The Court of Appeals of Iowa Provides Clarification When It Has Jurisdiction to Consider a Claimant’s Petition for Alternate Medical Care and When it is Compelled to Mandatorily Dismiss the Same

by | Nov 7, 2013

Recently, in Cooksey v. Cargill, Inc., 2013 WL 5508539 (Iowa.App.2013), the Court of Appeals of Iowa clarified when it was appropriate for the Iowa Workers’ Compensation Commissioner to consider a claimant’s Petition for Alternate Medical Care. Under I.C.A. §85.27, the employer has the right to direct medical care for accepted workers’ compensation injuries filed in Iowa. However, I.C.A. §876-4.48 does provide an injured worker in an accepted claim the right to petition the Workers’ Compensation Commissioner for alternate medical care. Practically speaking, this provision typically arises when the claimant is dissatisfied with the employer-directed care or alleges that the employer has “abandoned” direction of care.

In Cooksey, the Claimant allegedly suffered an injury in 2008 while working for the employer. The employer recommended that the Claimant be treated by a specialist. Subsequent to the alleged injury, the employer acknowledged on the record that it did not dispute liability for the injury at the time. This is a key issue, as alternate medical care is only provided pursuant to Iowa statute in situations where the employer is not disputing liability. Therefore, in denied claims, as the employer is not directing care, the claimant has no right to request alternate medical care.

After approximately three years of medical care, a physician indicated that Claimant needed further injury-related care. However, at least two specialists indicated that Claimant’s ongoing symptoms were the result of a pre-existing medical condition and not related to the original work accident. At that point, the employer refused to authorize any further medical care.

The Claimant subsequently filed a Petition for Alternate Medical Care. Although the employer had previously acknowledged in court pleadings that there was a work-related accident resulting in some injury, the employer indicated that it was disputing liability for the medical condition for which care was sought. Accordingly, as liability was then disputed, the reviewing Deputy dismissed the Claimant’s Petition for Alternate Medical Care, but also indicated to the employer that it would be barred from asserting a lack of authorization defense in the future if the Claimant sought recovery of costs in obtaining medical care.

At that point, the Claimant filed an appeal alleging that the Commission should not have allowed the employer to deny liability as the employer was judicially estopped from doing so after admitting liability in prior hearings. Essentially, the Claimant argued that as the employer acknowledged in prior pleadings that an accident/injury occurred, the employer could not dispute liability in the hearing for Alternate Medical Care, but rather could only dispute the extent of needed care.

Addressing the issue of alleged judicial estoppel, the Court of Appeals of Iowa noted that judicial estoppel prohibits a party who has unequivocally previously asserted a position in one proceeding from asserting an inconsistent position in a subsequent proceeding. Distinguishing the case from prior appellate decisions on the issue, the Court noted that as the employer and Claimant previouslyagreed upon the care and no prior judicial determination or pleading was made regarding the employer’s liability or acceptance thereof for the injury, judicial estoppel would not apply. The Court noted that while the employer had previously admitted liability at a prior hearing, the Court had not judicially accepted that admission, as the two parties had come to an agreement independent of the underlying admission and moved to dismiss the application before the reviewing Deputy Commissioner made a determination.

For any questions regarding direction of care under Iowa Workers’ Compensation Law, please contact Iowa workers’ compensation attorneys Tim Clarke, Caroline Westerhold, or Paul Barta