Ramirez-Trujillo v. Quality Egg, L.L.C.
| Decision Date | 15 April 2016 |
| Docket Number | No. 14–0640.,14–0640. |
| Parties | Deanna Jo RAMIREZ–TRUJILLO, Appellant, v. QUALITY EGG, L.L.C., Wright County Egg Division, and Selective Insurance Company of America, Appellees. |
| Court | Iowa Supreme Court |
Mark S. Soldat of Soldat, Parrish–Sams & Gustafson, PLC, West Des Moines, for appellant.
Richard G. Book of Huber, Book, Cortese & Lanz P.L.L.C., West Des Moines, for appellees.
, Justice.
An employee injured her back at work. Her employer acknowledged its liability for the injury and authorized care. The employer paid for the cost of the care the employee received to treat the back injury through September 30, 2009. The employee brought a workers' compensation claim seeking reimbursement of medical expenses she incurred for additional back treatment between May 2010 and April 2011 and workers' compensation benefits for the same period. The employer argued it did not authorize the medical expenses the employee incurred between May 2010 and April 2011. The employer also maintained the expenses did not have a causal connection to her compensable workplace injury. The workers' compensation commissioner concluded the treatment the employee received between May 2010 and April 2011 was not causally related to her workplace injury. However, the commissioner held the employer was liable for the claimed medical expenses because the employer failed to notify the employee it was no longer authorizing care as required by Iowa Code section 85.27(4) (2009)
. Both parties sought judicial review.
The district court reversed the final agency decision in part, concluding the agency misinterpreted section 85.27(4)
. Both parties appealed, and we transferred the case to the court of appeals. The court of appeals reversed the district court in part, concluding the district court erroneously interpreted section 85.27(4).
Both parties sought further review, which we granted. On further review, we will let the court of appeals decision stand as the final decision of this court to the extent it affirmed the district court decision affirming in part the final agency decision. However, we find the commissioner erroneously interpreted Iowa Code section 85.27(4)
. Accordingly, we affirm in part and vacate in part the decision of court of appeals, affirm in part and reverse in part the district court judgment, and remand the case to the district court with instructions to remand the case to the commissioner for further proceedings consistent with this opinion.
On August 1, 2009, Deanna Ramirez–Trujillo slipped on an egg on the floor at her workplace in Clarion, Iowa. Although Ramirez–Trujillo managed to catch herself and did not fall to the floor, she injured her back. Her employer, Quality Egg, L.L.C., Wright County Egg Division, completed an incident report acknowledging her workplace injury.
Quality Egg authorized Wright Medical Center to evaluate and treat Ramirez–Trujillo. Physician assistants at Wright Medical Center treated Ramirez–Trujillo for acute low back strain and severe muscle spasms on August 3, 7, 13, 21, and 31. At each visit, Ramirez–Trujillo signed the bottom of the authorization form to release her medical records to Quality Egg and its insurer, Selective Insurance Company of America. After her August 3 visit, her health care provider released her to return to work with restrictions.
Throughout the months of August and September, Ramirez–Trujillo received prescription medications, transcutaneous electrical nerve stimulation
treatment, and physical therapy. Though she received an authorization form from Quality Egg each time she saw a physician assistant at Wright Medical Center, she did not receive any authorization forms for her physical therapy appointments. On September 30, Ramirez–Trujillo had a follow-up appointment with a physician assistant at Wright Medical Center. Quality Egg once again authorized Wright Medical Center to evaluate and treat Ramirez–Trujillo, and she once again signed the authorization form to release her medical records to Quality Egg and its insurer. The physician assistant released Ramirez–Trujillo to full duty without any work restrictions. The physician assistant's notes indicated Ramirez–Trujillo's back strain was resolving and no follow-up care was required. The notes also indicated Ramirez–Trujillo could return to the clinic should further problems arise.
On December 26, Ramirez–Trujillo sought treatment for low back pain radiating up to her head and down to her toes at the emergency room at Wright Medical Center. She received an injection, prescriptions for several medications, and a temporary work release. The physician assistant's notes indicated Ramirez–Trujillo said the pain had begun after she shoveled snow the previous day. She returned to work on December 29.
On May 1, 2010, Ramirez–Trujillo again sought treatment for low back pain at the emergency room at Wright Medical Center. She received two injections, prescriptions for several medications, and a temporary work release. The treating physician advised Ramirez–Trujillo to seek follow-up care in one week. The physician's notes acknowledged Ramirez–Trujillo's historical problems with back pain and indicated there had been no clear triggers for her pain that day.
Over the next several weeks, Ramirez–Trujillo received follow-up care from a physician assistant and a doctor at Wright Medical Center. She began physical therapy and continued to take prescription medication. On May 17, Ramirez–Trujillo reported her pain was gone and she felt ready to return to work. The doctor released her to full duty without work restrictions. During a follow-up appointment on June 9, however, Ramirez–Trujillo reported she was still experiencing intermittent low back pain and muscle spasms.
On June 13, Ramirez–Trujillo again sought treatment at the emergency room at Wright Medical Center. An x-ray of her lumbar spine showed disc space narrowing at L5–S1. Her treating physician prescribed medication and instructed her to seek follow-up care. The physician's notes indicated Ramirez–Trujillo said she had been experiencing intermittent back pain since she injured her back when she slipped on an egg at work.
On June 14, Ramirez–Trujillo sought follow-up care at Wright Medical Center. The doctor who treated Ramirez–Trujillo ordered an MRI, which revealed a prominent disc extrusion with mild to moderate spinal stenosis
at L5–S1. The doctor's notes indicated Ramirez–Trujillo said she had previously injured her back at work but characterized her recent pain as a separate episode. The notes also indicated Ramirez–Trujillo expressly stated "this is not workman's comp." The doctor referred Ramirez–Trujillo to orthopedic surgeon Mark Palit.
On June 28, Dr. Palit saw Ramirez–Trujillo at Wright Medical Center and administered a steroid injection. On July 19, Dr. Palit saw Ramirez–Trujillo at a follow-up appointment. Because Ramirez–Trujillo reported she continued to experience severe pain, Dr. Palit offered to perform decompression surgery
. Dr. Palit's notes indicated Ramirez–Trujillo told him the August 2009 slip injury had resolved with conservative care by October 2009 and said she did well until May 2010 when she was going up some stairs and her back locked up.
On August 4, Dr. Palit performed decompression surgery
on Ramirez–Trujillo. Dr. Palit discharged her from Wright Medical Center the following day. Ten days later, she sought treatment at the emergency room at Wright Medical Center due to drainage occurring at the surgical site and received an antibiotic to treat cellulitis. Ramirez–Trujillo attended follow-up appointments with Dr. Palit at Wright Medical Center in August, September, and October. Ramirez–Trujillo sought further treatment in November and December for increased pain in her back radiating to her right hip and foot. Dr. Palit prescribed medication and physical therapy. Between the date of the surgery and the end of the year, she received three temporary work releases from Dr. Palit. However, each work release covered only a few days.
At a follow-up appointment on January 3, 2011, Dr. Palit imposed work restrictions on Ramirez–Trujillo and ordered another MRI of her lumbar spine
due to her continuing pain. The MRI revealed a recurrent disk protrusion at L5–S1. Ramirez–Trujillo attended several additional follow-up appointments during January and February, during which she received prescriptions and a steroid injection. On March 23, Dr. Palit performed a revision of the decompression surgery
. He discharged Ramirez–Trujillo from Wright Medical Center the following day.
This appeal follows from a notice and petition Ramirez–Trujillo filed with the workers' compensation commissioner against her employer and its insurer1 on October 13, 2010. She sought workers' compensation benefits, penalty benefits, and medical expenses she incurred from May 2010 through April 2011.2 Quality Egg stipulated Ramirez–Trujillo sustained an injury in the course of her employment on August 1, 2009, that caused her a temporary disability. Additionally, Quality Egg stipulated the treatment Ramirez–Trujillo received was reasonable and necessary and the fees charged by her care providers were fair and reasonable. Quality Egg argued it did not authorize the medical expenses Ramirez–Trujillo incurred between May 2010 and April 2011. Quality Egg also argued those medical expenses did not have a causal connection to her compensable workplace injury. However, Quality Egg did not dispute the medical expenses Ramirez–Trujillo incurred were at least causally connected to the medical condition upon which her claim of injury was based.
The evidence presented at the arbitration hearing established medical providers treated Ramirez–Trujillo for low back strains and spasms on several occasions dating back to the time when she was eleven years old, but that her prior back issues had resolved before her August 2009 work injury....
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