Court of Appeals Affirms 65% Industrial Disability Award for Sequela Injury to Back. Penalty Benefits Denied.

In Presbyterian Homes and Services, Inc. v. Buchanan, No. 19-0010 (Iowa App. Jan. 9, 2020), the agency concluded that claimant had established industrial disability as a result of a sequela injury to the back suffered after a left foot injury.  Claimant was awarded 65% industrial disability as well as penalty benefits for withholding of healing period benefits without reasonable or probable cause or excuse.  The district court affirmed on medical causation and industrial disability but reversed the penalty award.

On appeal, the court noted that claimant had a long history of left foot problems,  right foot problems and back injuries.  She suffered an injury to her left ankle in 2014, but did not immediately report the problems to her employer. She sought treatment approximately 3 months later.  The initial medical reports did not establish a work-related injury.  Her pain increased in an August she reduced her shifts.  The employer offered to start workers' compensation but claimant declined.  the ankle pain continued and claimant was examined by the employer's physician, who prescribed limitations.  The physician did not specifically relate the problems to work at that time.

On November 29, while using a Hoyer lift, claimant's ankle pain increased.  A limitation was placed on her use of the lift.  The doctor indicated that this was work-related and at this point the employer indicated it would no longer treat the matter as a workers' compensation action.  Later testing revealed tendon tears and a five pound lifting limit was imposed.  Ultimately Dr. Albrecht performed surgery and related the injury to work.  The employer's evaluation (Mooney) found no work injury.  Claimant's IME (Bansal) found there was a work injury.  

Claimant also alleged a back injury as a result of the ankle injury and Dr. Bansal concluded that the back problems had occurred as a result of a change in her SI joint biomechanics because of the ankle injury.  

On the medical causation question, the court concluded that substantial evidence supported the claim.  The court noted that the conclusions of the agency had taken into account the original findings of no work related injury and concluded that the findings of the agency were not so impossible or absurd or self-contradictory that they should be deemed a nullity.  Similarly, the finding of a back injury was supported by substantial evidence.  With respect to the industrial award, the court again found substantial evidence to support the award and also concluded that the determination was not irrational, illogical or wholly unjustifiable. 

With respect to penalty the court concluded that the commissioner's determination of penalty was not supported by substantial evidence and affirmed the district court's denial of the penalty.  The district court had concluded that although the basis of the denial and the fact that the denial stemmed from an investigation must be conveyed to claimant, "the language of the statute does not require that the 'results of the investigation' be conveyed" to claimant.  The court concluded that although a reason must be given for the denial, the employer does not need to provide the results of the investigation to the claimant, based on 86.13(4)(b)(3).  Additionally, because Dr. Mooney had concluded that the injury was not work-related, the employer had a reasonable basis for denying the claim.  Penalty benefits were denied.