Supreme Court Reverses Court of Appeals on Substantial Evidence Issue
In one of the more detailed discussions of substantial evidence in workers' compensation cases, the Iowa Supreme Court, in Cedar Rapids Community School District v. Pease, 807 NW2d 839 (Iowa 2011), reversed the decision of the Iowa Court of Appeals that had denied benefits to claimant. Pease is a classic example of the weighing of the medical evidence that the commissioner must do in reaching a conclusion. In Ms. Pease's case, the agency concluded that claimant's claim of altered gait, back injuries, and depression were supported by the evidence, and awarded permanent total disability. The district court affirmed on these issues, but the court of appeals reversed, finding that substantial evidence did not support the findings of the agency.
Ms. Pease's original injury was to her right ankle, and she complained that this injury caused her to have an altered gait, contributing to injuries to her back and left ankle. She also alleged that as a result of these injuries, she suffered from depression. Pease presented testimony from physicians indicating that her back problems had become worse as a result of her ankle injury, that she had developed depression as a result of the injury, and that she was no longer employable. Defendants offered evidence that claimant's injuries were less substantial than claimed, and offered evidence that claimant's depression was not related to the work injury. The psychiatrist who indicated that the depression was not work related also asserted that claimant was malingering. The decision of the court of appeals was based on its belief that the reliance of Dr. Miller, claimant's physician, was misplaced because the history provided by the claimant was flawed, and because surveillance undermined claimant's credibility.
The Supreme Court began its opinion by noting that "our decision is controlled in large part by the deference we afford to decisions of administrative agencies." The court noted that medical causation was a question of fact that was "vested in the discretion of the workers' compensation commission." The court noted that its review of the record was to be "fairly intensive" and indicated that the agency's findings of fact should not simply be rubber stamped. The court then stated that evidence was not insubstantial merely because different conclusions could be drawn from the evidence. Evidence may be substantial even though the court may have drawn a different conclusion from the fact finder. The task of the court is "to determine whether substantial evidence, viewing the record as a whole, supports the findings actually made."
In applying this standard to the facts before them, the court noted that the real issue was the extent to which expert testimony constituted substantial evidence in a workers' compensation case. The court noted that medical causation was "within the domain of expert testimony" and that the "commissioner, as trier of fact, has a duty to weigh the evidence and measure the credibility of witnesses." Although expert opinions are not necessarily binding on the commissioner if based on an incomplete history, the determination of whether to accept or reject such testimony is "within the 'peculiar province' of the commissioner."
The court of appeals had rejected the opinions of Dr. Miller, one of claimant's experts, on the grounds that he miscited another doctor's opinion and relied on a "questionable" history provided by the claimant. The Supreme Court noted that the agency had found claimant's testimony credible and further noted that credibility determinations are within the domain of the commissioner as trier of fact. The court noted that Dr. Miller had not relied solely on claimant's history, but had performed a physical exam and reviewed medical records concerning her case. The court also noted that Dr. Miller's opinion did not change after seeing video surveillance footage.
With respect to video surveillance, the court noted that this evidence was hardly a smoking gun. The court cited to Professor Larson in noting that surveillance evidence "must be used with great caution." The court cited to decisions from other jurisdictions which pointed to the limitations of surveillance evidence, largely based on the fact that it demonstrates only a limited time period of activity, and not the whole of claimant's activity or inactivity. Ultimately, the court again found that since the commissioner had rejected the contention that the surveillance undercut claimant's credibility, substantial evidence supported the conclusions of the commissioner.
The court also affirmed the decision of the agency on substantial evidence grounds relating to allegations of depression. The court noted that there was evidence on both sides of this issue and indicated that the commissioner was free to rely on either party's witness, and the court was "not at liberty to accept contradictory opinions of other experts in order to reject the finding of the commissioner." The court noted that the decision of the commissioner was sufficiently detailed to show the path the agency took through the conflicting evidence, citing Terwilliger and Catalfo.
Other issues were also presented by the parties. The court indicated that the commissioner had performed a de novo review. The court also found that the permanent total disability finding was supported by substantial evidence. The court rejected the argument of the employer that Pease's other injuries prevented her from returning to employment, not her work injuries. This, according to the court, was an attempt to resurrect an apportionment claim which had not been preserved because it had not been raised before the deputy. Finally, the court found that defendants were responsible for payment of certain medical bills.
Although Pease addresses issues of substantial evidence that have been discussed in detail in the past, the court makes clear that in any case in which the question involves a battle of the experts, the decision of the commissioner will be affirmed. Practitioners have long attempted to find a legal issue for the courts to decide so that the court's judgment could be substituted, and Pease will encourage this trend, and hopefully make it less likely that cases that are premised on the facts will not be taken up on judicial review. The discussion of surveillance in the case is must reading for any practitioner who is faced with either attempting to introduce surveillance video or defend against such a video.
Ms. Pease's original injury was to her right ankle, and she complained that this injury caused her to have an altered gait, contributing to injuries to her back and left ankle. She also alleged that as a result of these injuries, she suffered from depression. Pease presented testimony from physicians indicating that her back problems had become worse as a result of her ankle injury, that she had developed depression as a result of the injury, and that she was no longer employable. Defendants offered evidence that claimant's injuries were less substantial than claimed, and offered evidence that claimant's depression was not related to the work injury. The psychiatrist who indicated that the depression was not work related also asserted that claimant was malingering. The decision of the court of appeals was based on its belief that the reliance of Dr. Miller, claimant's physician, was misplaced because the history provided by the claimant was flawed, and because surveillance undermined claimant's credibility.
The Supreme Court began its opinion by noting that "our decision is controlled in large part by the deference we afford to decisions of administrative agencies." The court noted that medical causation was a question of fact that was "vested in the discretion of the workers' compensation commission." The court noted that its review of the record was to be "fairly intensive" and indicated that the agency's findings of fact should not simply be rubber stamped. The court then stated that evidence was not insubstantial merely because different conclusions could be drawn from the evidence. Evidence may be substantial even though the court may have drawn a different conclusion from the fact finder. The task of the court is "to determine whether substantial evidence, viewing the record as a whole, supports the findings actually made."
In applying this standard to the facts before them, the court noted that the real issue was the extent to which expert testimony constituted substantial evidence in a workers' compensation case. The court noted that medical causation was "within the domain of expert testimony" and that the "commissioner, as trier of fact, has a duty to weigh the evidence and measure the credibility of witnesses." Although expert opinions are not necessarily binding on the commissioner if based on an incomplete history, the determination of whether to accept or reject such testimony is "within the 'peculiar province' of the commissioner."
The court of appeals had rejected the opinions of Dr. Miller, one of claimant's experts, on the grounds that he miscited another doctor's opinion and relied on a "questionable" history provided by the claimant. The Supreme Court noted that the agency had found claimant's testimony credible and further noted that credibility determinations are within the domain of the commissioner as trier of fact. The court noted that Dr. Miller had not relied solely on claimant's history, but had performed a physical exam and reviewed medical records concerning her case. The court also noted that Dr. Miller's opinion did not change after seeing video surveillance footage.
With respect to video surveillance, the court noted that this evidence was hardly a smoking gun. The court cited to Professor Larson in noting that surveillance evidence "must be used with great caution." The court cited to decisions from other jurisdictions which pointed to the limitations of surveillance evidence, largely based on the fact that it demonstrates only a limited time period of activity, and not the whole of claimant's activity or inactivity. Ultimately, the court again found that since the commissioner had rejected the contention that the surveillance undercut claimant's credibility, substantial evidence supported the conclusions of the commissioner.
The court also affirmed the decision of the agency on substantial evidence grounds relating to allegations of depression. The court noted that there was evidence on both sides of this issue and indicated that the commissioner was free to rely on either party's witness, and the court was "not at liberty to accept contradictory opinions of other experts in order to reject the finding of the commissioner." The court noted that the decision of the commissioner was sufficiently detailed to show the path the agency took through the conflicting evidence, citing Terwilliger and Catalfo.
Other issues were also presented by the parties. The court indicated that the commissioner had performed a de novo review. The court also found that the permanent total disability finding was supported by substantial evidence. The court rejected the argument of the employer that Pease's other injuries prevented her from returning to employment, not her work injuries. This, according to the court, was an attempt to resurrect an apportionment claim which had not been preserved because it had not been raised before the deputy. Finally, the court found that defendants were responsible for payment of certain medical bills.
Although Pease addresses issues of substantial evidence that have been discussed in detail in the past, the court makes clear that in any case in which the question involves a battle of the experts, the decision of the commissioner will be affirmed. Practitioners have long attempted to find a legal issue for the courts to decide so that the court's judgment could be substituted, and Pease will encourage this trend, and hopefully make it less likely that cases that are premised on the facts will not be taken up on judicial review. The discussion of surveillance in the case is must reading for any practitioner who is faced with either attempting to introduce surveillance video or defend against such a video.
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