- Sep 01, 2021
The Iowa Court of Appeals recently ruled on several workers’ compensation matters.
In Pesicka v. Snap-On Logistics Company, the Claimant and Employer reached a settlement agreement following a foot injury. The parties agreed there was a thirteen percent permanent partial disability (PPD) to the right leg. After settlement, the Claimant underwent eight additional surgeries related to the work injury, including amputation of all toes on his right foot. Claimant Pesicka filed a petition for review-reopening, seeking a benefit increase and asserting the condition of his right leg had worsened. The Claimant also asserted that compensation should be based on loss of each scheduled toe (forty weeks for loss of the great toe, plus fifteen weeks for each additional toe), rather than the leg. See Iowa Code § 85.34(2) (2017). However, the court held the Claimant was bound by his prior agreement within the settlement and hearing report that the injury was to the leg. He was precluded from a separate award based upon the toes, because it would prejudice the employer who did not have adequate notice to dispute the newly asserted impairment. Additionally, injuries to the toe, foot, and knee can be considered or included in the assessment of permanency to the leg. In a review-reopening proceeding, the “situs” or location of the injury will be that which was the subject of the underlying action or defined in the approved settlement.
The Court of Appeals interpreted Iowa Code section 85.21 concerning liability disputes between multiple carriers or employers in American Home Assurance v. Liberty Mutual Fire Insurance Company. The issue in this case was whether there is an indefinite time for which an insurer can claim reimbursement for benefits paid. The Commissioner had determined a consent order must be obtained prior to the arbitration hearing, whereas the district court found the plain language and purpose of the statute provided no time constraint. The Court of Appeals found the Commissioner’s interpretation was not erroneous and contested cases against another insurance carrier or employer must be commenced within three years from the last benefit payment. In this case, more than five years had passed before the insurance company realized it did not provide coverage on the date of injury. The reimbursement action would have been precluded had the Claimant not filed a review-reopening petition. It is best to review dates of coverage and determine liability for each date of injury or loss as soon as possible, so all parties have early notice of reimbursement claims and an opportunity to address liability.
Peddicord Wharton attorneys Tim Wegman and Joe Barron won on appeal in Smith v. TPI Iowa, LLC.The Claimant asserted a cumulative injury to the rotator cuff, which the employer denied. The Defendant employer produced opinions from two credible doctors that the shoulder injury was not caused by employment. The Claimant did not meet her burden of establishing the injury arose out of employment (causation). One opinion was produced by the Claimant, which opined that impairment resulted from a shoulder injury, but not that a shoulder injury arose from employment. “The critical component that [was] missed [was] an opinion that the Claimant’s alleged repetitive activities caused the shoulder injury.”
The court affirmed denial of alternate medical care in Dotts v. City of Des Moines. The employer had the authority to choose the medical care, given the injury was accepted as compensable. In considering the petition for alternate care, the Agency considered the Claimant’s testimony, communications between counsel, medical records, and statements made at the hearing. The Claimant did not meet the burden of proving the authorized care was unreasonable and alternate care was necessary. A back injury was found non-compensable in Cufurovic v. Tyson Foods, Inc. Although differing expert opinions were provided regarding the work-related nature of the injury, the opinions that the back injury was personal were found to be more credible because they were factually accurate as to work history and duties. Commissioners’ and credibility determinations are given considerable weight on appeal.
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