A Somatic Symptom Pain Disorder is a condition in which the patient’s subjective pain profile is higher than what would be expected for the physical injury.  Doctors who work in the area of pain disorders find that approximately 5% of all pain clinic patients have Somatic Symptom Pain Disorder.  Under Iowa law an injured worker who has developed Somatic Symptom Pain Disorder is entitled to receive workers’ compensation benefits.

On February 26, 2019 the Iowa Workers’ Compensation Commissioner filed an Appeal Decision in the case of Swanger v. Cloverleaf Cold Storage and AIG Insurance that dealt with a Somatic Symptom Pain Disorder.

The Claimant suffered a stipulated low back injury on June 24, 2014.  An MRI showed a small low back disc herniation and an annular tear in the low back.

The Claimant was seen by numerous doctors and underwent a wide variety of tests and non-surgical treatment.  The doctors agreed that the Claimant had a minor low back injury.  The doctors uniformly found that the Claimant’s complaints were much more severe than one would expect from the injury.  Therefore, the doctors generally agree that surgery would likely not be helpful.

After about nine months of conservative treatment the Claimant underwent a psychological exam which concluded that the patient saw himself in the sick role and it was unlikely that he would be able to make progress because of his belief that he could not participate in any activity without severe discomfort.

Additional testing showed that the Claimant had a significant psychological overlay to his pain complaints and that his elevated pain behaviors were encouraged by his wife.

The Claimant was seen for an alternate evaluation by the Mayo Clinic.  By this time the Claimant had gone through several MRIs.  The Mayo Clinic found that the Claimant’s low back injuries were healing or had substantially healed, and Claimant definitely did not require surgery.  The Mayo Clinic recommended the Claimant go through a work-hardening program and be seen by a pain management specialist.

The Claimant would not cooperate with work hardening.  Attempts to have the Claimant return to work for a few hours per day were unsuccessful.

At trial the Defendants attempted to argue against liability by claiming that the psychological aspects of the Claimant’s problems had pre-existed the minor low back work injury.  The Claimant provided expert opinions that while the Claimant had some psychological problems prior to his low back injury, the low back injury had substantially and materially aggravated the Claimant’s psychological problems to the point that he is no longer able to work.

The Workers’ Compensation Commissioner ruled that the Defendants were responsible to pay benefits for both the low back injury and the resulting Somatic Symptom Pain Disorder.

The parties also disagreed about the extent of damages.  The defense argued that in light of the Claimant’s failure to cooperate with work hardening he should only receive minimal damages.

The Work Comp Commissioner agreed that the Claimant’s refusal to participate in work hardening should diminish the extent of the Claimant’s industrial disability, but the Commissioner still felt the Claimant’s back injury and Somatic Symptom Pain Disorder entitled him to a substantial workers’ compensation award.  In assessing the amount of damages the Commissioner noted that the Claimant was only 34 years old.  He did have a high school degree, but the Claimant had some learning disabilities and his high school grades were poor. The Commissioner found that the Claimant’s work history had generally involved heavy labor, but the Commissioner was convinced that the Claimant could not return to heavy physical labor.  Therefore, the Commissioner awarded the Claimant 50% industrial disability which entitled the Claimant to 250 weeks of permanent partial disability benefits.