Cutler Law Firm, P.C.

A Refusal of Medical Treatment Can Decrease Work Comp Benefits

A recent Iowa workers’ compensation decision may be the start of a new trend at the Commission to decrease the compensation awarded to employees if they unreasonably refuse medical treatment that is likely to improve their condition.

In Kehrli v. Overhead Door Co. of Waterloo, Inc., File No. 1653327.01 (Arb. Dec. Jan. 19, 2023), the employee suffered a meniscus tear in a work-related injury. His surgeon offered to perform arthroscopic surgery to repair the tear. However, the employee refused surgery. His reason for his refusal was his upbringing on the family farm and the negative experiences his wife had experienced with her own meniscus surgery. The surgeon provided an expert opinion that said if the employee had undergone the surgery, he would not have lost the same range of motion in his knee, which in turn resulted in an increased impairment rating under the AMA Guides. Deputy Humphrey concluded that the AMA Guides allow a patient to refuse surgery, but they also say that the examining physician can nevertheless opine as to how the refusal impacted the patient’s recovery. He held that the Commission can take this expert’s opinion into account when assigning permanent disability under Iowa Code section 85.34(2). However, because the employer had not pled the “failure-to-mitigate affirmative defense” in their answer or on the hearing report, it could not be raised for the first time in their post-hearing brief.

We wanted you all to be aware of this decision. Currently, the parameters relative to the employee’s refusal are unclear. Certainly, not all refusals of treatment should diminish an employee’s entitlement to benefits. Not every treatment has the same success rate, some treatments carry risks that patients may reasonably find are unacceptable, etc. Also, this particular case involved a surgery very likely to increase range of motion. What if the treatment that is offered is steroid injections? Physical therapy? Pain medication? The contours of this defense will likely have to be worked out in subsequent decisions.

As always, please feel free to contact any of our attorneys for questions regarding this or any other workers’ compensation issues.

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