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.
- 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.
The Claimant ended up having hernia repair surgery on January 9, 2014. She was then off work until she returned to full duty on March 3, 2014.
The Defendants contested the hernia claim with the argument that the Claimant had pain in the stomach area several months before the lifting incident, and the hernia could have happened before the lifting incident.
However, both the treating physician and the IME physician felt that the incident in which the Claimant reported pain after lifting a 50-pound bag was at least an aggravating factor leading to the hernia surgery. Therefore, the Commissioner found that the hernia was a work injury, and ordered the Defendants to pay for the medical expenses, and to pay healing period benefits for the 8 weeks that the Claimant was off work.
However, the Commissioner ruled that the Claimant had not suffered a permanent injury from the hernia and therefore was not entitled to any permanent partial disability benefits for the hernia injury.
In my experience many hernia injuries heal well and no permanent disability is awarded. However, with a smaller number of hernia injuries there are lingering problems, and the Claimant can obtain permanent partial disability benefits.
- THE SIGNIFICANCE OF MAXIMUM MEDICAL IMPROVEMENT
The Claimant injured her low back on June 27, 2014 while stepping out of a work jeep. The Claimant was diagnosed with low back injuries, but the doctors felt that surgery would not help her condition. The Claimant began an extensive course of pain management that was still continuing at the time of the April 18, 2016 workers’ compensation trial.
“Maximum medical improvement” is a term that doctors and lawyers use in workers’ compensation cases. Maximum medical improvement does not mean the injured worker is cured, but rather the injured worker has healed as well as they are going to heal.
When a worker has reached maximum medical improvement they are no longer entitled to receive temporary partial disability benefits or healing period benefits; and instead the payment of permanent partial disability benefits begins. As a general matter the employer would prefer maximum medical improvement to come as soon as possible, and the worker would prefer maximum medical improvement to come as late as possible.
In the Clay case the Claimant argued that she was still receiving significant medical care, and therefore she had not reached maximum medical improvement.
The Defendants argued that the Claimant’s condition had stabilized, and was not changing, and therefore she should be found to have reached maximum medical improvement. The Commissioner agreed with the defense arguments and stopped the payment of temporary partial disability benefits effective February 5, 2016.
As a result of the Claimant’s back injury she had moved to a less physically demanding position with the company, and had taken a pay cut. The Commissioner found that the Claimant had incurred 35% industrial disability and therefore awarded her 175 weeks of permanent partial disability benefits.