2 N.W.3d 838
Iowa2024Background
- Marshall Sandlin was injured while working for Mid American Construction in September 2017 and disputed the employer-retained physician’s (Dr. Kennedy’s) 0% impairment rating.
- Sandlin, through his attorney, obtained an independent medical examination (IME) from Dr. Taylor, who determined a 2% impairment and charged $2,020 for the examination, report, and records review.
- Sandlin sought reimbursement for the full $2,020 under Iowa Code section 85.39(2), and the Workers' Compensation Commissioner awarded the full fee, finding it reasonable based on Dr. Taylor's statement.
- The district court affirmed, but the court of appeals limited reimbursement to $500, holding the 2017 amendment to section 85.39(2) capped reimbursement at the typical local fee for an impairment rating.
- The Iowa Supreme Court granted further review to clarify the meaning of the 2017 amendment to section 85.39(2) and determine the scope and reasonableness of IME fee reimbursement.
Issues
| Issue | Sandlin’s Argument | Mid American’s Argument | Held |
|---|---|---|---|
| Whether Sandlin was entitled to IME reimbursement | Employer’s insurer retained Dr. Kennedy, triggering Sandlin’s right to a reimbursable IME | Dr. Kennedy was not retained for an 85.39(2) evaluation; no reimbursement | Court held substantial evidence supported insurer chose Dr. Kennedy; reimbursement right triggered |
| Scope of reimbursable IME fees under § 85.39(2) (2017) | Full reasonable cost of examination, including records review/testing, should be reimbursed | Only the typical local cost of impairment rating (not full exam/report) should be reimbursed | Statute requires reimbursement of reasonable cost of full exam to perform impairment rating, not limited to flat impairment rating fee |
| Standard for reasonableness of IME fee | Dr. Taylor’s reported fee and services are reasonable | Only $500 is reasonable as per local typical fee schedule | Reasonableness must be determined by reference to typical local fees for impairment ratings; burden is on employee to prove |
| Adequacy of commissioner's findings regarding reasonableness | Substantial evidence supported commissioner’s award | No finding re: typical local fees, so no support for $2,020 fee | Remanded for agency to find typical local fee and set reasonable reimbursement accordingly |
Key Cases Cited
- Gumm v. Easter Seal Soc'y of Iowa, 943 N.W.2d 23 (Iowa 2020) (standard of review on commissioner’s factual and legal findings)
- Bell Bros. Heating & Air Conditioning v. Gwinn, 779 N.W.2d 193 (Iowa 2010) (remand required when agency findings are insufficient or not supported by substantial evidence)
- Bluml v. Dee Jay’s Inc., 920 N.W.2d 82 (Iowa 2018) (liberal construction of workers' compensation statutes in employee’s favor)
- Larson Mfg. Co. v. Thorson, 763 N.W.2d 842 (Iowa 2009) (doubt in construction resolved in employee’s favor)
- IBP, Inc. v. Harpole, 621 N.W.2d 410 (Iowa 2001) (substantial evidence standard for agency review)
- Quaker Oats Co. v. Ciha, 552 N.W.2d 143 (Iowa 1996) (factual findings binding if supported by substantial evidence)