The recent Appeal Decision in the case of Michael Warren v. Altec, Inc. and Sentinel Insurance Company is an example of how post-concussion injury cases are handled in Iowa workers’ compensation.

The claimant was injured on March 22, 2017 when a J-hook he was using came unhooked from a tank he was pulling, and the claimant fell back and struck his head and was knocked unconscious.  The claimant’s initial symptoms were a mild headache, dizziness and nausea.  The local physician recommended waiting on a neurology referral to see if claimant’s symptoms would clear up on their own.

Unfortunately, the claimant’s symptoms did not clear up and he was referred to see Beth Triebel, O.D. at Vision Park in Des Moines.  Dr. Triebel’s diagnosis was bilateral myopia, presbyopia, vertical heterophoria, and post-concussion syndrome.  Dr. Triebel changed the prescription of the Claimant’s glasses.  Dr. Triebel also ordered vision therapy which ran from October 19, 2017 through July 24, 2018.

In early May of 2018 the claimant was referred to see Deema Fattal, M.D., who was the Director of the Balance Disorders Clinic in the Department of Neurology at the University of Iowa Hospitals & Clinics.  Dr. Fattal noted that the claimant was walking very slow and felt that the claimant’s glasses were inappropriate.  Dr. Fattal recommended gait physical therapy with emphasis on speed for one to two times a week for 4 to 6 months.  Dr. Fattal also recommended a cervical MRI, evaluation with ophthalmology and vision therapy and new glasses.  By the Fall of 2018 the claimant was doing much better and both Dr. Triebel and Dr. Fattal recommended discharge from treatment.

However, the claimant still felt foggy and slow.  He felt his balance was off and that he tended to list to the left.  He also continued to have problems with memory and finding the proper words.  Claimant had also developed depression, mood swings and irritability.

The claimant used his own health insurance to see Shawn Spooner, M.D. at UnityPoint Clinic in Des Moines.  Dr. Spooner felt that all the claimant’s problems were from a concussion from the fall at work.  Dr. Spooner recommended that the claimant be treated through UnityPoint’s multi-disciplinary approach to concussions which included physical therapy, speech/cognitive therapy and referral to an alternative neuro-optometrist.

Dr. Spooner felt that the proposed special optometry and physical therapy could help the claimant quite a bit.

The work comp insurance company had the claimant see Joseph J. Chen, M.D. at the University of Iowa Hospitals & Clinics.  Dr. Chen issued two separate reports giving the opinions that the claimant’s depression symptoms were unrelated to his work injury, that the claimant had not suffered any permanent impairment as a result of the fall and that Dr. Spooner’s recommendations for treatment also were not related to the fall.

The claimant’s lawyer had him seen for an independent medical exam on October 1, 2019.  The resulting IME report gave the opinion that the claimant had suffered a closed head trauma with post-concussive syndrome.  The specific symptoms included:

  1. Short-term memory dysfunction.
  2. Irritability and unstable emotions.
  3. Visual dysfunction.
  4. Post-traumatic headaches.
  5. Post-concussive vestibular dysfunction affecting the claimant’s balance.

Both the Deputy Workers’ Compensation Commissioner that heard the trial and Workers’ Compensation Commissioner Joseph Cortese II rejected the defense opinions of Dr. Chen, and found that the claimant’s many post-concussive problems were caused by the fall at work.

The defense was ordered to pay the claimant 125 weeks of permanent partial disability benefits.  The award was relatively modest because the employer did an excellent job of providing the claimant a job with modified work duties.

The Commissioner also ordered that the work comp insurance company pay for the claimant’s past treatment which the claimant had received after the defendants denied liability.  The Commissioner quoted language from the Iowa Supreme Court’s Decision in Bell Bros. Heating v. Gwinn:

“The first circumstance in which an employee can select his or her own medical care is when the employer denies compensability of the injury.  The right to control medical care emanates entirely from the duty to furnish medical care for injuries compensable under the workers’ compensation laws. . . Without the duty to furnish care, the employer has no right to control care.  Thus, if the employer contests the compensability of the injury following notice, the statutory responsibility of the employer to furnish reasonable medical care to the employee or pay other employee benefits described in the workers’ compensation statute is not imposed until the issue of compensability is resolved in favor of the employee.  Likewise, the employer has no right to choose the medical care when compensability is contested.  Instead, the employee is left to pursue his or her own medical care for the injury at his or her own expense and is free to pursue a claim against the employer to recover the reasonable cost of medical care upon proof of compensability of the injury.  If the employee establishes the compensability of the injury at a contested case hearing, then the statutory duty of the employer to furnish medical care for compensable injuries emerges to support an award of reasonable medical care the employer should have furnished from the inception of the injury had compensability been acknowledged.

Thus, the statute contemplates that an injured employee may select his or her own medical care when the employer abandons the injured employee through the denial of compensability of the injury. When this circumstance occurs, the employee may subsequently recover the costs of the reasonable medical care obtained upon proof of compensability of the injury derived from the statutory duty of the employer to furnish reasonable medical care and supplies for all compensable injuries.”