Iowa Claimant Allowed Alternate Treatment in Spite of Employer’s IME Request
In a proverbial “battle of the statutes,” an Iowa appellate court held that, under the facts of the case, a workers’ compensation decision granting a claimant’s application for alternate medical care was appropriate in spite of the fact that the claimant had refused to attend an independent medical examination to determine whether the requested treatment related to a compensable injury [Harris Steel Group, Inc. v. Botkin, 2020 Iowa App. LEXIS 40 (Jan. 9, 2020)].
Background
Claimant suffered a right shoulder injury in June 2015 and was authorized to receive medical treatment from Dr. Tuvi Mendel, who performed surgery on claimant’s shoulder in November of that year. Claimant sought to schedule an appointment with Dr. Mandel in late 2017 but, because more than two years had passed since his injury, claimant was told to get the employer’s authorization. The employer scheduled claimant for an independent medical examination to take place in December 2017, but claimant refused to attend. In turn, the employer failed to respond to claimant’s written requests to authorize additional treatment with Dr. Mendel.
In April 2018, claimant submitted a claim for alternate medical care to the workers’ compensation commissioner. The agency found that Dr. Mendel was the only medical provider authorized to treat claimant and that the employer, therefore, was not allowed to interfere with Dr. Mendel’s treatment practices. Further, the agency found that claimant’s request for continued treatment with Dr. Mendel was reasonable and ordered the employer to pay for the additional treatment. The employer’s request for rehearing was denied and the district court affirmed.
Parties’ Contentions on Appeal
The Court initially acknowledged the employer’s contention that under Iowa Code § 85.39(1), if an injured employee refuses to attend an independent medical examination, compensation is suspended for the period of the refusal. Essentially, the employer argued that claimant had forfeited his right to medical care benefits until he attended the independent medical examination. The Court further noted that claimant contended the agency decision was correct because whether alternate medical care is reasonable is a separate issue from claimant’s refusal to attend the IME. Claimant further contended that because the only issue before the agency was claimant’s request for alternate care, and since he had shown it was reasonably suited to treat his injury, the agency must be affirmed.
The employer also argued that because a petition for alternate medical care was an expedited proceeding, the agency must settle an employer’s request for an IME at the same time as a petition for alternate medical care. Otherwise, any employers contesting alternate medical care would be unable to obtain an IME before the alternate-care decision issues. The employer indicated it was concerned that by not requiring the agency to consider the issues together, the effect was to prevent all employers who contested compensability from challenging a request for alternate medical care.
Appellate Court’s Decision
Initially, the Court indicated the two provisions of the state’s Workers’ Compensation Act were separate and operated with different objectives. Further, it found the employer’s argument unpersuasive. An alternate care claim was meant only for those situations in which compensability was uncontested. Compensability was not at issue here, said the Court. The employer had admitted claimant sustained a work injury in June 2015.
Although the employer questioned whether the care claimant sought related to his work injury, it admitted at the hearing that it authorized Dr. Mendel to treat the work injury and never conveyed that it was no longer authorizing Dr. Mendel. As a result, the employer had conceded that claimant was entitled to continue care with Dr. Mendel regardless of any proceeding as long as Dr. Mendel indicated it was related to the work injury. The Court concluded that under the facts before the Court, the agency properly granted claimant’s petition for alternate care.