NWCDN Members regularly post articles and summary judgements in workers’ compensations law in your state.
Select a state from the dropdown menu below to scroll through the state specific archives for updates and opinions on various workers’ compensation laws in your state.
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NID, Inc., and Great West Casualty Company v. Troy Monahan, Court of Appeals of Iowa, No. 14-0292
On March 15, 2007, Claimant, Troy Monahan, fell at work, landing on his left side. He treated at a local hospital and was prescribed medication. On September 28, 2007, NID assigned Claimant to a project. Claimant did not think he was physically able to do the project, and he left without ever returning to work. Over the next two years Claimant treated on multiple occasions for pain on his left side.
On February 26, 2009, Claimant filed his petition in arbitration, alleging a March 15, 2007, work-related injury to his upper left extremity, including shoulder, elbow, and hand. The matter came on for hearing in March 2010. The joint hearing report shows the parties stipulated that Claimant sustained an injury on March 15, 2007, that arose out of and in the course of his employment with NID. The parties disputed whether the injury caused disability, Claimant’s entitlement to healing period benefits or to permanent partial disability benefits, and whether Claimant’s medical expenses were causally connected to the injury.
On June 1, 2010, Monahan filed a petition for alternate medical care seeking arthroscopy recommended by Dr. Neff, an orthopedic surgeon who Claimant, on his own volition, treated with. NID filed its answer, disputing liability for Claimant’s “current left shoulder complaints for which he seeks care.” The agency dismissed the petition for alternate care.
On October 27, 2010, the agency filed its arbitration decision. The deputy found Claimant’s work injury was causally related only to the left hand carpal tunnel syndrome and awarded benefits for the period Claimant was off work following carpal tunnel surgery. The deputy ordered that Claimant was entitled to alternate medical care, specifically that “defendants shall provide claimant a second opinion by an orthopedic doctor of their choosing for his shoulder.” The parties appealed and cross-appealed the arbitration decision. In April 2012, the agency issued its appeal decision, affirming and adopting the arbitration decision.
On April 15, 2013, Claimant filed a second application for alternate medical care. The agency dismissed the application, explaining “before any benefits can be ordered, including medical benefits, compensability of the claim must be established, either by admission of liability or by adjudication.” The agency granted Claimant’s request for rehearing. It held the defendants were “barred by the doctrine of res judicata from contending they are not liable for claimant’s continued shoulder problems.” The rehearing decision also stated: “Since the April 2, 2012 appeal decision, defendants have not provided claimant with a second opinion regarding care for his shoulder injury. Defendants are therefore ordered, once again, to provide the alternate medical care prescribed in the October 27, 2010 arbitration decision in this case.” The agency then imposed attorney’s fees and costs as a sanction against NID.
NID sought judicial review of the rehearing decision. The district court concluded the application for alternate medical care “should have been dismissed” because causation was still at issue. The court remanded the case to the agency to hold a hearing on causation. Both parties filed post-ruling motions. The court summarily denied all postruling motions. This appeal and cross-appeal followed.
Claimant concedes the agency erred in applying the doctrine of res judicata to conclude that NID was barred from contesting causation and liability. He argues that the agency decision should nonetheless be affirmed by application of the doctrine of judicial estoppel because NID previously stipulated to causation and liability. The Court of Appeals concludes NID stipulated only that Claimant suffered a work-related injury. NID actually contested causation and liability at every point in these proceedings. Because NID has not asserted inconsistent positions, there is no reason to apply the doctrine of judicial estoppel. The Court of Appeals thus affirms the district court insofar as it held the agency committed legal error in holding res judicata barred NID from denying causation and liability and also insofar as it declined to judicially estop NID from denying causation and liability.
Additionally, the Court of Appeals agrees with the district court that section 86.42 is the appropriate method for seeking judicial enforcement of the agency’s orders and that the agency erred by ordering compliance with the agency’s prior order in the context of an alternate care proceeding. The agency does not have the authority in an alternate medical care proceeding under section 85.27(4) to enforce a prior order.
Finally, the Court of Appeals finds sanctions against NID were not appropriate. The agency’s primary basis for imposing sanctions was NID’s failure to comply with the appeal decision and obtain a second medical opinion regarding Claimant’s shoulder. That issue was not properly before the agency in this alternate medical care proceeding, and NID had a legitimate basis to contest causation and liability.
Given the Court of Appeals’ conclusion the agency erred in applying res judicata, erred in issuing an enforcement order in an alternate medical care proceeding, and erred in imposing sanctions, the appropriate remedy is remand to the agency for dismissal of the alternate medical care petition.
Tyson Foods v. Maria Gaytan, Court of Appeals of Iowa, No. 14-1397
Claimant, Maria Gaytan, suffered a left shoulder injury while working at Tyson’s in November 2005. She filed a petition in arbitration for workers’ compensation benefits with the Iowa Workers’ Compensation Commissioner. In his arbitration decision, the deputy commissioner concluded the injury was the cause of permanent disability and Claimant had “a 40 percent loss of earning capacity or industrial disability.” Claimant was awarded two hundred weeks of permanent partial disability benefits. Tyson did not seek intra-agency review of the decision.
In June 2010, Claimant underwent left shoulder surgery. In March 2012, Claimant filed a review-reopening petition asserting a change of condition since the arbitration decision. She claimed she suffered additional industrial disability as a result of the November 2005 injury. In his review-reopening decision, the deputy commissioner found that at the time of the arbitration decision, Claimant had a two percent permanent impairment to the body as a whole. Since her surgery, Claimant’s functional impairment had risen to ten percent to the body as a whole. Given this record, Claimant had carried her burden of proof that she had a change in condition related to her work injury with Tyson since the original award of benefits. The deputy then awarded Claimant healing period benefits from June 23, 2010, through May 24, 2011, and permanent total disability benefits commencing on November 22, 2005.
Tyson appealed the decision to the Commissioner, and the Commissioner affirmed the decision without additional comment. Tyson then filed its petition for judicial review. In denying the petition, the district court concluded there was substantial evidence of a change in Claimant’s condition after the original arbitration decision and substantial evidence supported an award of permanent total disability benefits under the odd-lot doctrine and an award of healing period benefits from June 23, 2010, through May 24, 2011. The district court affirmed the Commissioner’s review reopening decision in its entirety.
Tyson now appeals, arguing substantial evidence does not support a finding that Claimant sustained a change in condition since the original arbitration decision. It also argues the award of permanent total disability benefits was not supported by substantial evidence.
The Court of Appeals affirms the district court’s decision affirming the Iowa Workers’ Compensation Commissioner’s decision. The Court noted that the district court’s ruling identifies and considers all the issues presented. The cardinal rule of administrative law is that judgment calls are within the province of the administrative tribunal, not the courts, and the Court is statutorily obligated to afford due deference to the commissioner’s findings of fact.
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