Review-Reopening Case Decided by Court of Appeals

In Verizon Business Network Services, Inc. v. McKenzie, No. 0-685 (Iowa App. Nov. 24, 2010), the Iowa Court of Appeals wrestled with issues involving review-reopening proceedings that had been addressed in Kohlhaas v. Hog Slat, 777 N.W.2d 387 (Iowa 2009).  The question raised in the case was whether the commissioner had used the correct standard in determining whether the claimant was entitled to an increase in benefits.

Claimant suffered a back injury, and was awarded 25% industrial disability benefits at the initial arbitration hearing.  Following the hearing, claimant continued to have difficulties with her back, although she had gastric bypass surgery to reduce her weight in the interim.  She filed a review-reopening petition, and at the arbitration and appeal levels was found to be permanently and totally disabled.  There was a great deal of emphasis in these decisions on whether claimant's continuing problems had been anticipated at the time of the original decision.  The decisions also required defendant to pay for claimant's gastric bypass surgery.

The district court affirmed the permanent total disability award, but indicated that the surgery did not need to be paid for by the employer because the claimant's doctor had not been authorized by the employer.  The district court also remanded the claim to the agency to determine whether the parties had stipulated to the correct date for commencement of benefits.

The COA noted that Kohlhaas had established that the claimant did not need to prove that the current extent of disability was not contemplated by the commissioner in the arbitration award.  The agency is only to look at the situation as it exists as the time the case is originally heard, and not speculate as to the physical condition of the claimant, or the economic situation at some future time.  The court found that because the agency had used the older standard of Acuity Insurance v. Foreman rather than the Kohlhaas test, the case should be remanded, even though the Acuity standard was more disadvantageous to claimant than Kohlhaas.  The court indicated remand was necessary because the commissioner's decision may have been affected by Acuity, and because the court was not a fact finder.  Because of the remand, the court did not address the question of whether the permanent total disability award was supported by substantial evidence.

On the issue of medical expenses, defendants argued that because they had not authorized the gastric bypass surgery, they were not responsible for paying for the surgery.  The district court rejected the defendants' argument and ordered payment for the surgery.  Following this decision, the Iowa Supreme Court issued its decision in Bell Brothers Heating & Air Conditioning v. Gwinn, 779 N.W.2d 193, 202 (Iowa 2010), in which the court indicated that the agency could order unauthorized care to be paid for by defendants "if it provides a more favorable medical outcome than would likely have been achieved by the care authorized by the employer."  The COA found that although the agency found the treatment was reasonable and necessary, it did not address the issue of whether the surgery was beneficial to the work related injury.  Accordingly, the court remanded this issue as well.

The final issue before the court was whether the agency erred in adopting the commencement date stipulated to by the parties.  Although defendants had raised this issue, they did not provide argument on the issue to the court.  Despite this, the COA found that the issue should be heard, and should have been addressed by the agency.  The court found that the mere presentation of the issue was sufficient to mandate that the agency consider the issue.  Citing Aluminum Co. of America v. Musal, 622 N.W.2d 476, 478 (Iowa 2001).

McKenzie is significant as the first appellate level case to consider the Bell Brothers standard concerning beneficial care.  The case also recognizes the significance of Kohlhaas in review-reopening cases. Although the court did not specifically rule on these issues, it is clear that the court considered these issues to be ones where new standards may well have compelled new results under recent Supreme Court caselaw.

Comments

Popular posts from this blog

Court of Appeals Affirms Denial of Workers' Compensation Benefits; Rules on Credit Issue

2021 Workers' Compensation Appeal Decisions

2024 Workers' Compensation Appeal Decisions