- May 15, 2020
On Friday, May 1, 2020, the Supreme Court of Iowa issued its decision in Anita Gumm v. Easter Seals, in which the Supreme Court agreed with the arguments that had been extensively briefed and then argued by attorneys Lee Hook and Tyler Smith on behalf of Easter Seals. The issue before the Court was:
Whether a workers’ compensation claimant who receives disability benefits for a traumatic injury can later recover disability benefits on a separate cumulative injury claim if the cumulative injury is based solely on aggravation of the earlier traumatic injury.
The Claimant, Anita Gumm, sustained a serious left ankle fracture on October 28, 2008, while she was working, and subsequently underwent an ORIF procedure. Ms. Gumm received weekly benefits, and she received the last weekly benefit check on May 21, 2010. Ms. Gumm sought medical treatment for her ankle in the weeks, months, and years following the date of the injury, but also following the date of her last benefit check. Pursuant to Iowa Code §85.26(2), Ms. Gumm had until May 21, 2013, to file a Review Re-opening Petition. Ms. Gumm filed multiple petitions on February 24, 2014, alleging cumulative injuries (with various manifestation dates) to her left ankle with sequela complaints to her back including an altered gait. The case went to hearing on March 12, 2015. The Deputy found that Ms. Gumm failed to prove by a preponderance of the evidence that she sustained a “distinct and discrete” new cumulative injury, pursuant to Ellingson, and awarded Ms. Gumm no additional benefits as her claim for any additional disability based on a worsening of her ankle (and sequela symptoms) for which she had previously received weekly benefits was time-barred by the three-year statute of limitations. Ms. Gumm argued at Hearing that the “distinct and discrete” requirement as set forth in Ellingson was not applicable but rather Floyd should control, which Ms. Gumm argued would allow her to recover benefits for the amount of the “increase in disability” to her ankle and sequela symptoms that could be attributed to her cumulative work duties.
LEGAL ISSUES AND ARGUMENTS
In reaching its decision, the Supreme Court addressed two prior Supreme Court of Iowa cases on point: Ellingson v. Fleetguard, Inc., 599 N.W.2d 440 (Iowa 1999) and Floyd v. Quaker Oats, 646 N.W.2d 105 (Iowa 2002). At each stage of the case, Easter Seals argued Ellingson was dispositive, and Claimant argued Floyd was dispositive. In the end,the Supreme Court, affirmed Ellingson and re-stated the acute-then-cumulative-injury claim (for same body part) standard: that the cumulative injury must be a “distinct and discrete” disability, not disability as a result of an aggravation of a previous traumatic injury. The Court framed the issue in Gumm as “whether the claimant has suffered an aggravation of her previous compensable injury or a distinct and discrete cumulative injury.”
The Court found that the Commissioner’s application of the distinct and discrete standard in Ellingson was appropriate and therefore the Commissioner’s finding that Ms. Gumm failed to meet her burden of proof for a cumulative injury claim was based on substantial evidence and thus should not be disturbed because, as the Court in Gumm noted: “whether a claimant has suffered an aggravation of a previous traumatic injury or a distinct and discrete cumulative injury is a fact issue to be determined by the commissioner.”
Overall, Gumm further supports and establishes the “distinct and discrete” standard for cases that involved traumatic-then-cumulative-injury claims initially put forth in Ellingson and also accepted in Excel Corp. v. Smithart. 654 N.W.2d 891, 898 (Iowa 2002) (“The separate and discrete requirement prevents a worker from transforming a chronic condition into multiple injuries, and obtaining the multiple separate recoveries feared by [employers]. Thus, employers are protected against paying for the prior disability over and over by the separate and discrete requirement.”). The Supreme Court ultimately held:
We therefore believe that the distinction drawn in Ellingson and Smithhart between cumulative aggravation of an existing compensable injury through the daily grind of working and a new, discrete injury remains valid in Iowa. In the former case, review-reopening is the recognized remedy if the claimant desires additional disability benefits. A claimant cannot avoid legislatively imposed restrictions by reclassifying an injury as a new injury unless the facts support that classification.
Regarding Floyd,the Court also articulated that Floyd is an exception to Ellingson: “[W]here the claimant was precluded from recovering payments for the original trauma, the claimant would be permitted to recover payments on a cumulative-injury basis for subsequent aggravation of the trauma.” The Court further noted that Floyd recognizes “that a claimant who is suffering the mounting, cumulative effects of a workplace trauma does not have to prove a distinct and discrete injury when the claimant never received an award for that trauma.”
In sum, this case is a win for employers and workers’ compensation carriers in Iowa as it affirmed the Ellingson standard that a claimant must prove a – distinct and discrete – new cumulative injury was sustained, not an aggravation or increase in previous disability, when a claimant is alleging a cumulative injury to a body part that was previously injured as part of an acute or traumatic work injury.