Opinion
No. 4-291 / 03-0414.
September 9, 2004.
Appeal from the Iowa District Court for Kossuth County, Don E. Courtney, Judge.
Appellant challenges the judicial review decision of the district court upholding the arbitration decision of the workers' compensation commissioner. AFFIRMED IN PART, REVERSED IN PART, AND REMANDED
Mark Soldat of Max Schott Associates, P.C., Des Moines, for appellant.
Joseph Barron of Peddicord, Wharton, Spencer Hook, L.L.P., Des Moines, for appellee.
Considered by Hecht, P.J., and Vaitheswaran, J., and Brown, S.J.
Senior Judge assigned by order pursuant to Iowa Code section 602.9206 (2003).
In this appeal, the appellant, Steven John Goodman, challenges the judicial review decision of the district court upholding the arbitration decision of the workers' compensation commissioner. We affirm in part, but reverse the district court's and commissioner's decision regarding the penalty benefits assessed for 1999, and remand for reconsideration of that issue.
I. Background Facts Procedures.
Steven Goodman lacerated the palm of his right hand on February 27, 1999, while employed by Snap-On Tools Corporation (Snap-On). The cut was stitched and apparently repaired. On March 2, 1999, he was treated for infection in the hand The infection cleared up; however, Goodman continued to complain of pain in his arm up to his shoulder. From that time until the hearing in this case on February 8, 2002, Goodman saw at least thirteen physicians, some authorized by Snap-On and some not. The ultimate diagnoses were carpal and cubital tunnel syndrome, lateral epicondylitis, adhesive capsulitis of the shoulder, cervical spondylosis, myofascial pain syndrome, and reflex sympathetic dystrophy. There are a number of medical opinions in the record in this case, expressing conflicting opinions regarding causation. The commissioner, and then the district court, concluded the carpal and cubital tunnel syndrome and lateral epicondylitis were caused by the injury to Goodman's hand, but that the other conditions were not. Consequently, Snap-On was found liable for Goodman's medical and other expenses incurred on or before July 2, 2001, but not thereafter.
The parties agreed the February 27, 1999, injury was compensable and resulted in temporary disability during a period of recovery. They also agreed that if it was found the injury extended beyond the right hand, the issues of healing period termination and the extent of permanent disability were to be bifurcated.
The commissioner also imposed a penalty of $80.00 under Iowa Code section 86.13 (1999) for untimely payments of compensation due in March 1999, but denied other requested penalty assessments.
Following the denial, in pertinent part, by the commissioner of Goodman's request for rehearing, he petitioned the district court for judicial review. The court affirmed the decision of the commissioner with two exceptions not relevant here. Goodman now appeals, alleging error in (1) the failure to conclude the shoulder adhesive capsulitis and the chronic pain syndrome were caused by Goodman's work injury; (2) awarding only an $80.00 penalty for delay in paying healing period compensation due in March 1999; (3) failing to award a penalty for failing to pay healing period compensation for June through September 2000, and temporary partial disability for September 2000 through June 2001; and (4) failing to award payment for medical and related expenses incurred after July 2, 2001.
II. Scope and Standard of Review.
Workers' compensation decisions of the workers' compensation commissioner are subject to judicial review under the Iowa Administrative Procedure Act, Iowa Code chapter 17A (2001). Iowa Code § 86.26. Our appellate function is to apply the standards of the act "to the agency action to determine if our conclusions are the same reached by the district court." University of Iowa Hosp. v. Waters, 674 N.W.2d 92, 95 (Iowa 2004). The district court thoroughly reviewed the record and the decision of the commissioner and resolved the issues of which Goodman complains adversely to him.
Goodman's claims principally challenge the sufficiency of the evidence to sustain the decision of the workers' compensation commissioner. Thus, at the onset Goodman is faced with a basic principle of administrative law which is not favorable to his position. The resolution of factual disputes is essentially the province of the agency, and we do not interfere with those decisions except to determine if they are supported by substantial evidence. Office of Consumer Advocate v. Iowa State Commerce Comm'n, 419 N.W.2d 373, 377 (Iowa 1988) ("We emphasize our continuing commitment to the principles which prohibit judicial meddling in administrative judgment calls."); Iowa-Illinois Gas Elec. Co. v. Iowa State Commerce Comm'n, 412 N.W.2d 600, 604 (Iowa 1987) ("Under the administrative law scheme nearly all disputes are won or lost at the agency level. Our review of agency action under Iowa Code section 17A.20 is carefully confined to the correction of errors of law."); Mercy Health Ctr. v. State Health Facilities Council, 360 N.W.2d 808, 809 (Iowa 1985) ("This case turns on the cardinal rule of administrative law: judgment calls are the province of the administrative tribunal and not of the courts. There is obviously much to be said for the plan proposed by the petitioner but it must be sold to the administrative agency.").
Substantial evidence is defined in Iowa Code section 17A.19(10)(f)(1) (2001) to mean "the quantity and quality of evidence that would be deemed sufficient by a neutral, detached, and reasonable person, to establish the fact at issue when the consequences resulting from the establishment of that fact are understood to be serious and of great importance."
III. Causation of shoulder injury and pain syndrome.
In determining Goodman had not carried his burden of proof to establish a causal connection between his work injury and the resulting adhesive capsulitis and chronic pain syndrome, the commissioner, and the district court, comprehensively examined the conflicting medical testimony regarding causation. This issue is primarily one for expert opinion and the weight to be given that evidence is determined by the commissioner. IPB, Inc. v. Harpole, 621 N.W.2d 410, 420 (Iowa 2001). The commissioner noted there were credibility problems with Goodman's testimony and found the medical causation opinions which considered the history related by Goodman of total immobilization of his arm every day for over a month at the insistence of Snap-On employees to be flawed. See Grundmeyer v. Weyerhaeuser Co., 649 N.W.2d 744, 752 (Iowa 2002) (accuracy of the facts relied upon by the expert affects weight of opinion evidence). The commissioner also cited the extended lapse of time between the injury and the onset of the additional medical problems claimed to be causally connected.
Contrary to Goodman's argument, the commissioner fully detailed his findings and explained the rationale for them. We agree with the district court's concurrence in those findings and conclusions. In doing so, we are fully cognizant of the contrary evidence cited by Goodman, however, it is axiomatic "that evidence is not insubstantial merely because it would have supported contrary inferences." Wal-Mart Stores, Inc. v. Caselman, 657 N.W.2d 493, 499 (Iowa 2003).
IV. Adequacy of penalty for March 1999 payment delay.
The commissioner awarded a penalty of $80.00 under Iowa Code section 86.13 (1999) for delay in and underpayment of healing period benefits he found to be due on March 10 and March 17, 1999. The commissioner determined Snap-On was excused from including three days in its calculation of the amount due for the initial week following the injury because of uncertainty as to the extent of the injury. Goodman asserts the amount of underpayment was miscalculated and no excuse for the delay was shown.
We essentially agree with Goodman's calculation of the dates on which payments were due and that Snap-On should not have been permanently excused from paying part of the first week of healing period benefits. Goodman was injured on the job on Saturday, February 27, 1999. He missed part of that day's work due to the injury, but in accord with company policy, he was paid for the whole day. On Monday, March 1, 1999, Dr. Hjelle directed Goodman not to work because the laceration of his hand had become infected. Dr. Hjelle authorized Goodman's return to work effective March 9, 1999. On March 16, 1999, Snap-On paid Goodman $257.06 it claimed represented healing period compensation only for March 4, 1999 through March 8, 1999. This was the only payment made for healing period compensation in 1999.
The due date for the first week of healing period compensation is the eleventh day after the injury. The subsequent due dates fall on the day after the end of each compensation week thereafter, that is, the eighth day after the first day of each subsequent compensation week. Robbenolt v. Snap-On Tools Corp., 555 N.W.2d 229, 235 (Iowa 1996).
The commissioner found Goodman's weekly compensation rate was $371.80, that he was entitled to healing period compensation from March 1 through March 8 and that Snap-On offered no evidence why it did not pay compensation by its due date, March 10, 1999. He also held the first week consisted of only six days (March 1 through March 6, 1999). Further, he determined the first three days of that first week were excused because it was reasonable to anticipate the injury would not be serious and cause permanent injury. See Iowa Code § 85.32. Then the commissioner held the second week ran from March 7 through March 8 and had a March 17 due date. Consequently, he imposed a penalty only on three days he found due on March 10, and two days he found due on March 17, 1999.
"Weekly compensation benefits payable under Iowa Code chapters 85 and 85A are based upon a seven-day calendar week." Iowa Admin. Code r. 876-8.6 (2000). Thus, the commissioner's use of an initial six-day week is incorrect, and March 7 should have been included in the initial week. His calculation of the second due date is also incorrect, as it should fall on the eighth day after the first day of the second week, March 15, not March 17, 1999.
Goodman also challenges the commissioner's determination that the first three days of the first week should be excused. We agree with Goodman's argument that even if payment was initially excused under section 85.32, it later became apparent there was some permanent impairment, and those three days should have been paid at some point. See Squealer Feeds v. Pickering, 530 N.W.2d 678, 683 (Iowa 1995) (a denial supportable at the time it is made may later lack a reasonable basis in light of subsequent information). We believe the initial three days should have been considered in the commissioner's penalty determination, and subsequently by the district court.
We do not decide Goodman's claim that the court should not have excused the three days sua sponte in view of a claimed absence of any proof by Snap-On regarding that issue.
We therefore remand this issue to the commissioner to recalculate the amounts due and reconsider the penalty imposed for late and underpayment of Goodman's initial healing period benefits. V. Other penalty benefits.
The district court remanded the issue of benefits for March 9 through April 2, 1999 as that issue was not decided by the commissioner. That remand is not part of this appeal and is not affected by this ruling.
Goodman asserts penalties should have been imposed for Snap-On's failure to pay healing period compensation from June 28 to September 8, 2000, and for failing to pay temporary partial benefits from September 9, 2000, to June 8, 2001.
The commissioner denied penalty benefits for Snap-On's failure to pay weekly benefits due after October 18, 1999. The commissioner determined there was substantial medical evidence of the absence of permanent injury which would have justified Snap-On's decision to deny liability for further payments. When a claim is fairly debatable, penalty benefits are not appropriate. Gilbert v. USF Holland, Inc., 637 N.W.2d 194, 199 (Iowa 2001).
Goodman argues Snap-On's denial of liability was based on a medical opinion later discredited, even to some extent by the commissioner. However, that determination was not made until evidence was finally presented at the hearing. The commissioner rightfully based his decision regarding Snap-On's denial on the information available to it prior to the hearing. The fact a medical opinion is ultimately rejected does not mean it was not reasonable for the employer to rely on that opinion.
We have already recognized in some circumstances the employer must update its position in light of later developments, see Squealer Feeds, 530 N.W.2d at 683; however, in view of the passage of some fifteen months while Goodman continued to work, and that as of August 20, 2001 his three treating physicians had indicated his shoulder, neck and back problems were not work related, the commissioner's assessment that Snap-On's actions were reasonable is certainly supportable. Perhaps hindsight might produce a different conclusion, but we believe the record contains substantial evidence to support the commissioner's resolution of this issue.
VI. Expenses incurred after June 6, 2001.
The commissioner's decision, upheld by the district court, relieved Snap-On from any responsibility for provider or other expenses incurred after July 2, 2001. There is substantial evidence in this record that treatment received by Goodman after that date was for conditions found by the commissioner to not be causally connected to Goodman's work injury.
VII. Summary.
We conclude the district erred in upholding the commissioner's resolution of the initial penalty for underpayment of 1999 healing period benefits. We remand the case to the compensation commissioner to redetermine the appropriate penalty for 1999 healing period benefits. On all of the remaining issues we affirm the district court.
AFFIRMED IN PART, REVERSED IN PART, AND REMANDED.
Vaitheswaran, J., concurs; Hecht, P.J., concurs in part and dissents in part.
I join in the opinion expressed in division IV of the majority opinion. I respectfully dissent, however as to other issues. We are empowered to reverse agency action when it is "[t]he product of reasoning that is so illogical as to render it wholly irrational." Iowa Code § 17A.19(10)(i) (2001). I find wholly irrational the agency's reasoning underlying the finding that the upper extremity (carpal tunnel and cubital tunnel) conditions are work-related, but that the other conditions (adhesive capsulitis of the right shoulder and myofascial pain syndrome) are not.
Goodman's wound was sutured on February 27, 1999 by Dr. Richards. On March 2, 1999, Goodman again sought medical care, reported "pain and red streaks coming up his forearm and into his upper arm," and informed the doctor he had pain into his arm-pit. An antibiotic was prescribed by the attending physician, Dr. Hjelle. Goodman's medical records show he continued to have throbbing pain in his upper arm on March 3, 1999. He was then referred to Dr. Deffer who ordered a course of physical therapy and released Goodman to return to work with restrictions on March 11, 1999. On April 2, Dr. Deffer concluded Goodman had reached maximum medical improvement without permanent impairment.
When Goodman next sought medical treatment on August 26, 1999, he reported to Dr. Deffer pain in his forearm extending across his elbow and up into his shoulder, and sometimes into his neck. Nerve conduction studies performed on September 10, 1999 revealed right carpal tunnel syndrome. On October 18, 1999, Dr. Deffer opined Goodman's "current condition [was] not related to his employment activity at Snap-On Tools." Snap-On Tools denied liability for the claim.
Goodman was examined by Dr. Reagan on April 13, 2000 for chief complaints of "right shoulder and arm pain, and twitching occasionally which also goes up into the neck." Among Dr. Reagan's initial impressions were carpal tunnel syndrome, cubital tunnel syndrome, lateral epicondylitis, and chronic pain of unknown etiology. On June 28, 2000 Dr. Reagan performed carpal tunnel and cubital tunnel releases and expressed post-surgical diagnoses of carpal tunnel syndrome, cubital tunnel syndrome, subacromial bursitis, and degenerative arthritis in the acromioclavicular joint. Dr. Reagan referred Goodman to Dr. Schulte in November of 2000 for evaluation of the shoulder complaints. Dr. Schulte diagnosed a shoulder strain, injected the shoulder, and sent Goodman back to work with no restriction. On November 18, 2000, Dr. Reagan opined Goodman's surgically treated upper extremity conditions were work-related, but the shoulder and chronic pain conditions were not.
Thereafter, Goodman continued to complain of shoulder and torso pain, and was subsequently evaluated by several physicians who diagnosed work-related right shoulder and chronic pain conditions. Among them were Dr. Ban, who diagnosed chronic pain syndrome; Dr. Koenig, who diagnosed right shoulder adhesive capsulitis and chronic right upper extremity pain syndrome due to myofascial pain syndrome; and Dr. Hart, who diagnosed mild adhesive shoulder capsulitis and severe myofascial pain syndrome. The adhesive capsulitis condition was treated by Dr. Hart by surgical closed manipulation on January 22, 2002.
As noted above, the agency found Goodman's upper extremity conditions were work-related but his shoulder and chronic pain conditions were not causally connected. In its explanation of this causation dichotomy, the agency found Dr. Deffer's opinion on causation entitled to "little weight because he was not provided with information of the unexpected subsequent events . . . and was not given an opportunity to comment upon whether or not any of those events altered his opinion." However, the agency credited the causation opinion of Dr. Reagan "because he [was] a treating physician" and "because [Goodman] exhibited full range of motion of his shoulder as recently as November 2000 . . ."
Dr. Reagan's status as a treating physician does not distinguish his opinion on causation from the opinions of several other doctors in this case. Dr. Deffer, Dr. Koenig, and Dr. Hart were all treating physicians whose opinions controverted Dr. Reagan's. Furthermore, Dr. Reagan's causation opinion on the shoulder and chronic pain conditions is clearly subject to the same infirmity as Dr. Deffer's. Neither physician was aware of the progression of the shoulder problem, the subsequent unexpected development of adhesive capsulitis, and the worsening chronic pain syndrome that occurred after Dr. Reagan's involvement in Goodman's care ended. The agency's decision to give Dr. Deffer's opinion little weight while crediting Dr. Reagan's opinion, when neither expert was asked to opine on causation of unexpected subsequent developments, is in my view wholly irrational. I would therefore reverse the agency's decision on the causation of the shoulder and chronic pain syndrome conditions because it is so internally inconsistent as to render it wholly irrational.
I also dissent from the majority's affirmance of the agency's determination that no penalty should be assessed for the delayed payment of weekly benefits which came due subsequent to October 18, 1999. Dr. Reagan, the surgeon who performed the carpal tunnel and cubital tunnel surgery, opined on November 14, 2000 that the upper-extremity conditions were work-related. He explained that the injury to Goodman's hand caused swelling, pressure and the resulting entrapment of the median nerve. By the time the arbitration hearing was held in this case on February 18, 2002, Dr. Ban and Dr. Koenig had joined Dr. Reagan in opining that those conditions were work-related. The adjudication of penalty claims requires an analysis of the reasonableness of the employer's delay in the payment of weekly benefits. As the majority notes, while an employer's refusal to pay benefits may be initially supportable, it may later lack a reasonable basis in light of subsequent information. Squealer Feeds v. Pickering, 530 N.W.2d 678, 683 (Iowa 1995). Thus, it may have been reasonable for Snap-On to refuse to pay weekly benefits for disability related to the upper extremity condition for some period of time after Dr. Deffer expressed his opinion on October 18, 1999. I conclude, however, that the agency erred in finding that Snap-On's delay, which persisted for more than fifteen months from the date (November 18, 2000) Dr. Reagan articulated a causal connection, was justified because causation of that condition was fairly debatable. Causation, in fact, was not fairly debatable. My view on this issue is strongly influenced by the fact that all doctors who expressed an opinion on the causation of the upper extremity conditions after November 18, 2000 affirmed Dr. Reagan's opinion that those conditions were work-related. I conclude the agency committed legal error by failing to apply the Squealer Feeds standard which requires the employer to continue its investigation of claims as additional information comes available. The agency's failure to apply the correct standard is in my view apparent. Despite its appropriate rejection of Dr. Deffer's causation opinion, the agency irrationally concluded that opinion continued to render Goodman's upper extremity claim fairly debatable long after it was repeatedly discredited by every doctor who subsequently expressed an opinion on the subject. I would therefore reverse the agency's determination that Goodman's claim for benefits was fairly debatable after October 18, 1999.