Workers’ Compensation’s Alternate Care:  Burden on Claimant to Show Treatment Offered is Unreasonable

Posted on: June 19th, 2015

In Lynch Livestock, Inc. v. Bushell, No. 14-1133, filed May 20, 2015, the authorized treating doctor for an accepted claim had recommended a laparoscopic lumbar sympathectomy for long-term relief and resolution of pain from CRPS. The employer presented the opinion of a different doctor recommending conservative treatment and psychological assessment of claimant instead of the surgery.

The deputy at the alternate care hearing found that the surgery treatment was “reasonable and necessary” and ordered the employer to pay for the procedure and associated treatment.

The Court of Appeals reversed the deputy’s decision because she had applied the wrong standard of proof. The Court explained:  “The employee must prove the care being offered by the employer is unreasonable to treat the work injury, not that another treatment plan is reasonable.”

Thus, even though the surgery was reasonable, absent a showing that the employer’s treatment plan was unreasonable, the employer was not required to authorize the treatment.

Of note, the Court’s ruling did not mean that the employer was off the proverbial hook for the surgery. If claimant went ahead with the unauthorized surgery, the employer would still have to pay for it if the claimant could prove the treatment was reasonable and beneficial under the case of Bell Bros. Heating & Air Conditioning v. Gwinn, 779 N.W.2d 193, 206 (Iowa 2010).

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