Court of Appeals Reverses District Court Decision, Affirms Decision of Agency
In Anderson v. Care Initiatives, No. 14-0090 (Iowa App. Aug. 13, 2014), the agency had found that medical evidence supported a finding of causation. On judicial review, the district court reversed. The court of appeals reverses the district court, finding that there was substantial evidence to support the agency's finding.
While working in a previous job, claimant had suffered an injury to her left shoulder and knee and was given permanent work restrictions in October of 2009 to avoid repetitive lifting, reaching above her head or working above her shoulder level. She began working for Care Initiatives in July of 2010. Care Initiatives knew of the restrictions, but found claimant was qualified to perform the job. Two days before she began work, claimant went to a nurse practitioner with complaints of back pain. She was given home exercises and medications, but did not see a doctor prior to being employed by defendant.
On February 25, 2011, claimant report sustaining an injury to her low back while lifting a case of juice to the top shelf of the refrigerator. Claimant was treated and had an MRI. On the date of the MRI, surveillance at Prairie Meadows showed her "walking normally" and getting in and out of vehicles with no difficulty. She also reported to her employer that her back was hurting from the ride and she would not be in on that date. She did not tell the employer about the trip to Prairie Meadows. Claimant was subsequently terminated for the result of her falsified time sheet and the fabrication.
The MRI was read as normal and claimant was released with no restrictions. Claimant treated on her own and had epidurals by Dr. Klein for pain management. Dr. Bansal saw her for an IME in August of 2011, and provided claimant with a 6% rating, discussed and found causation and provided 30 pound lifting restrictions. He reviewed the surveillance and noted that she was sitting most of the time and had a slightly antalgic gain in the video.
The deputy found claimant truthful about her injuries and pain, despite acknowledging that she was not truthful about the events on the day of the MRI. The deputy believed that claimant had exaggerated her symptoms, and assigned a 25% industrial disability rating. On appeal, the deputy to whom the claim was assigned indicated claimant had problems with "honesty and truthfulness" but affirmed the finding of causation and 25% award.
At the district court level, the judge concluded that Dr. Bansal had not been fully appraised of claimant's prior complaints of back pain. The judge also found that Dr. Bansal had not made a finding that claimant had aggravated an underlying condition, and that the deputy had reached this conclusion without medical support. The district court reversed.
On appeal, the court of appeals reversed the decision of the district court. Citing Cedar Rapids Comm. Sch. Dist. v. Pease, 807 N.W.2d 839, 844 (Iowa 2011), the court noted that medical causation was a question of fact vested in the discretion of the workers' compensation commission." The court noted that the weight to be given to an expert depends on the accuracy of the facts given to the expert, but that the decision of whether to accept or reject an expert's opinion was for the agency, not the appellate court. The court notes that Dr. Bansal was aware of prior back tenderness. The court concludes that as a fact finder, the deputy was within his rights to use lay testimony to bolster medical testimony. Based on this evidence, the agency's decision was found to be supported by substantial evidence.
This case represents a part of the continuing trend which shows deference to the agency on issues of fact, and particularly issues of medical causation. The Supreme Court decisions in Pease and in Mike Brooks v. House appears to have solidified the approach that factual findings on medical causation are virtually untouchable at the appellate level. This holds true regardless of whether the finding is in favor of or against causation in a particular case.
While working in a previous job, claimant had suffered an injury to her left shoulder and knee and was given permanent work restrictions in October of 2009 to avoid repetitive lifting, reaching above her head or working above her shoulder level. She began working for Care Initiatives in July of 2010. Care Initiatives knew of the restrictions, but found claimant was qualified to perform the job. Two days before she began work, claimant went to a nurse practitioner with complaints of back pain. She was given home exercises and medications, but did not see a doctor prior to being employed by defendant.
On February 25, 2011, claimant report sustaining an injury to her low back while lifting a case of juice to the top shelf of the refrigerator. Claimant was treated and had an MRI. On the date of the MRI, surveillance at Prairie Meadows showed her "walking normally" and getting in and out of vehicles with no difficulty. She also reported to her employer that her back was hurting from the ride and she would not be in on that date. She did not tell the employer about the trip to Prairie Meadows. Claimant was subsequently terminated for the result of her falsified time sheet and the fabrication.
The MRI was read as normal and claimant was released with no restrictions. Claimant treated on her own and had epidurals by Dr. Klein for pain management. Dr. Bansal saw her for an IME in August of 2011, and provided claimant with a 6% rating, discussed and found causation and provided 30 pound lifting restrictions. He reviewed the surveillance and noted that she was sitting most of the time and had a slightly antalgic gain in the video.
The deputy found claimant truthful about her injuries and pain, despite acknowledging that she was not truthful about the events on the day of the MRI. The deputy believed that claimant had exaggerated her symptoms, and assigned a 25% industrial disability rating. On appeal, the deputy to whom the claim was assigned indicated claimant had problems with "honesty and truthfulness" but affirmed the finding of causation and 25% award.
At the district court level, the judge concluded that Dr. Bansal had not been fully appraised of claimant's prior complaints of back pain. The judge also found that Dr. Bansal had not made a finding that claimant had aggravated an underlying condition, and that the deputy had reached this conclusion without medical support. The district court reversed.
On appeal, the court of appeals reversed the decision of the district court. Citing Cedar Rapids Comm. Sch. Dist. v. Pease, 807 N.W.2d 839, 844 (Iowa 2011), the court noted that medical causation was a question of fact vested in the discretion of the workers' compensation commission." The court noted that the weight to be given to an expert depends on the accuracy of the facts given to the expert, but that the decision of whether to accept or reject an expert's opinion was for the agency, not the appellate court. The court notes that Dr. Bansal was aware of prior back tenderness. The court concludes that as a fact finder, the deputy was within his rights to use lay testimony to bolster medical testimony. Based on this evidence, the agency's decision was found to be supported by substantial evidence.
This case represents a part of the continuing trend which shows deference to the agency on issues of fact, and particularly issues of medical causation. The Supreme Court decisions in Pease and in Mike Brooks v. House appears to have solidified the approach that factual findings on medical causation are virtually untouchable at the appellate level. This holds true regardless of whether the finding is in favor of or against causation in a particular case.
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