DES MOINES REGISTER, Employer/Petitioner-Appellee, and LIBERTY MUTUAL, Insurance Carrier/Petitioner-Appellee, vs. DONNA SUE SHARON, Claimant/Respondent-Appellant.
Annotate this Case
Download PDF
IN THE COURT OF APPEALS OF IOWA
No. 9-346 / 08-1678
Filed June 17, 2009
DES MOINES REGISTER,
Employer/Petitioner-Appellee,
and
LIBERTY MUTUAL,
Insurance Carrier/Petitioner-Appellee,
vs.
DONNA SUE SHARON,
Claimant/Respondent-Appellant.
________________________________________________________________
Appeal from the Iowa District Court for Polk County, Joel D. Novak, Judge.
Employee appeals from a district court judicial review ruling affirming the
appeal decision of the workers’ compensation commissioner. REVERSED AND
REMANDED WITH DIRECTIONS.
Charles E. Cutler and Rebecca M. Threlkeld of Cutler Law Firm, P.C.,
West Des Moines, for appellant.
Jason T. Farley and James C. Huber of Huber, Book, Cortese, Happe &
Lanz, P.L.C., West Des Moines, for appellees.
Heard by Vaitheswaran, P.J., and Potterfield and Doyle, JJ.
2
DOYLE, J.
Donna Sue Sharon appeals from a district court judicial review ruling
affirming the appeal decision of the workers’ compensation commissioner. We
reverse the judgment of the district court and remand to the agency for further
proceedings consistent with this opinion.
I. Background Facts and Proceedings.
While working for the Des Moines Register in October 1987, Sharon was
involved in a serious motor vehicle accident that rendered her a paraplegic.
Mary Jo Moser has been providing Sharon with home nursing services since her
accident. When Moser first started caring for Sharon, she was employed by a
company known as Nurse Force as a licensed certified nursing assistant. Moser
eventually left that position and began working for Sharon directly. She and
Sharon now live together so Moser can care for Sharon full-time.
Moser performs a variety of tasks for Sharon throughout the day. She
assists Sharon with bathing, dressing, and exercises for her arms and legs. She
also repositions Sharon in bed, checks the skin on her legs for lesions, tends to
her bowel and bladder regimes, assists her in irrigating her catheter, helps her
put on compression stockings, and administers her medications. In addition to
those tasks, Moser helps Sharon get out of bed in the mornings, brings her
breakfast, runs errands for her, takes her to physical therapy and doctors’
appointments, and helps her get ready for bed in the evenings.
3
Moser is paid ten dollars per hour for four hours each day for her services
in caring for Sharon.1 She estimates, however, that Sharon actually requires
eight to twelve hours of care each day. Sharon’s physicians have also indicated
she needs full-time care.
Liberty Mutual, the insurer for Sharon’s former
employer, has refused to reimburse Sharon for more than four hours of nursing
services per day at ten dollars per hour.
Sharon filed a petition pursuant to Iowa Code section 86.14 (2005) with
the Iowa Workers’ Compensation Commissioner in August 2005 seeking medical
expenses under section 85.27.
The parties’ hearing report stipulated, “The
issues to be decided by the deputy in this case are the appropriate amount to be
paid to Mary Jo Moser for care and services she is providing to Donna Sue
Sharon, both in the past and future.” However, in a post-hearing brief, Liberty
Mutual contested whether the services provided by Moser were compensable
“nursing” services under section 85.27. It additionally asserted Sharon did not
have standing to seek a higher rate of pay for Moser.
Following an arbitration hearing, the deputy workers’ compensation
commissioner found the services provided by Moser were compensable nursing
services under section 85.27.2 However, the deputy declined to determine the
rate of compensation Moser should be paid for those services because the
parties did not use the health service dispute resolution procedure set forth in
Iowa Administrative Code rule 876-10.3 prior to the initiation of the contested
case proceeding.
1
2
Sharon appealed, and a different deputy workers’
Sharon pays Moser herself and is reimbursed by Liberty Mutual.
Liberty Mutual did not appeal this determination.
4
compensation commissioner, sitting as commissioner, affirmed and adopted the
hearing deputy’s decision with some additional analysis. Sharon then filed a
petition for judicial review. Following a hearing, the district court affirmed the
agency decision.
Sharon appeals. She claims the agency erred in interpreting rule 87610.3 and finding it applied to the facts of this case.3
II. Scope and Standards of Review.
The Iowa Administrative Procedure Act, chapter 17A of the Iowa Code,
governs the scope of our review in workers’ compensation cases. Iowa Code §
86.26; Meyer v. IBP, Inc., 710 N.W.2d 213, 218 (Iowa 2006). We apply the
standards of section 17A.19(10) to the agency’s decision and decide whether the
district court correctly applied the law in exercising its judicial review function.
Lakeside Casino v. Blue, 743 N.W.2d 169, 172-73 (Iowa 2007).
“The interpretation of workers’ compensation statutes and related case
law has not been clearly vested by a provision of law in the discretion of the
agency.” Finch v. Schneider Specialized Carriers, Inc., 700 N.W.2d 328, 330
(Iowa 2005); see also Iowa Code § 17A.19(10)(c). We are therefore free to
substitute our own judgment de novo for the agency’s interpretation of the law.
Finch, 700 N.W.2d at 330; see also Office of Consumer Advocate v. Iowa Utils.
Bd., 744 N.W.2d 640, 643 (Iowa 2008) (“Regardless of the standard of review the
legislature requires courts to use when reviewing agency action, the
interpretation . . . of a statute, or an agency rule interpreting a statute, is an issue
3
Because our determination of this issue is dispositive, we need not and do not address
Sharon’s other claims on appeal.
5
for the courts to decide.”). On the other hand, application of the law to the facts
is clearly vested in the agency.
See Lakeside Casino, 743 N.W.2d at 173.
Therefore, we may reverse the commissioner’s application of the law to the facts
only if it is “irrational, illogical, or wholly unjustifiable.” Id.; see also Iowa Code
§ 17A.19(10)(m).
III. Discussion.
Iowa Code section 17A.10(1) provides that “informal settlements of
controversies that may culminate in contested case proceedings according to the
provisions of this chapter are encouraged.”4 To that end, administrative rule 87610.3 establishes a procedure for informal resolution of “health service” disputes
“under Iowa Code section 85.27 between a provider and a responsible party over
the treatment rendered by a provider to an injured worker.” Iowa Admin. Code r.
876-10.3(1) (emphasis added). That procedure is set forth in part in rule 87610.3(3)(d) as follows:
If the provider does not agree to accept the amount of the charge
the responsible party agrees to pay, the provider shall notify the
responsible party in writing. The provider and the responsible party
shall submit the dispute to a mutually agreed upon person for
review. . . . The selected person or persons shall review information
submitted by the provider and the responsible party and make a
determination.
(Emphasis added.) If the procedure detailed in rule 876-10.3 “does not resolve
the dispute . . . a contested case may be initiated.” Iowa Admin. Code r. 8764.46(2).
4
We note the statute additionally provides “[t]his subsection shall not be construed to
require either party to such a controversy to utilize the informal procedures or to settle
the controversy pursuant to those informal procedures.” Iowa Code § 17A.10(1).
6
Sharon argues that because she is not a “provider” within the meaning of
that rule, the agency erred in finding she was required to utilize the informal
procedure set forth in rule 876-10.3 before bringing her claim for section 85.27
benefits. We agree.
Our courts have applied nearly identical rules for the construction of
statutes to the construction of administrative rules.
Office of Consumer
Advocate, 744 N.W.2d at 643. “When a statute or rule is plain and its meaning is
clear, the rules of statutory construction do not permit courts to search for
meaning beyond its express terms.” Id. “Courts only resort to rules of statutory
construction when the explicit terms of a statute or rule are ambiguous.” Id. at
644.
A statute or rule is ambiguous if reasonable minds could differ or be
uncertain as to its meaning. Id. We do not believe that is the case here.
By its express terms, the health service dispute resolution procedure
outlined in rule 876-10.3 applies only to disputes “between a provider and a
responsible party.” Iowa Admin. Code r. 876-10.3(1). A “provider” is defined by
rule 876-10.3(2) as “any person furnishing surgical, medical, dental, osteopathic,
chiropractic, podiatric, physical rehabilitation, nursing, ambulance, hospital
services and supplies, crutches, artificial members and appliances.” Under that
definition, Sharon is clearly not a “provider” within the meaning of rule 876-10.3.
Liberty Mutual nevertheless argues that we should view her as such because the
only way Sharon could have brought a claim seeking increased compensation for
Moser’s nursing services was as a health service provider under Iowa Code
7
section 85.27(3). We do not think that subsection has any application to the facts
of this case.5
Sharon filed a petition with the workers’ compensation commissioner as
an injured employee seeking benefits, i.e. compensation for medical expenses
she paid herself for her work-related injury. See Rethamel v. Havey, 715 N.W.2d
263, 267 (Iowa 2006) (stating a workers’ compensation claimant is not entitled to
be paid sums for medical expenses unless the claimant paid the expenses
himself). We believe she was entitled to pursue such a claim for section 85.27(1)
benefits contrary to Liberty Mutual’s suggestions otherwise.
That section
provides
[t]he employer, for all injuries compensable under this chapter or
chapter 85A, shall furnish reasonable surgical, medical, dental,
osteopathic, chiropractic, podiatric, physical rehabilitation, nursing,
ambulance and hospital services and supplies therefor. . . .
Iowa Code § 85.27(1). “Reduced to its essentials, section 85.27 requires an
insurer to furnish reasonable medical services and supplies . . . to treat an injured
employee.” Stone Container Corp. v. Castle, 657 N.W.2d 485, 490 (Iowa 2003).
Claims for section 85.27(1) benefits present two separate questions of
fact: first, whether the claimed expenses are reasonable services compensable
under the statute, and second, whether the claimed value of the services is
5
Section 85.27(3) states,
Notwithstanding section 85.26, subsection 4, charges believed to be
excessive or unnecessary may be referred by the employer, insurance
carrier, or health service provider to the workers’ compensation
commissioner for determination, and the commissioner may utilize the
procedures provided in sections 86.38 and 86.39, or set by rule, and
conduct such inquiry as the commissioner deems necessary.
(Emphasis added.) Section 85.26(4) limits the individuals that may maintain a claim or
proceeding for benefits to “the injured employee, or the employee’s dependent or legal
representative if entitled to benefits.”
8
reasonable. Quaker Oats Co. v. Ciha, 552 N.W.2d 143, 154 (Iowa 1996). Here,
the agency answered the first question in finding the services performed by
Moser were compensable as “nursing” services. But it declined to proceed to the
second question and determine whether the claimed value of those services was
reasonable, instead requiring the parties to use the informal settlement
procedure set forth in rule 876-10.3 for health service disputes. We conclude this
was in error.
In Quaker Oats, an employee sought compensation under section
85.27(1) from his employer for home nursing services provided to him by his wife
after his work-related injury.
Id. at 156.
The employer “only dispute[d] the
amount of nursing expenses” claimed by the employee. Id. at 154 n.9 (emphasis
added).
The court affirmed the agency’s award of $58,447 in-home nursing
expenses to the claimant, finding substantial evidence supported the agency’s
determination that amount was reasonable. Id. at 157. No mention was made of
the informal dispute resolution procedure in rule 876-10.3.
Indeed, Liberty
Mutual has not cited any cases, nor are we aware of any, where an injured
worker was required to proceed under rule 876-10.3 before bringing a contested
case proceeding seeking medical expenses under section 85.27(1).
Our conclusion is supported by the purpose behind the workers’
compensation act:
The fundamental reason for the enactment of [the workers’
compensation act] is to avoid litigation, lessen the expense incident
thereto, minimize appeals, and afford an efficient and speedy
tribunal to determine and award compensation under the terms of
this act.
9
It was the purpose of the legislature to create a tribunal to do
rough justice—speedy, summary, informal, untechnical.
Marovec v. PMX Indus., 693 N.W.2d 779, 787 (Iowa 2005) (citations omitted)
(emphasis added).
That purpose was clearly undermined by the agency’s
actions in this case, which has been pending since 2005 with no resolution of the
stipulated issues presented to the agency at the arbitration hearing.
It is
apparent Sharon has not been afforded the “speedy, summary, informal, [and]
untechnical” type of justice the workers’ compensation act was designed to
provide.6 Id.; see also Zomer v. West River Farms, Inc., 666 N.W.2d 130, 134
(Iowa 2003) (refusing to “read into the statute a limitation on the commissioner’s
authority to decide claims for compensation, particularly when to do so would
defeat one of the primary purposes of the statute—the provision of a prompt and
adequate remedy”).
IV. Conclusion.
We conclude the district court erred in affirming the agency’s
determination that Sharon was required to utilize the health service dispute
resolution procedure set forth in Iowa Administrative Code rule 876-10.3 before
filing a contested case proceeding seeking home nursing expenses under Iowa
Code section 85.27. The judgment of the district court is therefore reversed and
the case is remanded to the agency to determine the reasonable value of the
claimed home nursing services.
REVERSED AND REMANDED WITH DIRECTIONS.
6
Our decision should not be construed as discouraging the use of the health service
dispute resolution procedure in rule 876-10.3 in cases where it properly applies.
Some case metadata and case summaries were written with the help of AI, which can produce inaccuracies. You should read the full case before relying on it for legal research purposes.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.