The Iowa Workers’ Compensation Commissioner entered an Appeal Decision on March 17, 2021 in the case of Baker vs. MSC Industrial Direct Co. and Ace American Insurance Co. The Claimant was injured when a cabinet weighing between 750 and 1,000 pounds fell on him on April 17, 2017. The Claimant’s main problems were headaches, thinking, memory and frequent seizure-like episodes. The Claimant never returned to work after this injury. The work comp insurance company directed the care in the case and the Claimant was seen by many health care providers. The health care providers generally believed the Claimant had suffered a concussion and traumatic head injury that resulted in serious lingering problems.
The workers’ compensation insurance company solicited multiple defense medical opinions from non-treating physicians, and on the basis of these defense medical opinions terminated paying weekly benefits and providing medical care approximately three years after the injury.
The case came on for trial in front of a Deputy Workers’ Compensation Commissioner on March 9, 2020, and the trial decision was filed on July 31, 2020 finding in favor of the employer and insurance carrier on the issues of weekly benefits and medical care. The Deputy Commissioner relied on the opinions of the non-treating medical experts. Three defense experts provided opinions based on record reviews without meeting the Claimant. One additional expert met the Claimant on one occasion. The defense experts gave the opinions that the Claimant’s problems were never correlated with any objective findings, and in various ways suggested that the Claimant had other stressors in his life, and he was taking advantage of the work incident.
The Claimant appealed this adverse decision. In appeals to the Iowa Workers’ Compensation Commissioner, the Commissioner is entitled to completely exercise his own judgment and can make alternate findings on both factual and legal disputes.
The Commissioner noted that the question of causal connection is essentially within the domain of expert witnesses. The Commissioner disagreed with the Deputy’s reliance on the opinions of the non-treating defense medical experts. The Commissioner felt that the opinions of the three main treating physicians who had worked with the Claimant for over three years should be relied upon. The opinions of the treating physicians were that the Claimant did suffer both a concussion and a traumatic brain injury when the cabinet fell over and struck him in the head. The treating physicians felt that this concussion/traumatic brain injury was the cause of the Claimant’s problems.
Additionally, the treating physicians felt that the Claimant required 24-hour supervision because of his history of dangerous actions since his head injury. The Claimant’s girlfriend had been providing all of the care for the Claimant since the Defendants had cut off the in-home care services. The Commissioner found that the Defendants should reimburse the Claimant’s fiancé at the rate of $2,454.48 per week for the past care she provided. Additionally, the Defendants should be ordered to provide professional 24-hour a day supervision going forward.
The Commissioner also found the Claimant had not reached maximum medical improvement based on the treating physicians believing that further treatment could increase the Claimant’s functioning, and perhaps allow the Claimant to return to some type of work on a part-time basis. Since the Commissioner concluded that the Claimant had not reached maximum medical improvement, the Commissioner did not make an award of permanency benefits.
Instead, the Commissioner ordered that the Defendants should pay back and future healing period benefits until such time as the Claimant reached maximum medical improvement. At that point the parties could bring the case back before the Workers’ Compensation Agency to determine the amount of permanency benefits to be awarded, including whether the Claimant was entitled to permanent total disability benefits.