Charles R. Coffey v. Mid Seven Transportation Company and Great West Casualty Company , 831 N.W.2d 81 ( 2013 )

IN THE SUPREME COURT OF IOWA
No. 11–1106
Filed May 10, 2013
CHARLES R. COFFEY,
Appellant,
vs.
MID SEVEN TRANSPORTATION COMPANY and
GREAT WEST CASUALTY COMPANY,
Appellees.
Appeal from the Iowa District Court for Polk County, Richard G.
Blane, II, Judge.
An injured employee appeals an adverse ruling by the district court
dismissing his review-reopening petition because it was untimely filed.
AFFIRMED IN PART, REVERSED IN PART, AND CASE REMANDED
WITH DIRECTIONS.
Charles E. Cutler and Amanda R. Rutherford of Cutler Law Firm,
P.C., West Des Moines, for appellant.
Stephen W. Spencer and Christopher S. Spencer of Peddicord,
Wharton, Spencer, Hook, Barron & Wegman, LLP, West Des Moines, for
appellees.
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WIGGINS, Justice.
An injured employee petitioned to review-reopen a workers’
compensation claim under Iowa Code section 85.26(2) (2007), seeking
additional workers’ compensation benefits from the employer and its
insurer. The workers’ compensation commissioner and district court
rejected the petition as untimely. The injured employee also sought
reimbursement for additional postarbitration medical expenses. The
commissioner rejected, and the district court affirmed denial of,
reimbursement for some of the medical expenses, finding substantial
evidence did not support a causal connection between the work-related
injury and certain claimed expenses. Next, the injured employee
requested that the commissioner, and later the district court, determine
the amount of workers’ compensation benefits still owed by the employer
and its insurer. Finally, the injured employee asked the district court to
decide whether the commissioner needed to enter an additional order
compelling payment to enforce the arbitration award for the unpaid
benefits. The commissioner did not provide the requested calculation,
but did rule that the compel-payment order was unnecessary, because
the injured employee could seek a judgment to enforce the award under
Iowa Code section 86.42. The district court affirmed.
On appeal, we reverse that part of the district court judgment
affirming the commissioner’s ruling on the statute of limitations for a
petition for review-reopening. Accordingly, we remand the case to the
district court to reverse the commissioner’s decision regarding the
statute of limitations and to remand the case to the workers’
compensation commissioner with directions. The district court should
direct the commissioner first to determine the outstanding amounts
under the arbitration award and the review-reopening decisions for
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medical expenses, mileage, healing period, permanent partial disability,
interest, and other amounts due under these decisions. Next, the
commissioner should determine the credit due to the employer and its
insurer in light of the third-party settlements.
We affirm that part of the district court judgment affirming the
commissioner’s ruling that addressed which medical expenses are
causally connected to the work-related injury.
I. Facts.
Charles Coffey worked full-time for Mid Seven Transportation
Company as an over-the-road truck driver. Great West Casualty
Company is the workers’ compensation insurer for Mid Seven.1
On February 8, 1994, while working in Missouri, Coffey fell on an
icy parking lot at a truck stop and an eighteen-wheel tractor-trailer
struck him and ran over his left leg and foot. The facts of this incident
are not in dispute. Coffey sustained a left medial malleolar fracture and
suffered from compartment syndrome in his left leg.
After several surgeries, Coffey began extensive physical therapy.
Coffey was motivated to rehabilitate so he could begin working again, but
has been unable to return full-time. Coffey reached maximum medical
improvement in August 1994.
Coffey also suffers from post-polio syndrome (PPS). This causes
whole-body fatigue, muscle weakness, pain, and cramping in both legs,
the pelvis, and the lower back. Other symptoms include difficulty
breathing and swallowing.
1For clarity, the opinion refers to Mid Seven and Great West collectively as “Mid
Seven.” Great West is only referred to by name where it acted independent of Mid
Seven.
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Physicians have indicated Coffey cannot return to work as a truck
driver. Since the accident, Coffey worked part-time during 1996, 1997,
and briefly in 1998 as a substitute school bus driver. The most he
earned annually was $7800 before terminating his employment due to
medical complications relating to his right shoulder.
Coffey applied for and received social security disability benefits for
PPS. The Social Security Administration found Coffey was disabled as of
June 26, 1997, and awarded benefits starting that December. Coffey
receives approximately $1192 per month.
II. Prior Proceedings.
Prior to filing his workers’ compensation claim, Coffey entered into
a settlement with a third party. On December 22, 1997, he settled a
third-party claim for $275,000. After the payment of fees, legal
expenses, and employer–insurer reimbursements, Coffey received
$134,784.95.
Coffey then filed a claim with the workers’ compensation
commissioner on January 28, 1998. Coffey claimed injury to his back,
leg, and head. He also indicated the accident caused PPS. Mid Seven
answered on February 2, admitting the work-related injury occurred on
the date specified on the face of the petition.
Prior to the arbitration decision, Mid Seven made workers’
compensation payments to Coffey totaling $70,783.19. This amount
included healing period, permanent partial disability, medical expenses,
and mileage. There is no indication the parties filed a memorandum of
agreement controlling the payment of benefits.
In late 2001, before the arbitration hearing, Coffey and his wife
entered into another third-party settlement for $100,000. The parties to
the settlement allocated $60,000 of this amount to the settlement of
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Coffey’s wife’s claim for loss of consortium. Of the remaining $40,000
allocated to Coffey, he netted $24,634.14 after the payment of legal fees
and expenses.
After rescheduling the arbitration proceeding numerous times at
the request of the parties, the hearing occurred on September 5, 2002.
The deputy commissioner found Coffey was entitled to workers’
compensation benefits. The deputy commissioner also determined
Coffey’s work-related accident caused PPS, which disabled not just his
extremities, but caused him a seventy-five percent industrial disability.
However, the deputy commissioner found Coffey’s pulmonary, cardiac,
vascular, and thyroid problems, as well as bladder cancer and issues
related to his spinal column and shoulders, were not work-related.
Based on these findings, the deputy commissioner ordered Mid
Seven to pay Coffey 375 weeks of permanent partial disability benefits
starting from August 16, 1994, at the weekly benefit rate of $472.18 per
week. As Mid Seven had underpaid healing period benefits at the rate of
$392.33 from February 9, 1994, through August 15, 1994, the deputy
ordered Mid Seven to satisfy that obligation by paying Coffey $79.85 per
week. Mid Seven was also ordered to pay certain disputed medical
expenses, including travel costs for all PPS-related medical care. Mid
Seven was required to pay accrued benefits in a lump sum with interest
at the rate allowable by law, while receiving a credit for all benefits
previously paid. The arbitration award assessed the costs to Mid Seven.
An intra-agency appeal followed. The commissioner affirmed the
deputy commissioner’s decision without modification on March 23, 2004.
Mid Seven then sought judicial review of the agency decision,
claiming the commissioner erred in finding Coffey developed PPS from
the work-related injury and in setting Coffey’s rate of compensation at
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$472.18 per week. The district court affirmed the commissioner’s
decision.
We transferred Mid Seven’s appeal to the Iowa Court of Appeals.
The court of appeals affirmed the district court’s decision. We denied
Mid Seven’s application for further review on January 11, 2006.
On January 18, Mid Seven wrote to Coffey’s attorney, stating the
third-party recoveries totally covered Coffey’s workers’ compensation
award, but asked if the attorney contended any sums were due to Coffey.
Coffey’s attorney responded on January 20, indicating he would “be
happy to go back and look to see what we think is due on this award. . . .
[A]t least one-third of the amount awarded is due.”
Four days later, counsel for Mid Seven wrote the following to
Coffey’s attorney: “I appreciate you letting us know what percentage
contingency you had for the Workers’ Compensation case.” The same
correspondence communicated Mid Seven’s claim of a $415,0002 credit
on any award. Counsel for Mid Seven calculated the employer’s
underpayment of weekly benefits owed under the agency’s appeal
decision to be $154,719.26. The $154,719.26 equaled an underpayment
of $7129.49 due to the higher weekly benefit rate awarded by the
commissioner plus $147,589.77 for an additional 312 weeks and 4 days
of weekly benefits. Counsel’s calculation of the underpayment total did
not include any amount for mileage, medical payments, or interest owed
by Mid Seven under the final agency decision. Because the available
credit arising from the third-party settlements exceeded the
2MidSeven’s claim of a $415,000 credit appears to be an error. The prior third-
party settlements grossed Coffey $315,000. The amount previously paid by Coffey to
Mid Seven was $70,904.33. Thus, the gross credit available to Mid Seven could not
exceed $244,095.67.
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underpayment of weekly benefits as calculated by Mid Seven’s counsel,
the letter further stated:
Under relatively recent Supreme Court precedent, it appears
that all we owe would be a reimbursement of attorney fees to
your client reimbursing him for attorney fees paid in the third
party case to establish our credit. I understand now that you
had a one-third attorney fee arrangement. A one-third fee of
$154,719.26 of the credit being used comes to $51,573.09. I
have asked my client to send you a check in that amount
made payable to Mr. Coffey.
....
Please let me know if you have any disagreement with our
math or any other problems or questions.
(Emphasis added.)
In response, Coffey’s attorney sent a letter to counsel for Mid Seven
on January 30, disagreeing with Mid Seven’s calculation of its credit
against its obligation to make additional payments under the
commissioner’s decision. This letter claimed Mid Seven owed Coffey
more than $154,719.26. Nonetheless, Great West issued a check that
same day to “Charles Coffey and Charles Cutler, His Attorney” for
“Reimbursement of Attorney Fees.” The check amount was $51,573.09—
one-third of the total amount of benefits Mid Seven claimed it owed
under the commissioner’s appeal decision.
On April 2, 2008, Coffey filed a petition for review-reopening under
Iowa Code section 85.26(2). Coffey sought additional disability benefits,
reimbursement of medical expenses, an order requiring Mid Seven to pay
the amount still due under the final agency decision, and a calculation of
the credit to which Mid Seven was entitled as a consequence of the third-
party recoveries. A deputy commissioner held a hearing on the petition
and found the claim for additional disability benefits was untimely under
the applicable statute of limitations. The deputy commissioner
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concluded the statute of limitations on Coffey’s review-reopening claim
for additional weekly benefits commenced running on March 23, 2004,
the date of the intra-agency appeal decision. Specifically, the deputy
commissioner’s decision stated:
I find the [workers’ compensation] statute is not ambiguous.
I find the three year statute of limitations period for filing a
petition in review-reopening set forth in Iowa Code section
85.26(2) contemplates, where no payment of weekly benefits
occurs after the award, that the three year period runs from
the final agency action awarding benefits, as it is that date
on which the award to be reviewed comes into existence. In
this case, that occurred when the workers’ compensation
commissioner issued his appeal decision on March 23, 2004.
Three years from that date is March 23, 2007. Claimant did
not file his petition for review-reopening until April 2, 2008.
However, the deputy commissioner did order Mid Seven to pay the
work-related medical expenses proved by Coffey at the hearing.
Nevertheless, the deputy commissioner did not determine the amount
still due, if any, under the commissioner’s appeal decision or the credit to
which Mid Seven was entitled as a consequence of the third-party
settlements. The deputy commissioner found Mid Seven’s payment of
$51,573.09 to Coffey was not intended as benefits by either party, but
rather as reimbursement of Coffey’s attorney fees incurred in achieving
the third-party settlements. Finally, the deputy commissioner concluded
an order compelling additional payment by Mid Seven was unnecessary
because Coffey could seek a judgment under Iowa Code section 86.42.
Both parties sought an intra-agency appeal of the review-reopening
decision. The commissioner thereafter issued an appeal decision
upholding the conclusion that Coffey’s review-reopening petition was
untimely. However, the commissioner reversed the previous finding that
Mid Seven must pay all of the medical expenses Coffey proved at the
hearing on the review-reopening petition. The commissioner found
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Coffey failed to prove that most of the medical expenses were causally
connected to his work-related injury. The commissioner’s ruling affirmed
the deputy’s conclusion that no further order requiring Mid Seven to pay
the medical expenses was necessary because Coffey could seek a
judgment for those expenses under Iowa Code section 86.42.
Coffey filed a motion to reconsider the review-reopening appeal
decision. The commissioner denied the motion. Coffey then sought
judicial review. The district court affirmed the commissioner’s decision.
Coffey appeals.
III. Issues.
In this appeal, we are required to determine when the statute of
limitations for a review-reopening petition commences when an employer
and its insurer are entitled to credit under Iowa Code section 85.22(1) for
benefits due. Next, we must decide if the commissioner erred in
identifying the medical expenses causally connected to Coffey’s work-
related injuries. Finally, we must determine whether the commissioner
erred in failing to calculate the total benefits due to Coffey under the
commissioner’s appeal decision and whether a compel-payment order is
a feasible method of enforcement if the calculation reveals Mid Seven has
not fully paid all of the workers’ compensation benefits owed under that
decision.
IV. Standard of Review.
An individual adversely affected by an action of the workers’
compensation commissioner is entitled to judicial review under the Iowa
Administrative Procedures Act (IAPA). Iowa Code § 86.26. Iowa Code
section 17A.19(10) of the IAPA governs judicial review of administrative
agency decisions. NextEra Energy Res. LLC v. Iowa Utils. Bd., 815
N.W.2d 30, 36 (Iowa 2012). When we review the district court decision,
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we apply the standards of the IAPA to determine if we would reach the
same conclusions as the district court. Xenia Rural Water Dist. v. Vegors,
786 N.W.2d 250, 252 (Iowa 2010).
This appeal concerns the interpretation of sections 85.22(1) and
85.26(2). “If the legislature clearly vested the agency with the authority
to interpret the statute at issue,” we reverse the agency decision only
when its interpretation is “ ‘irrational, illogical, or wholly unjustifiable.’ ”
NextEra, 815 N.W.2d at 37 (quoting Doe v. Iowa Dep’t of Human Servs.,
786 N.W.2d 853, 857 (Iowa 2010)). However, if the legislature did not
clearly vest the agency with such authority, we will reverse the agency
decision if it relies on an erroneous interpretation of the law. Id.
We have previously held the legislature has not delegated any
special powers to the workers’ compensation commissioner regarding
statutory interpretation of Iowa Code chapter 85, which governs workers’
compensation. Waldinger Corp. v. Mettler, 817 N.W.2d 1, 4–5 (Iowa
2012). The same analysis applies to sections 85.22(1) and 85.26(2).
Accordingly, we conclude the legislature has not clearly vested the
agency with interpretive authority for these statutes. Therefore, we
review the questions of statutory interpretation in this instance for errors
at law. Iowa Code § 17A.19(10)(c); see also Xenia, 786 N.W.2d at 252–53.
The second issue on appeal concerns the commissioner’s finding of
fact that only certain medical expenses were causally connected to the
work-related injury. When reviewing the commissioner’s findings of fact,
the following principles guide our review:
The industrial commissioner’s findings have the effect of a
jury verdict. We may reverse the commissioner’s findings of
fact only if they are unsupported by substantial evidence in
the record made before the agency when the record is viewed
as a whole. Evidence is substantial if a reasonable mind
would find it adequate to reach the same conclusion. An
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agency’s decision does not lack substantial evidence because
inconsistent conclusions may be drawn from the same
evidence.
2800 Corp. v. Fernandez, 528 N.W.2d 124, 126 (Iowa 1995) (citations
omitted). We further define substantial evidence as:
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.
Iowa Code § 17A.19(10)(f)(1).
We look to the whole record made before the agency to determine
whether substantial evidence supports the commissioner’s decision. Id.
§ 17A.19(10)(f). We do not consider the evidence insubstantial merely
because we may draw different conclusions from the record. Arndt v.
City of Le Claire, 728 N.W.2d 389, 393 (Iowa 2007).
V. Statute of Limitations.
Iowa Code section 85.26(2) contains the statute of limitations for
review-reopening proceedings. It provides in relevant part:
An award for payments or an agreement for settlement
provided by section 86.13 for benefits under this chapter or
chapter 85A or 85B, where the amount has not been
commuted, may be reviewed upon commencement of
reopening proceedings by the employer or the employee
within three years from the date of the last payment of
weekly benefits made under the award or agreement.
Iowa Code § 85.26(2). All parties acknowledge a review-reopening
petition must be filed within three years from the date of the last
payment of weekly benefits made under the award or agreement.
However, the parties disagree on when the date of last payment occurred
on this record, given that Coffey received third-party settlements before
the arbitration decision, allegedly offsetting any benefits due to Coffey
because of the employer’s subrogation rights under section 85.22(1).
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Mid Seven argues the three-year statute of limitations for the
review-reopening petition commenced from the date the commissioner
issued the arbitration award. The commissioner agreed with this
interpretation of section 85.26(2).
Coffey challenges this conclusion with two arguments. First, if the
three-year limitation period commences on the date the commissioner
issues the award, Coffey contends the $51,573.09 payment by Mid Seven
constituted weekly benefits under the award; therefore, the statute of
limitations commenced on the date of that payment. Second, Coffey
argues the three-year limitation period did not commence until this court
denied further review of the arbitration action.
When interpreting a statute contained in the workers’
compensation act, our goal “ ‘is to determine and effectuate the intent of
the legislature.’ ” Second Injury Fund of Iowa v. George, 737 N.W.2d 141,
147 (Iowa 2007) (quoting United Fire & Cas. Co. v. St. Paul Fire & Marine
Ins. Co., 677 N.W.2d 755, 759 (Iowa 2004)) (internal quotation marks
omitted). We determine legislative intent by looking at the language
chosen by the legislature. Id. In doing so, we adopt “ ‘a reasonable or
liberal construction which will best effect, rather than defeat, the
legislature’s purpose.’ ” Id. (quoting United Fire, 677 N.W.2d at 759).
The plain language of the statute requires the three-year period to
commence from “the date of the last payment of weekly benefits made
under the award or agreement.” Iowa Code § 85.26(2). In this record, a
factual dispute exists concerning the date Mid Seven made its last
payment of weekly benefits to Coffey. Coffey asked the commissioner to
determine this factual dispute in his petition for review-reopening.
Instead of resolving this issue, the commissioner framed the legal
question as follows: “[H]ow is the statute to be interpreted in terms of a
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statute of limitations for bringing a review-reopening action when no
weekly benefits were paid after the arbitration decision?” Essentially, the
commissioner agreed with Mid Seven that no further benefits were owed
to Coffey after the arbitration award because of the credit due to the
employer and its insurer under section 85.22(1).
Under this record, we cannot say the section 85.22(1) credit
covered all the weekly benefits awarded in the arbitration proceeding.
This conclusion is required in light of Coffey’s claim that not all of the
weekly benefits owed by Mid Seven were offset by the credit, given the
amount of interest due on those benefits and the failure of Mid Seven to
pay all the medical bills, mileage, and interest awarded under the
arbitration decision. We agree with Coffey that the commissioner must
first decide these issues of fact before determining the date of
Mid Seven’s last payment of weekly benefits under the arbitration award.
Consequently, we must remand this case to the commissioner for a
determination of whether all benefits owed by Mid Seven under the
arbitration award, plus interest, were offset by the credit Mid Seven was
entitled to receive pursuant to section 85.22(1) as a consequence of the
third-party settlements. In making this calculation, the commissioner
should be aware that we have recognized that when the injured employee
receives a third-party settlement prior to the employer or its insurer
paying all the benefits due under an arbitration award, the proper way to
calculate attorney fees is using the periodic payment method. Ewing v.
Allied Const. Servs., 592 N.W.2d 689, 691 (Iowa 1999). The periodic
payment method requires the commissioner to calculate the date of the
last payment of weekly benefits made under the award or agreement as
the date the employer was required to make the last payment under the
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award, even if the setoff would not require the employer to make future
payments after the arbitration decision.
If, after sorting out these matters, the commissioner finds Mid
Seven still owed Coffey weekly benefits after the date of the arbitration
decision, notwithstanding the offset occasioned by the third-party
recoveries, the commissioner then must determine whether Mid Seven
has paid the last installment of weekly benefits—and if it has, the date
when that last payment of weekly benefits was paid. If the commissioner
finds Mid Seven still owed Coffey weekly benefits after the arbitration
award notwithstanding any offset allowed as a consequence of Coffey’s
third-party recoveries under section 85.22(1), the three-year statute of
limitations for Coffey’s petition for review-reopening began on the date
Mid Seven made the last payment of weekly benefits.
However, if the commissioner finds Mid Seven is deemed to have
paid all weekly benefits prior to the date of the arbitration award because
of the credit afforded to it under section 85.22(1), we still must determine
the date on which the statute of limitations commences.
Coffey’s first argument is that Mid Seven’s payment of $51,573.09
constituted weekly benefits paid under the award. Therefore, Coffey
suggests the statute of limitations commenced when that payment was
made, deeming his petition for review-reopening timely. We disagree
with this argument for several reasons.
First, if the commissioner determines Mid Seven is credited with
full payment of its obligations under the arbitration award as a
consequence of Coffey’s recoveries against the third-parties prior to the
date of the $51,573.09 payment, that amount could not have been paid
for weekly benefits because the credit under section 85.22(1) had already
satisfied Mid Seven’s obligation to pay weekly benefits under the award.
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Second, the statute giving the employer or its insurer subrogation
rights states:
If compensation is paid the employee or dependent or the
trustee of such dependent under this chapter, the employer
by whom the same was paid, or the employer’s insurer which
paid it, shall be indemnified out of the recovery of damages
to the extent of the payment so made, with legal interest,
except for such attorney fees as may be allowed, by the
district court, to the injured employee’s attorney or the
attorney of the employee’s personal representative, and shall
have a lien on the claim for such recovery and the judgment
thereon for the compensation for which the employer or
insurer is liable.
Iowa Code § 85.22(1).
The statute clearly provides that the employer or its insurer must
pay its share of attorney fees to the injured employee’s attorney. We have
construed section 85.22(1)’s purpose as ensuring a fair distribution of
attorney fees between the employee and the employer or its insurer when
the efforts of the employee’s attorney result in a third-party settlement.
Farris v. Gen. Growth Dev. Corp., 381 N.W.2d 625, 627 (Iowa 1986).
Thus, the language of the statute makes clear that such payments are a
reimbursement for attorney fees, not weekly benefits. As Coffey already
paid attorney fees to his counsel for services rendered in achieving the
third-party settlements, Coffey’s attorney would be receiving double
attorney fees or a windfall if he were allowed to collect and retain
additional attorney fees from the employer for the same services. See
Iowa Ct. R. 32:1.5 (discussing appropriate fees for legal services). Hence,
in this case, Coffey’s attorney was obligated to pay Coffey the fees
received from Mid Seven as a reimbursement for attorney fees previously
paid, rather than as weekly benefits paid by Mid Seven.
The next argument made by Coffey is that if Mid Seven paid all
weekly benefits prior to the date of the arbitration award because of the
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credit afforded by the third-party settlements, the statute of limitations
commenced when this court denied the application for further review of
the arbitration proceeding.
We do not have any caselaw interpreting the phrase, “the date of
the last payment of weekly benefits made under the award or
agreement,” to instruct when the limitation period commences, where an
injured employee receives a third-party settlement that offsets the
employer’s obligation to pay weekly benefits before the commissioner files
his arbitration award. However, we do have caselaw interpreting this
language where there has been a prior award of medical expenses, but
no weekly benefits. Beier Glass Co. v. Brundige, 329 N.W.2d 280, 287
(Iowa 1983).
There, we interpreted section 85.26(2) and held where only medical
benefits and no weekly benefits are awarded or agreed upon, the three-
year statute of limitations commences from the date of the arbitration
award or the filing of a memorandum of agreement. Id. This conclusion
furthers the goal of liberally construing workers’ compensation statutes
in favor of the employee and provides certainty and predictability in
results by using a readily identifiable event as the date when the
limitation period commences. Id.
The same rationale applies when an injured employee receives a
third-party settlement that offsets the employer’s entire obligation to pay
weekly benefits before the commissioner files the arbitration award. In
this situation, until the commissioner enters an award as to the healing
period or permanent partial disability, or the parties establish the healing
period or permanent partial disability by filing a memorandum of
agreement, the injured employee has no legally established entitlement to
these weekly benefits. There may be times when the employer’s
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obligation to pay weekly benefits is fully satisfied before the injured
employee’s entitlement to weekly benefits is determined by final agency
action or on judicial review of agency action. It would be unfair if the
limitations period governing a claimant’s time to file a review-reopening
petition commenced from a date unknown by the injured employee.
Moreover, by using the arbitration award date, the injured employee, the
employer, and its insurer have a readily identifiable event defining when
the limitation period for review-reopening proceedings commences.
Coffey argues the limitations period for review-reopening
proceedings commences when either party exhausts its appeal. He
contends this is the truly final date of the award. There is no merit to
such an argument. As soon as the commissioner’s decision is final, our
district courts are required “to enter a judgment in conformance with the
workers’ compensation award.” Rethamel v. Havey, 679 N.W.2d 626,
628 (Iowa 2004). In other words, the award is enforceable by the
collection process once the court enters the judgment. It would be unfair
to the employer and its insurer to toll the limitation period pending the
appeal process when the injured employee can enforce the
commissioner’s decision in the district court without delay.
Accordingly, we hold where an injured employee receives a third-
party settlement completely satisfying the employer’s obligation to pay
weekly benefits before the commissioner files the arbitration award, the
three-year statute of limitations in section 85.26(2) commences from the
date of the arbitration award. Consistent with our opinion in this
matter, the agency shall, on remand, make findings necessary for its
determination of whether Mid Seven’s obligation to pay weekly benefits
was completely satisfied by Coffey’s recoveries from the third parties. If
the commissioner determines on remand that Mid Seven’s obligation to
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pay weekly benefits under the arbitration award was not completely
satisfied by the recoveries from the third parties, the statute of
limitations on Coffey’s review-reopening petition will commence running
on the date Mid Seven makes its last payment of weekly benefits under
the arbitration award. See Iowa Code § 85.26(2).
VI. Medical Expenses.
In the original arbitration decision, the commissioner found
Coffey’s PPS was work-related and ordered Mid Seven to be “liable for all
medical expenditures incurred because of claimant’s post polio
syndrome.” Thus, the commissioner ordered Mid Seven to cover Coffey’s
section 85.27 medical expenses including “reasonable surgical, medical,
dental, osteopathic, chiropractic, podiatric, physical rehabilitation,
nursing, ambulance and hospital services and supplies for all conditions
compensable under the workers’ compensation law.”
In his petition for review-reopening, Coffey seeks additional
benefits for PPS treatment, daytime somnolence, right knee and ankle
osteoarthritis—conditions Coffey claims were caused or aggravated by
PPS, a work-related condition. After intra-agency appeal of Coffey’s
review-reopening petition, the commissioner found the evidence
insufficient to support a causal connection between Coffey’s daytime
somnolence and osteoarthritis in relation to his PPS. The district court
affirmed. The district court concluded,
[T]here is substantial evidence in the record to support the
Commissioner’s determination that Coffey failed to meet his
burden of proof on some of the new medical expenses he
claimed were causally connected to his work injury and/or
his work-related condition.
However, the district court found Mid Seven is still liable for the cost of
treatment at the University of Iowa on November 28, 2007, in the
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amount of $808, as well as the treatment at Lucas County Health Center
from October 27 to October 31, 2008, in the amount of $609.
We can only reverse the district court if we find the record does not
contain substantial evidence supporting the commissioner’s finding that
certain medical expenses were not work-related. To recover for medical
expenses in a workers’ compensation action, the employee must
demonstrate the personal injuries “ar[ose] out of and in the course of the
employment.” Iowa Code § 85.3(1). The burden rests upon Coffey “to
show by a preponderance of the evidence that [these conditions] arose
out of and in the course of his employment.” Dunlavey v. Econ. Fire &
Cas. Co., 526 N.W.2d 845, 849 (Iowa 1995). To determine whether
Coffey has met this burden, we ask whether the “commissioner’s decision
is supported by substantial evidence in the record made before the
agency when that record is viewed as a whole.” Id.; accord Iowa Code §
17A.19(10)(f). Under the definition of substantial evidence found in
section 17A.19(10)(f)(1), we find the commissioner’s decision rests upon
substantial evidence, even though there is a possibility of drawing
inconsistent conclusions from the same evidence. See Arndt, 728
N.W.2d at 393 (“An appellate court should not consider evidence
insubstantial merely because the court may draw different conclusions
from the record.”).
Citing testimony from Coffey’s experts, the commissioner found
Coffey failed to show by a preponderance of the evidence that a work-
related injury caused his daytime somnolence and osteoarthritis.
Regarding the daytime somnolence, Dr. Joseph Chen testified and
Dr. Donna Bahls indicated in a report that Coffey’s fatigue possibly
stems from his age, a sleep disorder, or one of the numerous other
conditions from which Coffey suffers. Moreover, relating to his chronic
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ankle pain due to osteoarthritis, Coffey admitted at a 2008 doctor visit
that he has been able to adapt to his right ankle weakness caused by
childhood polio and “does not feel his [current] symptoms are related to
polio.” Although we may not agree with the commissioner’s findings, the
record supports the conclusion that there was insufficient evidence to
establish a causal connection between Coffey’s daytime somnolence and
osteoarthritis in relation to his PPS.
Accordingly, we affirm the commissioner’s finding that only the
treatment at the University of Iowa on November 28, 2007, for $808, as
well as the treatment at Lucas County Health Center from October 27 to
October 31, 2008, for $609, is causally connected to the work-related
accident.
VII. Disposition and Summary.
We reverse that part of the district court judgment affirming the
commissioner’s ruling on the statute of limitations for the petition for
review-reopening. Accordingly, we remand the case to the district court
to reverse the commissioner’s decision regarding the statute of
limitations and to remand the case to the workers’ compensation
commissioner with directions. The district court should direct the
commissioner first to determine the unpaid amounts under the
arbitration award and the review-reopening decisions for medical
expenses, mileage, healing period, permanent partial disability, interest,
and other amounts due under these decisions. Next, the commissioner
should determine the credit due Mid Seven because of the third-party
settlements. The district court should direct the commissioner in
making the calculations to identify the date of the last payment of weekly
benefits made under the award. If the actual date of the last payment of
weekly benefits made under the award is after the date of the arbitration
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decision, the three-year limitations period commences from the date of
that payment. If the actual date of the last payment of weekly benefits
made under the award is before the date of the arbitration decision, the
three-year limitations period will commence from the date of the
arbitration decision. If the commissioner finds Mid Seven has not paid
all of the weekly benefits because the credit from the third-party
settlement is inadequate to cover the weekly benefits due under the
award, the three-year limitations period shall commence on the date Mid
Seven’s weekly benefit obligation is fully paid.
We affirm that part of the district court judgment that affirms the
commissioner’s ruling determining those medical expenses that are
causally connected to the work-related injury.
AFFIRMED IN PART, REVERSED IN PART, AND CASE
REMANDED WITH DIRECTIONS.