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Charles R. Coffey v. Mid Seven Transportation Company and Great West Casualty Company

May 10, 2013


Appeal from the Iowa District Court for Polk County, Richard G. Blane, II, Judge.

The opinion of the court was delivered by: Wiggins, Justice.

An injured employee appeals an adverse ruling by the district court dismissing his review-reopening petition because it was untimely filed. AFFIRMED IN PART, REVERSED IN PART, AND CASE REMANDED WITH DIRECTIONS.

An injured employee petitioned to review-reopen a workers' compensation claim under Iowa Code section 85.26(2) (2007), seeking additional workers' compensation benefits from the employer and its insurer. The workers' compensation commissioner and district court rejected the petition as untimely. The injured employee also sought reimbursement for additional postarbitration medical expenses. The commissioner rejected, and the district court affirmed denial of, reimbursement for some of the medical expenses, finding substantial evidence did not support a causal connection between the work-related injury and certain claimed expenses. Next, the injured employee requested that the commissioner, and later the district court, determine the amount of workers' compensation benefits still owed by the employer and its insurer. Finally, the injured employee asked the district court to decide whether the commissioner needed to enter an additional order compelling payment to enforce the arbitration award for the unpaid benefits. The commissioner did not provide the requested calculation, but did rule that the compel-payment order was unnecessary, because the injured employee could seek a judgment to enforce the award under Iowa Code section 86.42. The district court affirmed.

On appeal, we reverse that part of the district court judgment affirming the commissioner's ruling on the statute of limitations for a petition for review-reopening. Accordingly, we remand the case to the district court to reverse the commissioner's decision regarding the statute of limitations and to remand the case to the workers' compensation commissioner with directions. The district court should direct the commissioner first to determine the outstanding amounts under the arbitration award and the review-reopening decisions for medical expenses, mileage, healing period, permanent partial disability, interest, and other amounts due under these decisions. Next, the commissioner should determine the credit due to the employer and its insurer in light of the third-party settlements.

We affirm that part of the district court judgment affirming the commissioner's ruling that addressed which medical expenses are causally connected to the work-related injury.

I. Facts.

Charles Coffey worked full-time for Mid Seven Transportation Company as an over-the-road truck driver. Great West Casualty Company is the workers' compensation insurer for Mid Seven.*fn1

On February 8, 1994, while working in Missouri, Coffey fell on an icy parking lot at a truck stop and an eighteen-wheel tractor-trailer struck him and ran over his left leg and foot. The facts of this incident are not in dispute. Coffey sustained a left medial malleolar fracture and suffered from compartment syndrome in his left leg.

After several surgeries, Coffey began extensive physical therapy. Coffey was motivated to rehabilitate so he could begin working again, but has been unable to return full-time. Coffey reached maximum medical improvement in August 1994.

Coffey also suffers from post-polio syndrome (PPS). This causes whole-body fatigue, muscle weakness, pain, and cramping in both legs, the pelvis, and the lower back. Other symptoms include difficulty breathing and swallowing.

Physicians have indicated Coffey cannot return to work as a truck driver. Since the accident, Coffey worked part-time during 1996, 1997, and briefly in 1998 as a substitute school bus driver. The most he earned annually was $7800 before terminating his employment due to medical complications relating to his right shoulder.

Coffey applied for and received social security disability benefits for PPS. The Social Security Administration found Coffey was disabled as of June 26, 1997, and awarded benefits starting that December. Coffey receives approximately $1192 per month.

II. Prior Proceedings.

Prior to filing his workers' compensation claim, Coffey entered into a settlement with a third party. On December 22, 1997, he settled a third-party claim for $275,000. After the payment of fees, legal expenses, and employer--insurer reimbursements, Coffey received $134,784.95.

Coffey then filed a claim with the workers' compensation commissioner on January 28, 1998. Coffey claimed injury to his back, leg, and head. He also indicated the accident caused PPS. Mid Seven answered on February 2, admitting the work-related injury occurred on the date specified on the face of the petition.

Prior to the arbitration decision, Mid Seven made workers' compensation payments to Coffey totaling $70,783.19. This amount included healing period, permanent partial disability, medical expenses, and mileage. There is no indication the parties filed a memorandum of agreement controlling the payment of benefits.

In late 2001, before the arbitration hearing, Coffey and his wife entered into another third-party settlement for $100,000. The parties to the settlement allocated $60,000 of this amount to the settlement of Coffey's wife's claim for loss of consortium. Of the remaining $40,000 allocated to Coffey, he netted $24,634.14 after the payment of legal fees and expenses.

After rescheduling the arbitration proceeding numerous times at the request of the parties, the hearing occurred on September 5, 2002. The deputy commissioner found Coffey was entitled to workers' compensation benefits. The deputy commissioner also determined Coffey's work-related accident caused PPS, which disabled not just his extremities, but caused him a seventy-five percent industrial disability. However, the deputy commissioner found Coffey's pulmonary, cardiac, vascular, and thyroid problems, as well as bladder cancer and issues related to his spinal column and shoulders, were not work-related.

Based on these findings, the deputy commissioner ordered Mid Seven to pay Coffey 375 weeks of permanent partial disability benefits starting from August 16, 1994, at the weekly benefit rate of $472.18 per week. As Mid Seven had underpaid healing period benefits at the rate of $392.33 from February 9, 1994, through August 15, 1994, the deputy ordered Mid Seven to satisfy that obligation by paying Coffey $79.85 per week. Mid Seven was also ordered to pay certain disputed medical expenses, including travel costs for all PPS-related medical care. Mid Seven was required to pay accrued benefits in a lump sum with interest at the rate allowable by law, while receiving a credit for all benefits previously paid. The arbitration award assessed the costs to Mid Seven.

An intra-agency appeal followed. The commissioner affirmed the deputy commissioner's decision without modification on March 23, 2004.

Mid Seven then sought judicial review of the agency decision, claiming the commissioner erred in finding Coffey developed PPS from the work-related injury and in setting Coffey's rate of compensation at $472.18 per week. The district court affirmed the commissioner's decision.

We transferred Mid Seven's appeal to the Iowa Court of Appeals. The court of appeals affirmed the district court's decision. We denied Mid Seven's application for further review on January 11, 2006.

On January 18, Mid Seven wrote to Coffey's attorney, stating the third-party recoveries totally covered Coffey's workers' compensation award, but asked if the attorney contended any sums were due to Coffey. Coffey's attorney responded on January 20, indicating he would "be happy to go back and look to see what we think is due on this award. . . .

[A]t least one-third of the amount awarded is due."

Four days later, counsel for Mid Seven wrote ...

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