Court of Appeals Affirms Denial of Alternate Medical Care

 Denemark v. Archer Daniels Midland Company, No. 21-1851 (Iowa App. Sept. 21, 2022)

Claimant injured his arm and originally had injections for the pain that developed in the wake of the injury.  This did not alleviate the pain and an arthroscopic surgery and debridement of the TFCC was recommended by Dr. Kuo.  On September 18, ADM indicated that it would investigate causation before authorizing surgery.  The surgery was authorized on October 21 and care was transferred to UIHC at the request of Dr. Kuo's office.  Surgery was authorized for December 29. This surgery was rescheduled for January 12.  A Covid screening was required prior to surgery, but ADM failed to schedule transportation to the screening.  The surgery was rescheduled and ultimately took place on January 29.

In the midst of these activities, claimant filed a request for alternate medical care alleging that defendant sent its safety manager to claimant's medical appointments, improperly challenged causation and transferring care to UIHC.  The deputy denied the alternate medical care application, finding that claimant was seeking to direct his own care and finding there was no evidence that the employer had abandoned care or provided inferior care. After the cancellation of the January 12 surgery, another alternate medical care application was filed.  This was also denied, with the deputy finding that ADM had followed treatment recommendations and had rescheduled the surgery within 17 days of the failure to provide transportation.  The deputy found ADM had failed to prove ongoing interference with care, abandonment of care or provision of inferior care.

Claimant filed for judicial review and the district court denied relief.  On appeal to the COA, claimant alleged an erroneous interpretation of law, lack of substantial evidence, inconsistency with past agency practice and an unreasonable, arbitrary and capricious decision on the part of the agency, citing 17A.19(10)(c), (f), (h) and (n).  

The Court addressed the abuse of discretion argument and found that the statute, 85.27(4), which provides that the "commissioner may, upon application and reasonable proofs of the necessity therefor, allow and order other care."  The Court found this language to be discretionary.  The Court found that the language of the statute allowed the agency to provide alternate care upon reasonable proof of the necessity therefore, but did not mandate the provision of such care.  With respect to the issue of delay in providing care, which claimant alleged was an inexcusable delay under the statute, the Court noted that the delay was only about 30 days and found that agency was within its discretion in denying alternate medical care.  The Court also agreed that claimant failed to meet his burden of demonstrating that care was ineffective, inferior, or less extensive than the care he sought.  The Court also concluded that substantial evidence supported the factual findings leading to the denial of care.  Finally, the Court found that the agency had properly followed past precedents.  The denial of alternate medical care was affirmed.