Supreme Court decision in Bell Brothers v. Gwinn
On March 5, 2010, the Supreme Court issued a decision in Bell Brothers Heating and Air Conditioning v. Gwinn, 779 NW2d 193 (Iowa 2010). The case involved the proof required by the employee to establish a claim for benefits and expenses on account of medical care obtained by the employee, but not authorized by the employer or the commissioner. Mr. Gwinn had obtained non-authorized care (surgery) a week before the arbitration hearing.
The court noted that the employer generally had the right to control care (the so-called authorization defense), but that the statute allowed the employee to choose care in certain emergency situations, when the employer and employee agreed to alternate medical care, and when the commissioner approved alternate medical care. The court concluded, however, that the employer's right to select the medical care did not prevent the employee from choosing medical care at his or her own expense under two circumstances. The first circumstance is when the employer denied compensability of the injury.
The second circumstance, which the court addresses for the first time in Gwinn, occurs when an employee seeks care on his own with neither the consent of the employer nor the approval of the workers' compensation commissioner. Where there are legitimate differences of opinion between the parties over the diagnosis and treatment of the injury , the court found that the employer's duty to provide medical care continues, even when the care is unauthorized "upon proof by a preponderance of the evidence that such care was reasonable and beneficial." The court went on to indicate that care is "beneficial if it provides a more favorable medical outcome than would likely have been achieved by the care authorized by the employer." The court noted that this was a "significant burden" on the claimant. The court also noted that the responsibility of the employer to provide care is not discharged "once an employee deprives an employer of its right to control medical care by obtaining alternate care not authorized by the statute."
The Gwinn case marks the first time that the courts have addressed the beneficial care rule, and thus the limits of the rule will need to be developed in future cases. The creation of the rule, however, provides claimants with an opportunity, in the appropriate circumstances, to seek care on their own where the care provided by defendants is inadequate to address the medical needs of the claimant.
The court noted that the employer generally had the right to control care (the so-called authorization defense), but that the statute allowed the employee to choose care in certain emergency situations, when the employer and employee agreed to alternate medical care, and when the commissioner approved alternate medical care. The court concluded, however, that the employer's right to select the medical care did not prevent the employee from choosing medical care at his or her own expense under two circumstances. The first circumstance is when the employer denied compensability of the injury.
The second circumstance, which the court addresses for the first time in Gwinn, occurs when an employee seeks care on his own with neither the consent of the employer nor the approval of the workers' compensation commissioner. Where there are legitimate differences of opinion between the parties over the diagnosis and treatment of the injury , the court found that the employer's duty to provide medical care continues, even when the care is unauthorized "upon proof by a preponderance of the evidence that such care was reasonable and beneficial." The court went on to indicate that care is "beneficial if it provides a more favorable medical outcome than would likely have been achieved by the care authorized by the employer." The court noted that this was a "significant burden" on the claimant. The court also noted that the responsibility of the employer to provide care is not discharged "once an employee deprives an employer of its right to control medical care by obtaining alternate care not authorized by the statute."
The Gwinn case marks the first time that the courts have addressed the beneficial care rule, and thus the limits of the rule will need to be developed in future cases. The creation of the rule, however, provides claimants with an opportunity, in the appropriate circumstances, to seek care on their own where the care provided by defendants is inadequate to address the medical needs of the claimant.
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