Under Iowa workers’ compensation law a worker can bring a review-reopening action to obtain additional compensation after an open file settlement or trial award if his functional impairment or loss of earning capacity has increased. The worker has to prove that his worsening condition was proximately caused by the original injury. The worsening can either be physical or a reduction in the worker’s earning capacity.
An interesting angle relating to review-reopening actions was addressed in the December 14, 2018 appeal decision of Hayes vs. Eagle Window & Door, Manufacturing, Inc. and Old Republic Insurance Company. The Workers’ Compensation Commissioner ruled that a review-reopening action could be based on an injury that previously existed, but which was unknown or could not have been discovered by the exercise of reasonable diligence at the time of the prior settlement or award.
In the Hayes case the Claimant was originally injured back on July 20, 2010 when he received an electrocution injury while working. The case went to hearing on May 6, 2013 and resulted in an award of 15 weeks of permanent partial disability benefits. At the time of the May 6, 2013 arbitration hearing the doctors had only identified that the Claimant had incurred minor bilateral arm injuries from the electrocution.
After the May 6, 2013 arbitration hearing the Claimant’s condition began to deteriorate severely. The Claimant underwent extensive assessment and treatment from numerous physicians. The medical care included the finding that the Claimant might have a neck injury. The Claimant also underwent the placement of a trial spinal cord stimulator.
The employer terminated the Claimant for an alleged safety violation and stopped paying for his medical care.
The Claimant was seen for an independent medical examination on May 6, 2016. The IME physician diagnosed the Claimant with cervical radiculopathy from the 2010 electrocution. The IME physician gave the opinion that the electrocution injury was a substantial aggravating factor in the Claimant’s cervical stenosis. The IME physician assigned restrictions of only rare lifting of no more than 20 pounds from floor to waist; and that the Claimant should not do any lifting above waist height. The IME physician also gave the opinion that the Claimant should limit gripping and grasping to waist height only and only on an occasional basis.
The IME physician noted that the Claimant’s symptoms in 2016 were much more extensive and more severe than prior to the 2013 work comp trial.
The work comp judge in her review-reopening decision and the head Workers’ Compensation Commissioner in his appeal decision both found that the IME physician provided a clear and persuasive explanation on the connection between the original injury and the Claimant’s worsening symptoms.
The appeal decision changed the injury from a scheduled bilateral arm injury to a loss of earning capacity injury because of the neck problems. The Commissioner ruled that the Claimant’s loss of earning capacity was 300 weeks of permanent partial disability. The employer had previously paid 15 weeks of disability based on the 2013 trial. Therefore, the employer owed an additional 285 weeks of weekly benefits. The Commissioner found that the key factors in assessing the amount of damages were:
- Following the May 6, 2013 trial the Claimant had been terminated from his job for an alleged safety violation. At the time the Claimant was terminated he was making $21.00 per hour.
- In the years since his termination the Claimant had tried a number of jobs, but was unable to perform them long term because of his physical limitations. The Claimant finally found a job that he could perform working 30 hours per week (split into six 5-hour shifts) in the kitchen at Casey’s. His earnings had declined to $9.25 per hour.
- The Work Comp Commissioner agreed with Dr. Sassman’s work restrictions and her assessment that the Claimant had sustained a 15% whole person impairment from his neck injury.
Finally, as mentioned above, the employer and insurance company had cut off all medical care shortly after terminating the Claimant. The Commissioner ordered that the Defendants pay for the medical care that had been incurred since then, and also provide medical care going forward.