Court of Appeals Affirms Commissioner on Case Involving Intervening Cause, Reverses District Court on Medical Bill Issue
Carl A. Nelson & Co. v. Sloan, No. 15-0323 (Iowa App. Nov. 25, 2015), involves issues concerning causation and intervening cause as well as the payment of medical bills. The district court upheld the commissioner's decision concerning causation, but did not allow payment of medical bills directly to claimant.
Claimant suffered an injury to his back on August 15, 2011 and was returned to full duty work on August 24. On October 30, 2011, claimant and a friend were moving go-kart frames into a trailer. Claimant had a sudden onset of pain and numbness in the back and legs while doing this. He subsequently had surgery and was found to be at MMI on January 14, 2013.
At the arbitration level, the deputy concluded that the go-kart incident was an intervening and superseding cause for claimant's back problems and denied benefits. On appeal, the commissioner reversed, finding that the greater weight of the evidence supported the finding that claimant's work injury was a proximate and natural cause of the disability he suffered at the time of the hearing. The commissioner stated that chain of causation is broken only when claimant's conduct amounts to an intentional violation of an express or implied prohibition and medically supersedes the claimant's original condition. The commissioner concluded that claimant was simply engaged in a normal activity of living and that claimant's conduct was not contrary to any duty he owed his employer.
The commissioner also awarded the costs for medical care, with the bulk of these costs to be paid to the medical provider, but costs paid by claimant's private health insurance reimbursed directly to claimant. In support, claimant cited to Midwest Ambulance Service v. Ruud, 754 N.W.2d 860, 867-868 (Iowa 2008).
On appeal, the court concludes that substantial evidence supported the claim that claimant's injuries were related to his original work injury. Dr. Bussey had opined that claimant continued to suffer from back pain and radiculopathy even after he was returned to full duty work. The commissioner noted that claimant returned to full duty work not because his condition had abated but because he couldn't afford to be off work. Giving deference to the commissioner's fact finding, the court concludes that substantial evidence supported the decision.
With respect to the intervening cause question, the court noted that the commissioner's conclusion was taken from Larson's treatise on workers' compensation. The court noted that the basic rule is that a subsequent injury, whether a new injury or aggravation, "is compensable if it is the direct and natural result of a compensable primary injury." Citing Larson's and Oldham v. Scofield & Welch, 266 N.W.480, 482 (Iowa 1936) ("employer is liable for all consequences that naturally and proximately flow from the accident"). The court noted that the commissioner's conclusion that claimant's back had been rendered more vulnerable by the initial injury was supported by substantial evidence. The activities in which claimant was engaged while off duty were no more strenuous than those in which he engaged at work. The court concluded that the commissioner's interpretation was not illogical, irrational or wholly unjustifiable.
On the medical expense issue, the Court of Appeals, citing Ruud, reversed the decision of the district court, noting that an employee who pays group health premiums has in effect paid for the medical expenses covered by the group plan and the claimant is therefore entitled to be paid directly for past medical expenses. The court found Ruud "definitive" and reinstated the decision of the agency. The court reversed the commissioner to the extent that he used the phrase "bills which have been paid" rather than the phrase "past medical expenses paid," which had been used in Ruud.
The Sloan case is a potentially important case in all situations involving intervening causes for injury. The Court of Appeals concludes that Larson's analytical approach to this issue is sound and adopts the "direct and natural consequences" rule from Larson's. Although Oldham had long ago adopted similar verbiage, this is the first recent appellate court decision adopting that language. Because of the potential significance of the case, it would not be surprising if further review is sought.
Claimant suffered an injury to his back on August 15, 2011 and was returned to full duty work on August 24. On October 30, 2011, claimant and a friend were moving go-kart frames into a trailer. Claimant had a sudden onset of pain and numbness in the back and legs while doing this. He subsequently had surgery and was found to be at MMI on January 14, 2013.
At the arbitration level, the deputy concluded that the go-kart incident was an intervening and superseding cause for claimant's back problems and denied benefits. On appeal, the commissioner reversed, finding that the greater weight of the evidence supported the finding that claimant's work injury was a proximate and natural cause of the disability he suffered at the time of the hearing. The commissioner stated that chain of causation is broken only when claimant's conduct amounts to an intentional violation of an express or implied prohibition and medically supersedes the claimant's original condition. The commissioner concluded that claimant was simply engaged in a normal activity of living and that claimant's conduct was not contrary to any duty he owed his employer.
The commissioner also awarded the costs for medical care, with the bulk of these costs to be paid to the medical provider, but costs paid by claimant's private health insurance reimbursed directly to claimant. In support, claimant cited to Midwest Ambulance Service v. Ruud, 754 N.W.2d 860, 867-868 (Iowa 2008).
On appeal, the court concludes that substantial evidence supported the claim that claimant's injuries were related to his original work injury. Dr. Bussey had opined that claimant continued to suffer from back pain and radiculopathy even after he was returned to full duty work. The commissioner noted that claimant returned to full duty work not because his condition had abated but because he couldn't afford to be off work. Giving deference to the commissioner's fact finding, the court concludes that substantial evidence supported the decision.
With respect to the intervening cause question, the court noted that the commissioner's conclusion was taken from Larson's treatise on workers' compensation. The court noted that the basic rule is that a subsequent injury, whether a new injury or aggravation, "is compensable if it is the direct and natural result of a compensable primary injury." Citing Larson's and Oldham v. Scofield & Welch, 266 N.W.480, 482 (Iowa 1936) ("employer is liable for all consequences that naturally and proximately flow from the accident"). The court noted that the commissioner's conclusion that claimant's back had been rendered more vulnerable by the initial injury was supported by substantial evidence. The activities in which claimant was engaged while off duty were no more strenuous than those in which he engaged at work. The court concluded that the commissioner's interpretation was not illogical, irrational or wholly unjustifiable.
On the medical expense issue, the Court of Appeals, citing Ruud, reversed the decision of the district court, noting that an employee who pays group health premiums has in effect paid for the medical expenses covered by the group plan and the claimant is therefore entitled to be paid directly for past medical expenses. The court found Ruud "definitive" and reinstated the decision of the agency. The court reversed the commissioner to the extent that he used the phrase "bills which have been paid" rather than the phrase "past medical expenses paid," which had been used in Ruud.
The Sloan case is a potentially important case in all situations involving intervening causes for injury. The Court of Appeals concludes that Larson's analytical approach to this issue is sound and adopts the "direct and natural consequences" rule from Larson's. Although Oldham had long ago adopted similar verbiage, this is the first recent appellate court decision adopting that language. Because of the potential significance of the case, it would not be surprising if further review is sought.
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