Des Moines, IA (WorkersCompensation.com) – How much weight do a worker’s reports of pain carry when multiple doctors opine on his limitations?
That was the question an Iowa court recently faced when a construction company worker sought permanent disability benefits despite inconsistencies between his pain reports and what he was able to do in examinations.
The worker fell approximately 12 feet off a roof on the job and was taken by ambulance to a hospital. CT scans and X-rays revealed rib and arm fractures as well as a collapsed lung and nerve damage. After leaving the hospital, the worker continued to experience pain, and he underwent surgery on his arm.
The company offered light-duty work within the worker’s restrictions, but the worker avoided the offer and stated that he could lift only two to three pounds. His doctors opined that he could lift up to 20 pounds.
Despite reporting continued pain to his doctor, during a functional capacities evaluation, the doctor noted that the worker “was able to lift on average nearly twice the amount of weight at the conclusion of testing as he was able to lift at the beginning of testing.”
Nonetheless, the worker continued to report “intense pain” in his arm, prompting the doctor suggest that the worker need to learn to manage the pain. The doctor advised that the worker should not limit his usual activities.
The worker did not return to work for the company but took a job with a hotel.
The worker underwent an independent medical examination, with the doctor opining that the worker had a left upper extremity impairment rating of 16 percent and a 10 percent permanent whole body disability.
The worker’s original doctor determined that the worker was at maximum medical improvement and opined that his pain complaints “might be consistent with ongoing nerve dysfunction.”
On the worker’s petition for benefits, a deputy commissioner concluded that the worker didn’t establish that he experienced a permanent disability, prompting the worker to appeal to court. The court agreed with the deputy commissioner, finding that the evidence didn’t support the worker’s case.
The worker then appealed to the next level in court, arguing that the deputy commissioner and lower court relied too extensively on American Medical Association guidelines in making their decisions.
Under Iowa law, the determination of whether a worker has a permanent impairment requires consideration of medical and nonmedical evidence.
Did the evidence suggest that the worker had a permanent impairment?
- Yes. The worker’s reports of intense pain should have been considered by the deputy commissioner and the court and balanced against the doctors’ opinions.
- No. The deputy commissioner and the court were aware of the worker’s reports of pain but nonetheless credited the doctor’s reports and appropriately followed AMA guidelines.
If you selected B, you agreed with the court in Millanes-Ortiz v. Loyd Roling Construction, N. 19-2077 (Iowa Ct. App. 01/21/21). The court upheld the lower court’s and deputy commissioner’s rulings against the worker, finding that both adequately considered all the evidence in the case.
The court explained that the worker’s reports of chronic pain alone weren’t enough to disturb the findings that medical evidence wasn’t sufficient to support a determination that he had a permanent disability.
While precedent cases in Iowa indicated that non-AMA evidence may be used to arrive at a functional disability rating, the court reasoned that the deputy commissioner and lower court “applied the appropriate legal standards to the facts and considered the lay testimony related to the subjective complaints of pain.”
The court also noted that the worker’s pain reports were on shaky evidential grounds following the evaluations he underwent.
“The FCE test referenced his failure to give maximum effort and offered inconsistent findings for a pain condition,” the court reasoned. “Medical providers noted the ‘overt and magnified pain behaviors and the failed validity criteria on the FCE.’”
Thus, the court found that, when balanced with the doctors’ opinions, the worker’s pain reports weren’t enough to establish his case for permanent disability benefits.
This feature does not provide legal advice.