Court of Appeals Rejects Penalty Claims, Affirms Permanent Disability and Alternate Care Findings

Clark v. Winnebago Industries, No. 20-0673 (Iowa App. April 14, 2021), involved an injury to claimant's right hand, as well a claimant's allegations of penalty benefits and request for alternate medical care.   Following hearing, claimant was awarded a 10% impairment of the right upper extremity and alternate care at the Mayo Clinic.  Penalty benefits were denied.  The commissioner affirmed the decisions of the deputy.

On the penalty questions, claimant had alleged penalty based on questions related to her marital status and whether she had suffered a permanent injury.  The penalty claims were denied on the basis that the issues were "fairly debatable."  Claimant testified at hearing she was married.  She could not find her marriage certificate and offered no tax returns confirming her martial status.  Winnebago presented a W4 showing that claimant was single.  Although the deputy ultimately found claimant was married, penalty benefits were denied because the question was fairly debatable and the court affirmed on this issue.  With respect to non-payment of permanency benefits, claimant argued that it was clear, after an initial denial of benefits, that she was entitled to permanency.  Defendants argued that Dr. Gibbons' original opinion that there was no permanency insulated them from payment of penalty and further argued that it was not until later in the case (with claimant's IME) that permanency was established.  The court found that substantial evidence supported the denial of permanency.

On a final penalty issue, the delayed payment of healing period, the court finds that this issue was not directly addressed by the commissioner despite being presented by claimant.  Because the issue was raised but not decided, the court remands for further proceedings on the issue of penalty for late payment of healing period benefits.  

On the issue of permanency, the court affirms the 10% permanency opinion based on the report of Dr. Bansal, finding that the decision of the agency on this matter was supported by substantial evidence.  Dr. Bansal was the only doctor to specifically opine on permanency and Dr. Kimelman noted only that it was "difficult to determine" permanency.  The court found these facts supported the decision of the agency.  The court also affirms the commissioner's findings on rate, finding claimant was married at the time of the injury.  

Finally, on the issue of alternate medical care, the court concluded that the commissioner's determination was only to be overturned if the decision of the agency was irrational, illogical or wholly unjustifiable. Here, Dr. Bansal had recommended Mayo Clinic for claimant's TFCC tear and the court found this finding was reasonable and affirmed the decision awarding medical care.