The Iowa Court of Appeals recently issued a ruling on intervening and superseding cause and payment of past medical expenses in the workers’ compensation context. An employee injured his back in the course and scope of employment on August 15, 2011. He returned to full-duty work with no restrictions on August 24, 2011. On October 30, 2011, he sustained another back injury while helping a friend move go-kart frames into a trailer. The employee underwent back surgery and reached maximum medical improvement on January 14, 2013. The deputy commissioner found the go-kart incident was an intervening and superseding cause and denied the claim. The Commissioner disagreed and found the October 30 injury was a proximate and natural cause of the previous disability and the employee had not intentionally violated any medical restrictions. The Iowa District Court found the Commissioner’s decision was supported by substantial evidence and the Iowa Court of Appeals agreed. It noted that a subsequent injury is compensable if it is the direct and natural result of a compensable primary injury. The Iowa Court of Appeals, however, reversed the district court’s ruling that the employer could either pay the past medical expenses to the employee directly or to his health insurance company (which the employer did not contribute to). It held that where an employer does not contribute to the health insurance, the employer must make payment directly to the employee for past medical expenses paid through insurance.