Iowa Court of Appeals Determines that Workers’ Compensation Commissioner has the Ability to Determine Medical Causation and Relation of Injury Even in the Absence of Medical Evidence On the Issue

by | Aug 7, 2013

Recently, in Martinez Construction v. Ceballos, 2013 WL 2646833 (Ct. App. IA.), Court of Appeals of Iowa affirmed a decision of the Iowa Workers’ Compensation Commissioner determining that a claimant had incurred work-related injuries. What is peculiar about this case is how causation of the claimant’s injury was determined by the Commission. Claimant was a roofer for the employer when he fell off a roof hitting his face, right shoulder, and twisting his left knee. Claimant lost consciousness and was transported to a hospital. At the hospital, the records demonstrated four broken ribs and a perforated lung.

Claimant subsequently saw a physician who determined that the Claimant had a dislocated shoulder and fluid on his left knee. However, the physician did not opine that those conditions were work-related. No medical evidence was presented at hearing specifically opining that the Claimant’s shoulder and knee injuries arose out of his work-related fall. Noting that “although a formal medical opinion is lacking, Claimant’s testimony as to his ongoing symptoms and the x-rays lead to the conclusion that Claimant’s current right shoulder and left knee conditions and any impairment or disability there from are causally related to his work injury.” Essentially, the Deputy concluded that based on the circumstantial evidence and testimony of the witnesses, Claimant incurred a shoulder and knee injury, despite any medical opinions linking those to his fall.

The matter was appealed both to the Commissioner and the civil District Court. The District Court agreed and concluded that the case “did not present a situation where Claimant’s right shoulder and left knee pain came out of nowhere.” Ultimately, the matter was appealed to the Court of Appeals of Iowa. The Court of Appeals acknowledged that the issue of whether an injury has a direct causal connection with the Claimant’s employment is “essentially within the domain of expert testimony.” However, the Court of Appeals also noted that expert opinion testimony, even if uncontroverted, could be accepted or rejected by the reviewing Deputy.

While acknowledging the case law “ordinarily” requires expert testimony to establish causation, the Court of Appeals reasoned that there is nothing in the law that states expert medical opinions are the sole basis for which medical causation may be made. Given that the law allows the Commission to wholly reject uncontroverted expert medical opinion testimony, the Court of Appeals found that the Commissioner could find non-medical evidence sufficient to support a causation finding linking non-apparent injuries to a work accident. Accordingly, the Court of Appeals determined that expert medical evidence is not required to establish causation although it is “typically necessary.”

Claimants in Iowa workers’ compensation matters bear the burden of proof to establish causation of their injuries. In the past, it was common place to assume that to do so, the claimant must obtain a medical opinion demonstrating work relation of the injuries. In light of the Court of Appeals’ decision in Ceballos, employers and insurers may be better served to seek medical opinions on their own to address issues of causation as opposed to waiting for the Claimant to first meet his or her burden of proof. For any questions related to this case and/or retention of expert medical witnesses for purposes of evaluation of workers’ compensation claims, please contact attorney Paul Barta at (402) 475-1075 or