Court of Appeals Reverses District Court, Upholds Commissioner's Death Benefits award

In Des Moines Public Schools v. Hildreth, No. 20-0742 (Iowa App. June 16, 2021), the Court of Appeals addressed a case where the commissioner, facing contradicting medical evidence, concluded that claimant had met his burden of demonstrating that his stroke had arisen from a head injury that he had sustained at work.  The district court reversed the findings of the commissioner and the Court of Appeals, in turn, reversed the decision of the district court, reinstating the commissioner's decision.  

Mr. Hildreth suffered a concussion at work in 2011, following a blow to the head.  He suffered severe problems following the injury and also suffered from neck and back problems.  Claimant retired and continued to experience symptoms.  In 2013, he suffered a stroke, which caused death as a result of an acute basilar artery infarction.  Claimant's spouse sought death benefits.  At hearing, claimant presented evidence from Dr. Francis Miller from Duke University.  Dr. Miller, citing medical research, noted that a TBI can increase the risk of stroke and also noted that claimant had no typical risk factors for a stroke.  He concluded that claimant's work injury was a significant contributing factor to the stroke.  Defendants relied on Dr. Michael Jacoby, who opined that the TBI was not a substantial contributing factor, noting that claimant had died from a blood clot blocking an artery, which was inconsistent with the TBI being a factor involved in the stroke.

The deputy found that although this was a close case, claimant had proven his claim that his death arose out of employment.  The commissioner affirmed.  The district court reversed.  On review, the Court of Appeals noted that medical causation was a question of fact vested in the discretion of the commissioner.  The court found that the commissioner's findings were supported by substantial evidence and reversed the decision of the district court.  The district court had found that the opinion offered by Dr. Miller was entirely conjectural.  The district court also found that it was immaterial that the deputy found these studies compelling.  The court found that the evidence from Dr. Miller was not substantial and therefore reversed the decision of the commissioner.  

The Court of Appeals found that it was error for the district court to exclude the testimony of Dr. Miller from evidence.  The court noted that in establishing medical causation "absolute certainty may never be achieved and is not required."  The lack of absolute certainty went to the weight of the expert's testimony, not to its admissibility.  The court noted that the district court had reweighed the evidence, which was inappropriate.  Ultimately, because the decision of the agency was supported by substantial evidence, the court was required to affirm the decision.  Although the decision does not discuss Daubert specifically, the upshot of the opinion of the court is that medical evidence does not need to meet that standard in the workers' compensation context.