers’ compensation case is found to have suffered permanent total disability, then the worker is entitled to receive weekly benefits for the rest of their life.

Under Iowa law, permanent total disability does not mean a state of absolute helplessness.  Permanent total disability occurs when the injury wholly disables the employee from performing work that the employee’s experience, training, education, intelligence and physical capabilities would otherwise permit the employee to perform.  A finding that an injured worker could perform some work despite the worker’s physical and educational limitations does not rule out a finding of permanent total disability.

In a recent May 3, 2018 appeal decision in the case of Houston v. Harding Enterprises, LLC d/b/a Tuffy Auto Service Center and Accident Fund National Insurance Company, the Iowa Workers’ Compensation Commissioner reviewed and approved a decision in which permanent total disability benefits had been awarded.

In some Iowa work comp cases foot or leg injuries end up causing low back problems to the injured worker because of changes in their gait.  Iowa workers’ compensation law provides that if a worker suffers an injury to one part of the body that ends up causing an injury to a second part of the body, both of the injured body parts are compensable under Iowa work comp law.  The most common type of a spill over injury is a worker who injures his foot or leg and ends up with a limp.  Sometimes the limp will unfortunately cause hip or low back problems.  In this situation the worker is entitled to receive compensation for both the original leg injury and the later back injury that develops as a result of the limp.

Additionally, an injury to a scheduled member that results in an injury to an unscheduled member will be treated as a combined unscheduled injury.  For example, if the worker injures his leg, the maximum recovery the worker can receive is 220 weeks of permanent partial disability benefits.  If the worker has a 10% impairment of the leg, he is therefore entitled to 22 weeks of permanent partial disability benefits.

If the same worker’s leg injury causes back problems, the injury to both the leg and back shift out of the scheduled injury category to the unscheduled category.  For unscheduled injuries the worker is entitled to be compensated for the extent to which the injuries affect the worker’s future earning capacity.  Generally, a worker will receive higher compensation for an unscheduled injury than for a scheduled injury.

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 workers’ compensation law a worker can receive substantially more benefits for injuries to certain body parts if the worker also had a prior injury to a different body part.  These types of cases are called Second Injury Fund claims.  The law relating to the Second Injury Fund of Iowa is set out in Iowa Code Sections 85.63 to 85.69.  The requirements for a worker to receive a Second Injury Fund award are as follows:

  1. The worker must have a work injury that results in permanent disability to one of his hands, arms, feet, legs or eyes.
  1. The worker must have suffered an earlier permanent loss to one of those same body parts. The earlier loss does not have to be related to a work injury.

Unfortunately, injuries will sometimes worsen after a workers’ compensation case is resolved.  The Iowa Workers’ Compensation Commissioner recently issued an Appeal Decision in the case of Dautovic v. Concord Hospitality and PMA Insurance Group and Zurich American Insurance which analyzes the legal implications of a worsening injury.

The claimant in Dautovic began working for a Marriott Hotel run by Concord Hospitality in 1997.  The claimant’s job involved a lot of heavy work including deep cleaning of rooms and hallways, working with laundry, and moving furniture.

The claimant originally injured his low back on the job in early 2006 when lifting a bed frame.

Sometimes a relatively minor physical injury can lead to a very severe mental injury, and even an inability to work.

The Iowa Workers’ Compensation Commissioner recently addressed such a situation in an Appeal Decision issued on December 12, 2017 in the case of Fitch v. Des Moines Public Schools and EMC Insurance Companies.

The Claimant in the Fitch case was a special education teacher who was assaulted by a student.  The Claimant suffered substantial cuts and bruises in the attack, but the physical injuries healed within several weeks.

The Iowa Workers’ Compensation Commissioner filed an Appeal Decision on December 1, 2017 in the case of Wilson v. Idex Corporation and Liberty Mutual Insurance.  One of the issues in the Wilson case was how non-work health problems that the Claimant developed after his work injury should affect the amount of disability to be awarded.

Under Iowa Work Comp law post-injury accidents are not to be used to reduce the amount of disability awarded.  The measurement of industrial disability is determined at the time healing period ends.

In the Wilson case the Claimant had worked for Viking Pump for 38 years.  At the time of his work injury the Claimant was a furnace tender.  The furnace tender job was very physically demanding and the furnace tenders worked a great deal of overtime.

The Iowa Workers’ Compensation Commissioner entered an appeal decision on November 29, 2017 in the case of Heim v. A.Y. McDonald Mfg. Co.  The main issue in the Heim case was whether the worker had suffered permanent total disability.

Under Iowa law permanent total disability does not mean that a worker is injured so severely that they are helpless.  Instead, the test is whether the injury disables the employee from performing the type of work that their experience, training, education, intelligence and prior physical ability would otherwise permit them to perform.  (See here for a longer explanation of how pre-July 1, 2017 permanent total disability injuries are analyzed under the workers’ compensation system.  See here for an explanation of the change in how injuries are analyzed for post-July 1, 2017 Iowa work comp injuries.)

The claimant in the Heim case was 63 years old at the time of the workers’ compensation trial.  His formal education ended with high school.  His work history had generally involved physically demanding jobs.