Court of Appeals Finds that Claimant Failed to Preserve Issue of Beneficial Care, Reverses Award of Medical Benefits
In Lynch Livestock v. Bursell, No. 17-1629 (Iowa App. March 6, 2019), claimant was awarded medical expenses for unauthorized care premised on a beneficial care theory. In an earlier appeal, the court of appeals had remanded the claim to the agency, finding that if alternate care had not been correctly ordered based on the correct legal standard, claimant must prove the treatment was reasonable and beneficial.
On remand, the agency denied the petition for alternate medical care because claimant had not exhausted conservative care before obtaining surgery. Following the alternate care hearing, an arbitration hearing was held and claimant was awarded medical care, finding that the deauthorization of certain previously authorized physicians was inappropriate and that claimant's care with these doctors was reasonable and beneficial.
At the district court level, the employer argued that claimant had not met the Bell Brothers standard. the district court agreed, holding that defendants were not liable for medical care. The district court then concluded that claimant should not be responsible for medical expense because authorized medical care had been authorized by the commissioner and ordered defendants to pay for medical expenses. According to the court of appeals, this created an inconsistency. Defendants appealed. Claimant did not cross-appeal.
The court of appeals found that because the district court had concluded that there was not substantial evidence to support the conclusion that care was reasonable and beneficial and claimant had not appealed this determination, it was inappropriate for the court of appeals to consider this issue. The court also concluded that there was no other reason to impose costs on the defendants. The court notes that the law is to be liberally interpreted in favor of claimants, but then indicates that this does not give the court license to ignore the plain language of the statute.
The court rejected claimant's argument that because treatment was authorized for a period of time, defendants should have provided care. The court limited the finding in Ramirez-Trujillo to something similar to the reasonable and beneficial care standard of Bell Brothers. The court finds this decision is supported by Brewer-Strong. Ultimately, the court concluded that because claimant failed to establish that his care was reasonable and beneficial, defendants were not liable for medical care.
Because of the unique facts of the case, there is a chance that Bursell will not have a major impact. Unfortunately, the case appears to undercut the longstanding agency rule that once care is allowed, the recommendations of the authorized treater are to be followed. The court does not specifically address this issue, but that is a possible implication of the decision.
On remand, the agency denied the petition for alternate medical care because claimant had not exhausted conservative care before obtaining surgery. Following the alternate care hearing, an arbitration hearing was held and claimant was awarded medical care, finding that the deauthorization of certain previously authorized physicians was inappropriate and that claimant's care with these doctors was reasonable and beneficial.
At the district court level, the employer argued that claimant had not met the Bell Brothers standard. the district court agreed, holding that defendants were not liable for medical care. The district court then concluded that claimant should not be responsible for medical expense because authorized medical care had been authorized by the commissioner and ordered defendants to pay for medical expenses. According to the court of appeals, this created an inconsistency. Defendants appealed. Claimant did not cross-appeal.
The court of appeals found that because the district court had concluded that there was not substantial evidence to support the conclusion that care was reasonable and beneficial and claimant had not appealed this determination, it was inappropriate for the court of appeals to consider this issue. The court also concluded that there was no other reason to impose costs on the defendants. The court notes that the law is to be liberally interpreted in favor of claimants, but then indicates that this does not give the court license to ignore the plain language of the statute.
The court rejected claimant's argument that because treatment was authorized for a period of time, defendants should have provided care. The court limited the finding in Ramirez-Trujillo to something similar to the reasonable and beneficial care standard of Bell Brothers. The court finds this decision is supported by Brewer-Strong. Ultimately, the court concluded that because claimant failed to establish that his care was reasonable and beneficial, defendants were not liable for medical care.
Because of the unique facts of the case, there is a chance that Bursell will not have a major impact. Unfortunately, the case appears to undercut the longstanding agency rule that once care is allowed, the recommendations of the authorized treater are to be followed. The court does not specifically address this issue, but that is a possible implication of the decision.
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