In an issue of first impression, the Iowa Supreme Court agreed with the Commissioner and District Court that an employer who had initially denied liability for a claim, but then subsequently agreed to accept the claim, was able to regain control over directing medical care, and consequently that healing period benefits claimed from unauthorized care were not the employer’s responsibility. (Kelly Brewer-Strong vs. HNI Corporation, No. 16-1364, filed June 8, 2018)
The claimant alleged bilateral carpal tunnel injuries in her original notice and petition. The employer, in its initial answer to the petition, denied liability for the injuries. Employer then solicited a physician’s written opinion, who stated “I do believe carpal tunnel can be/is related to her work activities.” Employer still did not view this as definitive on the causation question and therefore denied claimant’s further request for medical care based upon that doctor’s statement.
Claimant then filed a petition for alternate care, seeking a ruling on further medical care and claiming an “abandonment of care”. Employer answered this petition still denying liability. The alternate care petition was therefore dismissed on procedural grounds because of the contested liability. However employer subsequently obtained an examination and this time a different physician opined that the injuries were in fact work related. Therefore, the employer amended its original answer to now admit liability, and authorized care with employer’s chosen medical provider.
However, claimant declined the offered treatment, and instead sought treatment from a different unauthorized physician, who ultimately performed surgeries. Employer on multiple occasions communicated to claimant that it was only authorizing care with its examining doctor, and attempted to set up follow up care with that doctor, but claimant refused. Employer also cautioned claimant that treatment with any other doctor was not authorized and that the expenses would not be covered. In addition to the unauthorized surgeries and care, employer refused to pay healing period benefits for the time claimant was recovering from the unauthorized surgeries.
In upholding the availability of employer’s authorization defense, even after its initial denial of liability, the Court explained that to hold otherwise would be contrary to the purposes of the Act, and that an employer should be encouraged to continue to investigate and monitor claims, and to have the opportunity to change its position to accept liability.
In affirming the denial of the unauthorized medical expenses and healing period benefits, the Court declined claimant’s invitation to lower the standard for a claimant to prove employer liability for unauthorized medical care and healing period benefits. The standard, established in Bell Bros. Heating & Air Conditioning v. Gwinn, 779 N.W.2d 193 (Iowa 2010) is that a claimant must show such care provided “a more favorable medical outcome than would likely have been achieved by the care authorized by the employer.“ Claimant’s surgeon had testified in deposition that he was unable to say that the care he provided would be any different than that of the authorized physician, or that his treatment provided a more favorable outcome. Claimant herself testified that she was unsure if she was satisfied with the results of the surgeries by the unauthorized physician.
This case illustrates the importance of the employer and carrier to continue to monitor and investigate liability for initially denied claims. Further, once liability is accepted, the employer should clearly communicate to the claimant what care is authorized, and that unauthorized care will not be covered.
Thanks to I&F Partner Terry Donohue for thus summary of this case. Terry handles Iowa claims for the firm and works out of the Chicago and Des Moines offices of Inman and Fitzgibbons. Please feel free contact Terry with any Iowa workers’ compensation questions.