Iowa Workers’ Compensation Symposium Explores IME Reimbursement and Causation Challenges (Part 3 of 4)

Pro Rata Reimbursement, Hearing Report Requirements, and Causation Issues in Workers' Compensation Cases

Des Moines, IA - The 61st Annual Iowa Workers' Compensation Symposium continued its informative sessions on agency case law updates. During this session, legal professionals Jordan Gehlhaar from Peddicord Wharton and Bryant Engbers from Spaulding & Shaull delved into the complex and evolving issues surrounding Independent Medical Examination (IME) reimbursement and the question of causation. The event, held at the Downtown Des Moines Marriott, attracted a diverse audience of legal practitioners, industry experts, and policymakers eager to gain insights into the latest developments in Iowa's workers' compensation system.

IME Reimbursement Challenges

The session continued with a comprehensive discussion on IME reimbursement, addressing various aspects of the process and its implications for claimants and defendants. One of the significant cases examined was Calderon v. Smithfield Foods, Inc., which shed light on whether IME reimbursement could be pro-rated based on the compensability of the conditions evaluated. Additionally, the case explored whether a second claimant's IME was reimbursable under Iowa Code § 85.39.

In Calderon, the Commissioner ruled that the defendant was liable for the total amount of the first IME as Iowa Code section 85.39 does not address pro rata reimbursement. The claimant successfully sought reimbursement for both IMEs conducted by Dr. Bansal, as each report contained ratings for both the accepted shoulder injury and the alleged cervical injury. However, the claimant was not awarded the cost of the second IME, as the statute only allows for the recovery of one independent medical examination.

Another notable case discussed during the session was Bradley v. Quick Flights, which focused on the issue of IME fee reimbursement. In this case, the claimant failed to meet the burden of proof to establish causation between the work injury and his disc herniation. The Commissioner ruled that the claimant was not entitled to IME reimbursement since the injury was deemed non-compensable under Iowa Code section 85.39(2).

The session also explored Fisher v. Arconic, Inc., which examined whether failing to acknowledge the request for an 85.39 IME reimbursement on a Hearing Report precluded the claimant from recovering the cost. The Commissioner determined that while the claimant was precluded from recovering under Iowa Code section 85.39, the cost of the IME report could still be recovered under Iowa Administrative Code 4.33.

Wenzel v. Archer Daniels Midland Co. shed light on the apportionment of IME costs between the defendant-employer and the Second Injury Fund. The case involved a claimant with multiple injuries and brought a claim against the Second Injury Fund. The Commissioner reduced the IME billing by 5% as only a tiny portion of the report addressed the claim related to the Second Injury Fund.

Kelly V. East Side Jersey Dairy, Inc. provided valuable insights into the factors permitting reimbursement of an 85.39 IME. The case involved a claimant who requested a second opinion and was directed to a specific physician by the adjuster. The Commissioner ruled that the claimant's evaluation did not qualify as an independent evaluation under 85.39, but the defendant was still liable for the cost of the IME.

Causation Challenges

The session also addressed significant challenges related to the issue of causation in workers' compensation cases. Myers v. Lazer Spot, Inc. focused on a case where the claimant sustained a skull fracture and intracranial injuries. Despite three medical opinions, none were conclusive in determining the mechanism of the injury. The Deputy ruled that the claimant did not meet the burden of proof to establish that the injury arose out of and in the course of employment, even under the actual risk doctrine.

Roberts v. Linn County, Iowa, examined a case involving a claimant diagnosed with PTSD following a distressing work-related incident. The Deputy found the mental injury compensable and awarded permanent total disability under the odd-lot doctrine. This case emphasized the importance of recognizing and compensating workers for mental injuries resulting from traumatic workplace experiences.

The agency case law update session at the 61st Annual Iowa Workers' Compensation Symposium gave attendees valuable insights into IME reimbursement and causation challenges in workers' compensation cases. The discussions surrounding pro rata reimbursement, hearing report requirements, and the complexities of establishing causation shed light on the evolving legal landscape in Iowa's workers' compensation system.

Legal professionals, stakeholders, and policymakers left the symposium with new knowledge and a deeper understanding of the intricacies involved in IME reimbursement and causation analysis. By staying informed about these critical aspects of workers' compensation law, attendees are better equipped to navigate the system effectively and ensure fair outcomes for injured workers and employers.

As the symposium continues, participants eagerly anticipate further discussions and insights that will shape the future of workers' compensation in Iowa, promoting fairness, efficiency, and justice for all parties involved.

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