Background
Jerry Hayes, a 67-year-old dishwasher with an extensive history of back problems including a 1999 surgery, multiple car accidents, and a permanent 20-pound lifting restriction, was hired by Ridgecrest Senior Living Center in July 2021. On September 12, 2021, he tripped and fell while taking out garbage, eventually developing worsening lumbar and leg pain. Ridgecrest directed him to Dr. Michael Dolphin, a board-certified orthopedic surgeon, who reviewed Hayes’s recent medical history and ultimately recommended spinal fusion surgery, attributing Hayes’s condition to the workplace fall. Ridgecrest then obtained an independent examination from Dr. Cassim Igram, who compared pre- and post-fall CT scans, found no structural change, and concluded that any ongoing symptoms were attributable to Hayes’s preexisting chronic back condition rather than the September fall.
Hayes applied for permanent partial disability benefits, arguing that Ridgecrest was legally bound by the causation opinion of Dr. Dolphin — the physician Ridgecrest itself had chosen to treat him. A deputy commissioner denied the claim, crediting Dr. Igram’s opinion (which was based on a more complete medical history and pre-injury imaging Hayes had not disclosed to Dr. Dolphin) and finding Hayes lacked credibility. The commissioner affirmed. On judicial review, the district court rejected Hayes’s “bound by treating physician” argument and upheld the denial. The court of appeals affirmed but ruled Hayes had not preserved his legal argument because he failed to file a motion for rehearing at the agency level.
The Iowa Supreme Court granted further review to resolve two questions: whether a claimant must file a motion for rehearing to preserve a legal argument the agency implicitly rejected, and whether an employer is bound in a contested case proceeding by the causation opinion of the treating physician it selected.
The Court’s Holding
The court held, unanimously, that Hayes did preserve error on his “bound by treating physician” argument. When an agency necessarily rejects a supporting legal argument by ruling against the party on the underlying issue — as happened here when the commissioner relied on Dr. Igram’s opinion to deny benefits — no motion for rehearing is required to preserve that argument for appellate review. The court of appeals had applied error-preservation rules too narrowly by requiring a specific written ruling on every subsidiary argument. The court vacated that portion of the court of appeals decision.
On the merits, however, the court rejected Hayes’s position. It held that an employer in a contested workers’ compensation case proceeding is not bound by the medical causation opinion of the physician the employer selected to treat the injured employee, where a contrary medical opinion supported by the record exists. The court reasoned that Iowa Code § 85.27(4) — governing alternate medical care — applies only in uncontested liability proceedings, not in contested case arbitration hearings. In contested proceedings, medical causation is a question of fact vested in the commissioner’s discretion, and requiring deference to the treating physician’s opinion would improperly interfere with the commissioner’s factfinding role.
The court also affirmed the commissioner’s denial of benefits as supported by substantial evidence. Dr. Igram had access to Hayes’s full medical history and pre-injury CT scans — neither of which Dr. Dolphin reviewed — and found no structural change attributable to the September 2021 fall. The deputy commissioner’s adverse credibility finding against Hayes further supported the agency’s conclusion. Because benefits were denied, Hayes was also not entitled to reimbursement for the cost of Ridgecrest’s independent medical examination under Iowa Code § 85.39(2).
Key Takeaways
- An agency implicitly and necessarily rejects a legal argument when it rules against the party advancing that argument on the underlying issue; a separate motion for rehearing is not required to preserve that argument for appellate review.
- In contested Iowa workers’ compensation proceedings, an employer is not bound by the medical causation opinion of the treating physician it selected — the commissioner retains full authority as factfinder to credit a contrary medical opinion supported by the record.
- Iowa Code § 85.27(4) and agency decisions construing it apply only to uncontested alternate-medical-care proceedings, not to contested case arbitration hearings where causation is disputed.
- A claimant is not entitled to reimbursement for an independent medical examination under Iowa Code § 85.39(2) unless the underlying injury is determined to be compensable.
Why It Matters
This decision resolves a recurring procedural question in Iowa administrative law: claimants who lose at the agency level need not pepper the agency with rehearing motions to preserve every supporting argument — implicit rejection through an adverse ruling is sufficient. That clarification reduces procedural traps for injured workers and streamlines appeals.
On the substantive side, the ruling is a significant win for employers and insurers in disputed permanency cases. Employers who direct injured workers to a treating physician retain the ability to seek and rely on a second medical opinion in contested proceedings, without being locked into the treating physician’s conclusions. The decision underscores that medical causation in Iowa workers’ compensation remains a battle of the experts resolved by the commissioner, not a default in favor of whichever doctor the employer first chose.