Today I am going to talk about the case of Plumrose USA and Zurich Ins. Co. v. Robert Hathaway which was issued by the Iowa Court of Appeals on January 23, 2014.
One of the big issues in the case was whether Mr. Hathaway was entitled to workers’ compensation benefits for a serious right knee injury in light of his long history of pre-existing knee problems.
The Court of Appeals summarized the Iowa work comp law on aggravation of pre-existing condition as follows:
“While a Claimant is not entitled to compensation for the results of a preexisting injury or disease, its mere existence at the time of a (later work) injury is not a defense. If a claimant had a pre-existing condition or disability, aggravated, accelerated, worsened or ‘lighted up’ by (a work injury), he would be accordingly entitled to compensation.”
Prior to his 2009 work injury Mr. Hathaway had already undergone three right knee surgeries. He had also received a number of Cortisone injections in his right knee, and his doctors had already told him that he would need a total knee replacement at some point in the future.
Then in 2009 Mr. Hathaway slipped and fell down some icy stairs while on the job and injured his right knee.
As a result of his fall at work, Mr. Hathaway suffered a meniscus tear, an ACL tear, and a patellar tendon tear. The doctors initially attempted to treat the knee injuries conservatively, but this was unsuccessful, and the doctors eventually performed a total knee replacement.
The employer and insurance carrier argued that prior to the fall at work Mr. Hathaway already had serious knee problems and that he would have had to undergo a total knee replacement regardless of whether or not he was hurt at work.
Mr. Hathaway’s counterargument was that he clearly had suffered severe structural damage to his knee in the fall at work. Additionally, he argued that the fall aggravated the poor condition of his knee and resulted in the need for an immediate total knee replacement, rather than a knee replacement at some uncertain time in the future.
The Deputy Workers’ Compensation Commissioner who presided over the trial and the Iowa Workers’ Compensation Commissioner who ruled on the first stage of the appeal process both recognized that each side in the case had arguments in their favor. However, both ruled for Mr. Hathaway and found that he had carried his burden of proof of showing that his pre-existing condition was aggravated, accelerated, worsened or lighted up by the fall at work.
Once the Iowa Workers’ Compensation Commissioner made this finding, all of the other reviewing Courts, including the Iowa Court of Appeals were required to accept the Commissioner’s resolution of the factual dispute concerning whether the work injury aggravated Mr. Hathaway’s pre-existing knee problems. As the Iowa Court of Appeals explained in their decision, “We review the commissioner’s decision only to find if the decision is supported by substantial evidence, not to determine if the evidence in the record could support a different finding.”
See here for my February 28, 2013 blog entry which gives a longer overview of the trial and appeal process in Iowa work comp cases, and explains how important the appeal decision of the Iowa Workers’ Compensation Commissioner is in all the later appeal stages.