IN THE SUPREME COURT OF IOWA

No. 21–0841

Submitted January 20, 2022—Filed June 3, 2022

MANDY TRIPP,

Appellant,

vs.

SCOTT EMERGENCY COMMUNICATION CENTER and IOWA 

MUNICIPALITIES WORKERS’ COMPENSATION ASSOCIATION,

Appellees.

Appeal from the Iowa District Court for Scott County, Mark Cleve, Judge.

An emergency dispatcher appeals the denial of her claim for workers’ 

compensation benefits based on post-traumatic stress disorder. REVERSED 

AND REMANDED.

McDermott, J., delivered the opinion of the court in which Christensen, 

C.J., and Appel and Oxley, JJ., joined. Christensen, C.J., filed a concurring 

opinion. Waterman, J., filed a dissenting opinion, in which Mansfield and 

McDonald, JJ., joined. 

Andrew W. Bribriesco (argued) and Gabriela Navarro of Bribriesco Law 

Firm, Bettendorf, for appellant.
2

Chandler M. Surrency (argued) and Jane V. Lorentzen of Hopkins & 

Huebner, P.C., Des Moines, for appellees.
3

McDERMOTT, Justice.

This case requires us to determine whether Iowa’s workers’ compensation 

statute places on emergency responders a different, higher bar to be eligible for 

benefits for trauma-induced mental injuries suffered on the job than workers in 

other roles with identical injuries.

Mandy Tripp, a sixteen-year veteran of Scott County’s emergency dispatch 

system, answered a 911 call from a woman screaming over and over at a high 

pitch, “Help me, my baby is dead.” The woman’s screams continued for more 

than two minutes. Tripp eventually got the woman’s address and dispatched first 

responders. She soon heard a report from a police officer that arrived on the 

scene about finding a dead infant that appeared to have been attacked with a 

claw hammer.

In the months that followed, Tripp couldn’t shake the mother’s screams 

from her mind or her ears. Loud noises, in particular, would trigger debilitating 

anxiety. Tripp sought medical help. A counselor and two doctors diagnosed her 

with PTSD resulting from the call. She was prescribed medication to address the 

PTSD and wore special headphones to drown out loud noises, sometimes even 

wearing special musicians’ earplugs under larger noise-canceling headphones. 

It helped, but not enough. Tripp found herself unable to perform her job duties 

as an emergency dispatcher as she had before.

Iowa’s workers’ compensation law permits workers to receive 

compensation for injuries that they suffer arising from and in the course of their 

jobs. Injuries from mental trauma suffered on the job have long been recognized 
4

as a basis to provide workers’ compensation. But when Tripp applied for workers’ 

compensation based on her PTSD, her request was denied. Tripp didn’t satisfy 

the test of legal causation, according to the workers’ compensation commissioner 

and district court, because 911 dispatchers routinely take calls involving death 

and traumatic injury, and the mother’s harrowing call thus wasn’t an 

“unexpected cause or unusual strain.” Tripp appeals. Because Tripp has 

established that her PTSD resulted from a manifest happening of a sudden 

traumatic nature from an unexpected cause or unusual strain, we hold she is 

entitled to workers’ compensation benefits. 

I.

Tripp began her career as an emergency dispatcher in 2002, first with the 

Davenport Police Department and then (when the police department’s emergency 

dispatch system later combined with the county’s system) with the Scott County 

Emergency Communications Center (SECC). Tripp soon was tabbed to train 

other emergency dispatchers. In a typical workday, Tripp estimated that she 

answered anywhere from 50 to 200 calls, including 911 emergency and 

nonemergency calls and administrative calls. An average call lasts thirty-five

seconds.

On September 30, 2018, Tripp answered a 911 call from a woman 

“screaming at a very high pitch, ‘Help me, my baby is dead. Help me, my baby is 

dead,’ over and over and over.” The screaming continued for two minutes and 

fifteen seconds. Tripp struggled to calm the women enough to get an address to 

dispatch an ambulance. She ultimately got an address and transferred the call 
5

to a medical dispatcher who tried to instruct the mother on lifesaving measures 

until the ambulance arrived.

Tripp continued to hear ongoing radio traffic about the incident after she 

transferred the call. She heard the medical dispatcher tell the mother how to 

perform CPR on an infant. She heard the emergency medics who arrived by 

ambulance at the scene say that “[r]igor was already set in.” And she heard police 

officers talking about “a potential crime scene” at the mother’s home. Injuries to 

the child’s face, according to one investigating officer speaking over the radio, 

suggested that the child had been beaten with a claw hammer. All the while, the 

child’s mother screamed in the background. 

Tripp’s supervisor asked Tripp if she needed a break. Tripp declined, 

responding that she “needed another call” to get the mother’s screams “out of 

my head.” Tripp texted her husband, Dennis, a Bettendorf Police Officer with 

twenty-three years’ experience in law enforcement. She told him that she’d taken 

“a really bad phone call” and needed to talk to him just to hear another voice. It 

was, according to Dennis, the first time that she’d ever requested such a thing. 

Tripp remained at work and continued taking calls until her shift ended.

In the days that followed, Tripp was on the verge of tears, didn’t want to 

answer calls, and didn’t want to talk with anyone. Although she had taken 

emergency calls involving serious injuries to children in the past from people at 

the scene of fatal incidents, including three calls involving a dead infant, she had 

never before answered a call from a dead child’s own mother. Tripp described 

the mother’s screams as something beyond “normal” sounds: “guttural, awful.” 
6

Tripp confided to her supervisor and several coworkers that she was struggling 

to deal with the call. She found herself constantly crying, unable to process her 

emotions, wanting to sleep, and becoming socially withdrawn. 

Tripp initially sought treatment with Lisa Beecher, a licensed mental 

health counselor, to help her address her mental health, which had been in a 

state of freefall since the call. Tripp’s employer approved the visit. Tripp saw 

Beecher at least five times over about a three-week period. Beecher diagnosed 

Tripp with post-traumatic stress disorder, a mental health condition commonly 

referred to by its acronym: “PTSD.” Tripp took two weeks off work at Beecher’s 

suggestion. When she returned to work, she did so with restricted hours. 

Beecher soon determined that Tripp’s condition wasn’t improving. Beecher 

referred her to a psychologist, Dr. Robert Gillespie, who had treated other 

Davenport first responders and police officers. Gillespie also diagnosed Tripp 

with PTSD. He instructed her to seek medication from her regular physician to 

treat it. Tripp’s physician prescribed her an antidepressant. Tripp took the 

prescribed antidepressants and continued to see Beecher for counseling and 

Gillespie for psychotherapy to treat her PTSD.

Gillespie’s notes of his meeting with Tripp in April 2019 (more than six 

months after the call) recount that Tripp had been having suicidal feelings at 

work but had been able to work through them. She continued to struggle with 

“heightened levels of emotional responsivity” brought on by certain sounds, 

particularly high-pitched voices. And she continued to experience episodic 
7

recurrence of traumatic stress, but with some improvement in the frequency and 

intensity of the episodes.

In September 2019, another psychiatrist, Martin Carpenter, M.D., 

performed an independent psychiatric evaluation of Tripp for this litigation. He 

also diagnosed Tripp’s condition as PTSD. Carpenter consulted the Diagnostic 

and Statistical Manual of Mental Disorders (the DSM-5), the fifth edition of a 

diagnosis manual for psychological disorders, in making his diagnosis. The 

DSM-5 states that PTSD can result from exposure “to actual or threatened 

death,” either through directly experiencing a traumatic event or experiencing 

“repeated or extreme exposure to aversive details of” a traumatic event. Am. 

Psychiatric Ass’n, Diagnostic and Statistical Manual of Mental Disorders 271 (5th. 

ed. 2013). Carpenter recommended that Tripp, on top of her ongoing prescription 

drug treatment, use physical interventions to address her PTSD symptoms. 

Among other things, Carpenter recommended that she wear special earplugs to 

limit hearing loud noises, which were a significant trigger of anxiety since the 

incident.

Tripp filed an application for workers’ compensation benefits based on her 

PTSD. At the evidentiary hearing, both Beecher and Gillespie’s reports found that 

Tripp’s PTSD resulted directly from her involvement in the traumatic events of 

the mother’s 911 call. Gillespie noted that the fourth edition of the DSM 

“explicitly contemplates the exposure risk for first responders, such as 911 

operators.” Gillespie testified to his opinion that, by May 2019, Tripp had reached 

“maximum medical improvement”—in other words, had achieved all the 
8

improvement that she reasonably would ever be expected to achieve—as to her 

PTSD. Tripp’s PTSD thus, according to Gillespie, constituted a “chronic episodic 

condition” resulting in a permanent disability. 

Carpenter similarly found that Tripp’s diagnosis resulted directly from the 

events of the mother’s 911 call. He concluded that Tripp’s condition satisfied the 

PTSD criteria in the DSM-5 as a “traumatic exposure” in which she experienced 

a mother’s discovery of a dead child in vivid and disturbing fashion. Carpenter 

also agreed that Tripp had reached maximum medical improvement and that 

she’d need both ongoing pharmacological management and psychotherapy to 

treat her PTSD.

Tripp’s employer, the SECC, contested her petition for workers’ 

compensation and called three of Tripp’s coworkers to testify at the evidentiary 

hearing: a medical dispatcher with twenty-four years’ experience (in fact, the 

same medical dispatcher who instructed the mother on CPR), the SECC’s 

director (who previously worked as a dispatcher), and the SECC’s deputy director 

(who also previously worked as a dispatcher). Each testified to their belief that

calls such as the one that brought on Tripp’s PTSD weren’t unusual or 

unexpected. They provided various estimates of similar calls based on their 

experience. One acknowledged that she’d fielded around 141,000 calls in her 

career and about a dozen involved an infant’s death; another estimated she’d 

taken about 572,000 calls of which fifteen involved a child’s death. Tripp’s 

current supervisor testified that the SECC provided Tripp with accommodations 

for her PTSD, including light-duty work, changing her seating arrangement when 
9

possible, and allowing her to leave if she experiences an anxiety-triggering call. 

No witness disputed any testimony from Tripp’s medical professionals.

Tripp agreed that fielding a 911 call from a distraught person was neither 

unexpected nor unusual in an emergency dispatcher’s work and that speaking 

with crying or even incoherent callers was a normal part of the job. Tripp also 

acknowledged that she’d fielded traumatic calls since the incident, including a 

call involving the suicide of a teenager (which, as reported in Gillespie’s notes, 

caused Tripp to hear the mother’s screams in her head from the earlier call and 

to start crying). And despite her sensitivity to loud sounds since the call, Tripp 

had personally attended a large business convention, although she wore noisecanceling headphones on top of musician’s earplugs during the convention. 

Tripp applied for a job as a librarian because of her sensitivity to sound. Tripp 

still tries, in her words, to “participate in life” despite her PTSD and wants to 

continue to work as an emergency dispatcher to the extent she’s able to because 

she “love[s] the job.”

Her husband Dennis testified that after the call, his wife had become 

withdrawn and unable to engage in many normal social activities, primarily 

because of her new sensitivity to loud sounds. Dennis saw some improvement in 

her condition from the psychotherapy and prescription drug treatments. He 

agreed that 911 operators anticipate taking emergency calls by nature of their 

jobs and agreed that a parent whose infant was dying would call 911 and be 

distraught. Dennis, for his part, has never in his career been called to respond 
10

to a matter involving a dead infant and would characterize such an event as 

unusual.

After hearing the evidence, the deputy workers’ compensation 

commissioner denied Tripp’s petition for benefits. Although acknowledging it was 

“a difficult case,” the deputy commissioner held that because 911 dispatchers 

“routinely” take calls involving death and traumatic injuries, Tripp failed to prove 

that the PTSD-inducing call was “unusual” or “unexpected” as required under 

our court’s prior mental injury cases. Tripp moved for rehearing, which the 

deputy denied. Tripp appealed to the workers’ compensation commissioner, who 

affirmed the deputy’s decision. Tripp then sought judicial review in the district 

court, which likewise affirmed the prior ruling. She appeals that ruling.

II.

The parties disagree on our standard of review. Tripp argues that we review 

for legal error because the standard for establishing a purely mental injury is an 

issue of law. The SECC argues that we must defer to the commission because 

legal causation is based on findings of fact, which should be upheld as long as 

substantial evidence in the record supports those findings. 

The commission’s decision involves an application of law to the facts and 

thus presents a mixed question of law and fact. Meyer v. IBP, Inc., 710 N.W.2d 

213, 219 (Iowa 2006). If the claimed error pertains to the agency’s findings 

of fact, then “the proper question on review is whether substantial evidence 

supported those” factual findings. Id. But if the claimed error pertains to the 

agency’s interpretation of the law, then the question on review is whether the 
11

agency’s interpretation was wrong. Id. We don’t defer to the commission’s 

interpretation of the legal standard to prove a purely mental injury under Iowa 

law. Dunlavey v. Econ. Fire & Cas. Co., 526 N.W.2d 845, 849 (Iowa 1995); see 

also Iowa Code § 17A.19(10)(c) (2019). That legal standard presents a legal 

question, and we’re thus not bound by the agency’s conclusions and instead 

substitute our own judgment. Lakeside Casino v. Blue, 743 N.W.2d 169, 173 

(Iowa 2007).

III.

Iowa’s workers’ compensation system is a creature of statute, being both 

conceived and constructed by legislative action. See Hansen v. State, 91 N.W.2d 

555, 556–57 (Iowa 1958). The system provides mutual benefits and tradeoffs for 

workers and employers. Harned v. Farmland Foods, Inc., 331 N.W.2d 98, 100 

(Iowa 1983) (en banc). Workers relinquish their right to sue the employer for 

damages on the condition that the employer promptly compensates workers for 

injuries that arise out of and in the course of employment regardless of fault. 

Baker v. Bridgestone/Firestone, 872 N.W.2d 672, 676–77 (Iowa 2015).

Our analysis centers on Iowa Code section 85.3(1), which establishes a 

worker’s eligibility to receive, and an employer’s duty to pay, workers’ 

compensation. It states: 

Every employer . . . shall provide, secure, and pay compensation 

according to the provisions of this chapter for any and all personal 

injuries sustained by an employee arising out of and in the course 

of the employment, and in such cases, the employer shall be relieved 

from other liability for recovery of damages or other compensation 

for such personal injury.
12

Iowa Code § 85.3(1). Interpreting the plain language of the statute, the question 

presented in this appeal has two parts: (1) whether Tripp’s PTSD is a “personal 

injury,” and (2) whether she sustained it “arising out of and in the course of” her 

job as an emergency dispatcher. If the answer to both parts is yes, she’s entitled 

to compensation; if not, then not.

Does Tripp’s PTSD constitute a “personal injury” under the statute? The 

terms “injury” and “personal injury” are elaborated on, although not necessarily 

defined, in section 85.61(4). That section states that these terms “shall be 

construed as follows” and then states that “they shall include death resulting 

from personal injury” and “shall not include a disease unless it shall result from 

the injury and they shall not include an occupational disease.” Id. § 85.61(4)(a), 

(b). Neither elaboration provides any help in this case since Tripp didn’t die and 

her PTSD isn’t a disease.

In Dunlavey v. Economy Fire & Casualty Co., we analyzed whether an 

employee’s “nontraumatic mental injury”—in that case, major depressive 

disorder—amounted to a “personal injury” under section 85.3(1). 526 N.W.2d at 

849–53. The employer argued that, as a matter of public policy, we should refuse 

to recognize psychological injuries without an associated physical injury 

(referred to as a “mental-mental injury”) because it would breed fraudulent and 

unverifiable workers’ compensation claims by employees. Id. at 856. But after 

surveying cases from states around the country with similarly-worded workers’ 

compensation statutes, finding no expression by the legislature in our statute to 

carve out a restriction for purely psychological injuries, and further finding “no 
13

really valid distinction between physical and ‘nervous’ injury,” we held that 

psychological injuries met the definition of “personal injuries” under the statute. 

Id. at 851, 853 (quoting 1B Arthur Larson, The Law of Workmen’s Compensation

§ 42.23(a), at § 7-906 (1993)). As to whether PTSD in particular qualifies, in 

Brown v. Quik Trip Corp., we held that a convenience store clerk’s PTSD diagnosis 

met the definition. 641 N.W.2d 725, 727–29 (Iowa 2002). Tripp’s PTSD diagnosis 

thus likewise qualifies as a “personal injury” under the statute.

Turning to the second part of the statutory inquiry: Does Tripp’s PTSD 

arise “out of and in the course of the employment”? In Dunlavey, we said that an 

employee seeking compensation for a mental injury required proof of both 

“medical causation” and “legal causation.” 526 N.W.2d at 853. Medical causation 

requires the employee to show “that the alleged mental condition was in fact 

caused by employment-related activities.” Asmus v. Waterloo Cmty. Sch. Dist., 

722 N.W.2d 653, 657 (Iowa 2006). Legal causation, on the other hand, requires 

the employee to show that the mental injury resulted from “workplace stress of 

greater magnitude than the day-to-day mental stresses experienced by other 

workers employed in the same or similar jobs, regardless of their employer.”

Dunlavey, 526 N.W.2d at 858.

But in Brown, we walked back part of the causation burden we’d 

previously imposed on employees in Dunlavey. 641 N.W.2d at 728–29. In Brown, 

we overturned the commissioner’s denial of benefits for a convenience store clerk 

who developed PTSD after seeing a customer get shot and, about a week later, 

had been held up at work by an apparently armed robber. Id. at 726–27. We 
14

formulated a different standard of causation when an employee establishes that 

the mental injury at issue is “based on a manifest happening of a sudden 

traumatic nature from an unexpected cause or unusual strain.” Id. at 729. Such 

a situation meets the legal-causation test “irrespective of the absence of similar 

stress on other employees.” Id. We could dispense with the legal-causation 

requirement in such a circumstance, we reasoned, because a mental injury that 

occurred rapidly and could be traced to a specific, sudden event had a 

sufficiently strong “badge of reliability” (in contrast to a mental injury alleged to 

have developed gradually over time). Id. at 728 (quoting Graves v. Utah Power & 

Light Co., 713 P.2d 187, 192 (Wyo. 1986), superseded by statute as stated in 

Brown, 641 N.W.2d at 728 n.1).

Neither Brown nor any of our cases since have explored the contours of 

what “manifest happening of a sudden traumatic nature from an unexpected 

cause or unusual strain” means. Id. at 729. The SECC argues that Brown

requires the factfinder to focus on that employee’s particular job duties to 

determine whether the injury-causing incident was an “unexpected cause or 

unusual strain” under Iowa Code section 85.3(1). Tripp, conversely, in effect 

argues that Brown requires the factfinder to focus on whether the sudden event 

constitutes an “unexpected cause or unusual strain” in employment life 

generally, without regard to the regular duties of the particular employee or 

employees in similar positions. The deputy commissioner adopted the SECC’s 

proposed interpretation. The commissioner and district court agreed, with the 

district court noting that the “baseline seems to be most appropriately drawn by 
15

looking to the unique features of each particular claimant’s experiences—

including their ordinary workplace activities.”

In Brown, we adopted the phrase “manifest happening of a sudden 

traumatic nature from an unexpected cause or unusual strain” from the test we 

found in a Montana case, Tocco v. City of Great Falls, to determine whether an 

injury met the legal standard for workers’ compensation. Brown, 641 N.W.2d at 

729 (citing Tocco v. City of Great Falls, 714 P.2d 160, 163–64 (Mont. 1986)). But 

the Montana Supreme Court in Tocco was quoting a phrase from Montana’s own 

workers’ compensation statute, Montana Code section 39-71-119, defining an 

“eligible injury.” Tocco, 714 P.2d at 163–64. The Montana statute defined an 

“eligible injury,” in part, as “a tangible happening of a traumatic nature from an 

unexpected cause or unusual strain resulting in” certain types of harm. Id.

(quoting Mont. Code § 39-71-119). 

Iowa workers’ compensation statute, by comparison, doesn’t contain any 

language stating that injuries must result from an “unexpected cause or unusual 

strain.” Iowa Code § 85.3(1). The relevant part of Iowa’s statute to which we 

applied the “unusual strain” test in Brown simply asks whether Tripp’s injury 

“ar[ose] out of and in the course of employment.” Id. On that inquiry, the evidence 

was unrebutted (from the testifying doctors, Tripp’s husband, and Tripp herself) 

that her PTSD arose directly from her handling of the screaming 911 call and 

the reports about the infant’s maiming that immediately followed it and that 

Tripp answered the call in the course of her work as an emergency dispatcher 

for the SECC. 
16

Focusing on the employee’s own job in determining an “unexpected strain” 

places workers routinely tasked with addressing traumatic incidents, such as 

emergency dispatchers, paramedics, police officers, and firefighters, in a 

disfavored position as compared with other workers. They would bear a burden 

to prove hyper-unexpected causes and hyper-unusual strains—some 

extraordinary species of traumatic event, above and beyond the perilous events 

that they regularly confront—to qualify for benefits that those in less hazardous 

professions receive by meeting a far lower bar. Yet nothing in the language of 

Brown—nor, more importantly, in the text of section 85.3(1)—makes the 

“unexpectedness” or “unusualness” of the traumatic event dependent on the 

employee’s own job duties. We thus hold that the district court erred in its 

interpretation of the statute in ruling otherwise.

This holding aligns with our existing workers’ compensation law. If a police 

officer, for instance, is physically injured in a crash while pursuing a suspect in 

a high-speed chase, her injury ordinarily would be compensable despite the fact 

that police officers often pursue dangerous, fleeing suspects. But if an officer 

with a pre-existing heart condition has a heart attack on the job, the officer must 

still prove “that the injury arose out of the employment.” P.D.S.I. v. Peterson, 685 

N.W.2d 627, 630 (Iowa 2004). Applying our mental injury cases as we do today 

treats mental injuries in a similar fashion. For mental injuries “based on a 

manifest happening of a sudden traumatic nature from an unexpected cause or 

unusual strain” legal causation is established without regard to the regular 

duties of the particular employee or other employees in similar positions. See 
17

Brown, 641 N.W.2d at 728–29. But for mental injuries that might result from a 

combination of work- and non-work-related factors, the claimant must prove 

both legal and medical causation. See Peterson, 685 N.W.2d at 630; Dunlavey, 

526 N.W.2d at 856–57.

The dissent never cites to, let alone analyzes, the actual text of the statute 

on which this case turns. The dissent’s preferred application of the statute is 

premised on a fear that, unless courts require emergency responders to prove 

hyper-unusual work events caused their PTSD, emergency responders will make 

(and reap the benefits of) fraudulent PTSD claims. The dissent recites, for 

instance, that our causation test in Dunlavey for mental-mental injuries sought 

to address “difficulties in the evaluation of psychological injuries, such as the 

ease with which such claims may be feigned and the difficulty with which 

fraudulent claims can be detected.” (Quoting Dunlavey, 526 N.W.2d at 855.) The 

dissent refers to our choice of the causation test in Dunlavey as “mindful” of an 

argument “that once ‘mental/mental’ claims are deemed compensable, 

employees will increasingly make fraudulent claims which the courts will not be 

able to detect and which will ultimately force employers out of business.” 

(Quoting id. at 856.) Stated in its purest form, the dissent believes that its 

approach to proving the unusualness of the PTSD-causing event will prevent 

“fraudulent claims that are difficult to disprove.” 

On this subject, the dissent fights a battle that the SECC doesn’t. The 

SECC doesn’t claim that Tripp’s PTSD diagnosis is “fraudulent” or unproven, or 
18

that it wasn’t causally connected to Tripp’s employment.1 No party in this appeal 

disputes that the 911 call in fact caused Tripp’s PTSD. There is no claim of fraud, 

and there is no question of causation. The dissent instead presents a legislative 

policy rationale that it then superimposes on the text of the statute to support 

its interpretation. “Presumably,” the dissent writes, “the legislature was 

unwilling to open the floodgates to mental injury claims as they are difficult to 

disprove and increase insurance costs while inhibiting job creation.” Yet no hint 

of any of the things that the dissent “presumes” here are found anywhere in the 

statute or in this record.

Lest we lose sight of the polestar for our legal analysis in this case, we 

must interpret our own causation test in harmony with the words of the workers’ 

compensation statute. The role of this court is to apply the words “of a statute 

as written.” In re Marshall, 805 N.W.2d 145, 160 (Iowa 2011). “[W]e may not—

under the guise of statutory construction—enlarge or otherwise change the 

terms of a statute as the legislature adopted it.” State v. Miller, 590 N.W.2d 45, 

47 (Iowa 1999). For us to interpret the statute to achieve some policy objective 

found nowhere in the statute’s language—to presume the statute requires a 

higher standard of proof for PTSD based on fears of fraud—invades a sphere 

reserved for the legislature. See In re Est. of Gist, 763 N.W.2d 561, 567–68 (Iowa 

2009). 

 

1All the dissent’s quotations from Dunlavey about fears of fraudulent mental-mental 

claims, it’s worth noting, relate to the legal causation standard that has no application to Tripp’s 

case in light of the holding in Brown.
19

The existence of any system of insurance, including workers’ 

compensation, brings with it the potential for abuse. But the solution to this 

problem resides in the truth-seeking function of the adversary process, in which 

the trier of fact “considers expert testimony with an eye toward the concern that 

the claimant may be malingering, exaggerating his or her injuries, or attempting 

to claim an injury unrelated to employment.” Travis J. Foels, Rescuing the 

Rescuer: Reforming How Florida’s Workers’ Compensation Law Treats Mental 

Injury of First Responders, 69 Fla. L. Rev. 1439, 1463 (2017). The workers’ 

compensation system “already depend[s] on triers of fact to detect and weed out 

fraudulent or illegitimate claims.” Id. Our court thus shouldn’t presume it needs 

to cure some perceived legislative inattention by foreclosing recovery for a class 

of injuries that might otherwise qualify under the statute. “Our task is to 

interpret the statute, not improve it.” Brakke v. Iowa Dep’t of Nat. Res., 897 

N.W.2d 522, 541 (Iowa 2017). 

The dissent relies heavily on Moon v. Board of Trustees of Municipal Fire & 

Police Retirement System of Iowa, in which we applied Dunlavey’s causation test 

to a disability claim by a police officer seeking benefits under Iowa Code chapter 

411. 548 N.W.2d 565, 568 (Iowa 1996). In that case, an officer became 

permanently disabled after developing a panic disorder and agoraphobia after a 

confrontation with an armed robbery suspect and the suicide of a fellow officer. 

Id. at 567. We denied benefits under the Dunlavey test because the disabled 

officer failed to establish that these incidents were “more than the day-to-day 

stresses commonly associated with police departments,” citing to testimony from 
20

another officer that “[t]here’s a lot of stress associated with the job” and similar 

testimony from other officers. Id. at 569–70. But Moon, and another case the 

dissent recites, City of Cedar Rapids v. Board of Trustees of Municipal Fire & Police 

Retirement System of Iowa, 572 N.W.2d 919 (Iowa 1998), offer little of substance 

to our analysis in light of Brown’s later reconstruction of the causation standard 

for “readily identifiable” events causing mental injury, as in this case.

Workers’ compensation statutes are generally unique to each state, but 

several courts in other jurisdictions, interpreting statutes similar to Iowa’s, have 

likewise held that purely mental injuries are compensable under an objective 

standard when the injury is caused by a readily-identifiable or directly-traceable 

event. For instance, the Oregon Supreme Court held a claimant’s mental injury 

was compensable because his injury resulted from “actual stress conditions at 

work when viewed objectively.” McGarrah v. State Accident Ins. Fund Corp., 675 

P.2d 159, 172 (Or. 1983). Oregon’s statute defined a compensable “occupational 

disease” as “[a]ny disease or infection which arises out of and in the scope of the 

employment, and to which an employee is not ordinarily subjected or exposed 

other than during a period of regular actual employment therein.” Id. at 169 

(quoting Or. Rev. Stat. § 656.802). 

The Arizona Supreme Court permitted recovery for an officer who 

developed PTSD after a shootout with a gunman during a welfare check. France 

v. Indus. Comm’n of Ariz., 481 P.3d 1162, 1163, 1167 (Ariz. 2021). The court 

rejected the employer’s claim that the officer needed to “prove that the injurycausing event was outside the scope of his assigned job duties” because under 
21

that standard “a deputy who suffers mental injuries caused by a gunfight, 

regardless of the circumstances, could never receive compensation because such 

an incident might possibly occur in the line of duty.” Id. The court emphasized 

that its holding was “limited to mental injuries arising from a specific workrelated incident” and distinguished cases involving “gradual injuries resulting 

from ordinary stresses and strains of the work regimen.” Id.

The Appellate Court of Illinois approved benefits for a police officer after 

he developed PTSD following a standoff with someone he believed to be wielding 

a gun. Diaz v. Ill. Workers’ Comp. Comm’n, 989 N.E.2d 233, 235–36 (Ill. App. Ct. 

2013). The court rejected the commission’s conclusion that the officer couldn’t 

“recover because the traumatic incident was not an uncommon event of 

significantly greater proportion than what he would otherwise have been 

subjected to in the normal course of his employment as a police officer.” Id. at 

241–42. Such a standard, the court noted, would make it “virtually impossible 

for police officers or others involved in dangerous occupations to qualify for a 

mental-mental claim.” Id. at 242. The court distinguished the incident from “a 

gradually developing mental disability” and found the appropriate standard for 

“whether a worker has suffered the type of emotional shock sufficient to warrant 

recovery should be determined by an objective, reasonable-person standard, 

rather than a subjective standard that takes into account the claimant’s 

occupation and training.” Id. at 241–42.

The Supreme Court of Louisiana likewise found that for “cases involving 

such readily identifiable, unusual and dramatic events,” the claimant must be 
22

compensated “when there is sufficient evidence that the sudden event caused 

the disabling mental condition.” Sparks v. Tulane Med. Ctr. Hosp. & Clinic, 546 

So. 2d 138, 147 (La. 1989) (emphasis added). But “an employee’s general 

allegation that he is unable to work due to stress or tension caused by working 

conditions,” according to the court, “would not give rise to a compensable claim.” 

Id.

The national landscape shows increasing support for laws that ensure 

emergency responders have an opportunity to receive workers’ compensation 

benefits for PTSD. “A vigorous trend is for states to make exceptions, within 

exclusionary laws, for first responders via the legislative ‘presumption of 

causation’ device.” David B. Torrey & Donald T. DeCarlo, Mental Stress Causing 

Mental Disability Under Workers’ Compensation Laws: A Short History, the 

Competing Arguments, and A 2021 Inventory, 56 Tort Trial & Ins. Prac. L.J. 91, 

134 (2021). The National Council on Compensation Insurance, “which carefully 

monitors proposed bills and enactments on this topic,” identified PTSD bills 

ensuring eligibility for emergency responders as “the top trending issue for 

2019.” Id. at 134–35, 173 (showing seventeen states with enacted legislation at 

the time of the article’s publication and another seventeen states with some kind 

of proposed legislation).

What’s more, making it harder for emergency responders to receive 

workers’ compensation for mental injuries would rest on a dubious assumption: 

that emergency responders have, or should have, some natural or acquired 

immunity to psychological injuries that might result from participating in 
23

traumatic human experiences. Few people, if any, could know if they possess 

such an immunity going in. And none would know for certain that they’d be able 

to maintain it. Tripp’s PTSD diagnosis, by all accounts, is a case in point: she 

was always able to deal with the trauma of the job for sixteen years until, one 

horrific day, she wasn’t.

Setting different baselines for proving workers’ compensation eligibility—

one for emergency responders and one for everyone else—further presupposes 

that emergency responders agreed to assume the risk of suffering psychological 

injuries simply by accepting the job. The legal basis for this “assumption of risk” 

notion is unclear; it’s certainly found nowhere in this record. In any event, our 

workers’ compensation statute embodies a “no fault” system: employers are not 

liable for their negligence in causing a workplace injury and workers are not 

subject to a setoff in benefits for their own conduct that might have contributed 

to their injury. See Peterson, 685 N.W.2d at 635. Workers thus can’t be denied 

benefits based on a common law “assumption of risk” defense to an injury claim. 

Hawk v. Jim Hawk Chevrolet-Buick, Inc., 282 N.W.2d 84, 91 (Iowa 1979) (en 

banc).

Our workers’ compensation statute doesn’t impose a higher burden on 

workers with jobs that involve frequent brushes with traumatic events than 

workers in other occupations. Workers’ compensation, it bears repeating, is a 

statutory creation, with eligibility for benefits determined by what the statute

provides. See McSpadden v. Big Ben Coal Co., 288 N.W.2d 181, 188 (Iowa 1980). 

We find it—as we must—not for us to create favored and disfavored 
24

classifications among occupations or injuries when the legislature has made no 

such classifications in its statute. Allowing emergency responders to receive 

workers’ compensation for their proven mental injuries, without imposing some 

heightened evidentiary hurdle absent in our statute, merely provides them with 

the compensation to which they’re legally entitled.

IV.

When a purely mental injury is traceable to a readily identifiable work 

event, the claimant proves legal causation by meeting the test that we set forth 

in Brown by analyzing the unexpected or unusual nature of the injury-inducing 

event without regard to the claimant’s own particular duties. Tripp satisfied the 

requirements for medical and legal causation. We thus reverse the decision of 

the district court and remand the case to the workers’ compensation 

commissioner to determine the extent of Tripp’s disability. 

REVERSED AND REMANDED.

Christensen, C.J., and Appel and Oxley, JJ., join this opinion. 

Christensen, C.J., files a concurring opinion. Waterman, J., files a dissenting 

opinion, in which Mansfield and McDonald, JJ., join. 
25

#21–0841, Tripp v. Scott Emergency Commc’n Ctr.

CHRISTENSEN, Chief Justice (concurring specially).

I agree with the majority that our court in Brown v. Quick Trip Corp., 641 

N.W.2d 725, 728–29 (Iowa 2002), walked back the causation burden we 

previously imposed on employees in Dunlavey v. Economy Fire & Casualty Co., 

526 N.W.2d 845, 854–59 (Iowa 1995), for cases of a manifest happening of a 

sudden traumatic nature from an unexpected cause or unusual strain. See

Asmus v. Waterloo Cmty. Sch. Distr., 722 N.W.2d 653, 657 n.1 (Iowa 2006) (“In 

the later case of Brown v. Quik Trip Corp., we formulated a different standard 

[than Dunlavey] for those situations in which the mental injury can be readily 

traced to a specific event.” (citation omitted)). Nevertheless, I write separately to 

discuss the statistics of this particular event and the higher rates of PTSD among 

first responders. I also write to propose that our state legislature adopt a statute 

similar to Minnesota’s that provides a rebuttable presumption that a PTSD 

diagnosis was caused by the first responder’s job. 

I. Statistical Data Puts the Claim that the Call was not an Unexpected 

Cause or Unusual Strain in Tripp’s Profession into Doubt.

The deputy commissioner held that “[g]iven the nature of the job of a 9-1-1 

dispatcher, taking a call regarding a dying or dead infant cannot be said to be 

an unexpected cause or an unusual strain.” It drew this conclusion from the 

testimony of Tripp, former Scott Emergency Communication Center 911 

dispatchers turned supervisors Denise Pavlik and Tracey Sanders, and the 

MEDIC EMS Jill Cawiezell. These witnesses each indicated that it was not 

uncommon for a 911 dispatcher to handle calls that involve distraught callers 
26

and life-or-death situations. There was also testimony from dispatchers Tripp, 

Pavlik, and Cawiezell indicating that they each fielded multiple infant death calls 

throughout their careers. The commissioner effectively adopted the deputy 

commissioner’s analysis, and the district court determined substantial evidence 

supported their conclusions. 

Evidence undoubtedly establishes that a 911 dispatcher normally handles 

calls involving distraught callers and life-or-death situations. But the relatively 

routine nature of these calls does not prevent such a call from being classified 

as a sudden, traumatic, and unexpected event. For example, a convenience store 

clerk normally interacts with store visitors and cleans up the store. Those general 

responsibilities do not prevent the possibility that some interactions or cleaning 

tasks, such as being a victim in a robbery or cleaning up blood from a shoot-out, 

can be sudden, traumatic, or unexpected events. Cf. Brown, 641 N.W.2d at 726–

27. 

To an extent, statistics can be helpful in analyzing whether a sudden, 

traumatic, or unexpected event has occurred. See, e.g., Brown v. Quik Trip Corp., 

No. 00–0868, 2001 WL 1132735, at *3 (Iowa Ct. App. Sept. 26, 2001) (en banc), 

vacated, 641 N.W.2d 725. For example, in Brown, “[t]o rebut the claimed legal 

causation, appellee Quik Trip offered an exhibit showing statistics as to 

occupational incidents in 1995,” which indicated that in the United States in 

1995, thirty-six convenience store clerk fatalities occurred and 0.027% of 

convenience store clerks had suffered nonfatal injuries from violence. Id. at *3 & 

n.2. The commissioner in Brown concluded that these statistics “reflect[] that 
27

these experiences are quite common for the industry in which he is employed.” 

Id. at *2. Those statistics were unimpressive to the court of appeals, as both 

opinion writers suggested that the statistics did not provide substantial evidence 

that violent acts committed on convenience store clerks were “quite common.” 

Id. at *3 (“Given the available statistics regarding the low incidence of death or 

injury of gas station attendants due to violence on the job, we would question 

whether the commissioner’s conclusion that violent acts are ‘quite common’ in 

the gas station business is supported by substantial evidence.”); id. at *5 (Hecht, 

J., concurring in part and dissenting in part) (“After a careful review of the data, 

I conclude the data proves beyond dispute the rarity of the incidence of assaults 

and violent acts in occupations similar to Brown’s.”) (footnote omitted)).2

Similarly, the majority’s case of France v. Industrial Commission of Arizona, 

481 P.3d 1162 (Ariz. 2021), used statistics to determine whether an attack on a 

law enforcement officer, who then shot and killed his attacker, during a welfare 

check, qualified as an unexpected, unusual, or extraordinary event. Id. at 1166–

67. In that case, “several law enforcement officers with many years of service 

testified that, while they are trained and prepared to use lethal force in the line 

of duty, they had never been involved in a gunfight.” Id. at 1167. Furthermore, 

“evidence showed that officer-involved shootings in Gila County were extremely 

rare, with fewer than ten such incidents occurring over the past forty years.” Id.

 

2On further review to the Iowa Supreme Court, Quik Trip appeared to abandon this 

statistical argument and solely argued that Brown failed to prove legal causation by not 

“produc[ing] testimony of similarly situated employees to establish his claim of legal causation.” 

Brown, 641 N.W.2d at 729. 
28

Based on the testimony and statistics, the court granted the officer’s claim. Id.

(“In short, the Shooting Incident is not the type of incident that is part of a law 

enforcement officer’s daily routine, nor is it expected that a deputy will face such 

a dramatic brush with death in responding to a welfare check.”). 

I turn to some relevant statistics as applied to this case. In 2018, 188 

infants died in Iowa. Nat’l Ctr. for Health Stat., U.S. Dep’t of Health & Hum. 

Servs., Infant Mortality Rates by State (Mar. 3, 2022), 

https://www.cdc.gov/nchs/pressroom/sosmap/infant_mortality_rates/infant_

mortality.htm [https://perma.cc/9MRX-R5ZU] (click 2018 under the “Year” 

filter) (classifying an infant as under one year old). In 2018, 990 emergency 

dispatchers worked in Iowa. U.S. Bureau of Lab. Stat., U.S. Dep’t of Lab., 

Occupational Employment and Wage Statistics (Apr. 4, 2022), 

https://www.bls.gov/oes/tables.htm (click on State XLS spreadsheet for May 

2018). A rough estimate indicates that an Iowa emergency dispatcher could 

expect to receive a call involving a dead infant once every five years (990 divided 

by 188 equals 5.27). This estimate, of course, assumes several variables, such 

as all infant deaths involved a 911 call, no repeats occurred among Iowa 

emergency dispatchers, and the amount of Iowa emergency dispatchers and 

infant deaths remain static over several years. That being said, this rough 

percentage is relatively consistent with Tripp’s experience (four calls over 

seventeen years) and Pavlik’s experience (three calls over twenty-two years).3

 

3Pavlik indicated that she had heard fifteen child-death-related calls. On crossexamination, Pavlik was asked how many involved the caller stating, “my baby is dead.” Those 

calls amounted to three. 
29

But diving further, the specific nature of this 911 call does stand out. 

There was evidence to suggest that the cause of death was a homicide: a report 

that the infant’s head had been maimed with an object consistent with a claw 

hammer. Tripp’s testimony indicated that the dispatchers in the room gasped 

after hearing that the cause of death may have been a murder. If seasoned 

dispatchers had a visceral reaction such as this, it could be a strong indicator 

that the event was traumatic, sudden, or unexpected. 

Moreover, the homicide of infants is extremely rare statistically. In Iowa, 

between 2016 and 2019, approximately less than ten infants died from homicide. 

See Ctrs. for Disease Control & Prevention, 2019, 2018, 2017, 2016, NVDRS: IA 

All Victims Death Counts and Rates per 100,000 Homicide, All Mechanisms, All 

Races, Both Sexes, Age 0, https://wisqars.cdc.gov/nvdrs/ (last visited June 6, 

2022) (in section 1, select “Crude Rates and Death Counts” under “Death and 

Rates”; in section 2, uncheck “All Intents” and select “Homicide”; in section 5, 

select 2016, 2017, 2018, and 2019 under “Year(s) of Report” and Iowa under 

“Individual State(s)”; under “Advanced Options,” select “Single Age Range of <1 

to <1”; and click “Submit Request”) (noting that “[t]he number of deaths fewer 

than 10; the number has been suppressed to retain confidentiality”). By applying 

an average that two Iowa infants died from homicide in 2018, the rough 

probability, assuming several variables, that any Iowa 911 dispatcher would field 

a call about a murdered infant is around once every five hundred years. These 

statistics indicate that the situation described by Tripp is something that rarely 

happens, even in her line of work. With these statistics, I am skeptical that this 
30

specific event could not be classified as an unexpected cause or an unusual 

strain. 

II. Further Legislative Action for First Responders.

This case involves the broader issue of higher rates of PTSD among first 

responders. “First responders are exposed to potentially traumatic events 

repeatedly while on the job.” Nina F Lewis-Schroeder et al., Conceptualization,

Assessment, and Treatment of Traumatic Stress in First Responders: A Review of 

Critical Issues, 26 Harv. Rev. Psychiatry 216, 217 (2018) [hereinafter LewisSchroeder]; see Kubajak v. Lexington-Fayette Urban Cty. Gov’t, 180 S.W.3d 454, 

463 (Ky. 2005) (Scott, J., dissenting) (“It is notable that included among those 

who are particularly susceptible to PTSD, due to the frequency of their exposure 

to such events, are ‘first responders,’ . . . . ”). “Given the high frequency and 

severity of traumatic exposures, it is not surprising that first responders are at 

an elevated risk for developing PTSD.” Lewis-Schroeder, 26 Harv. Rev. Psychiatry 

at 217. 

Several studies suggest that first responders develop PTSD at a range of 

10% to 30% higher than members of the general public. Id.; Miriam Heyman, 

Jeff Dill, & Robert Douglas, The Ruderman White Paper on Mental Health and 

Suicide of First Responders 12 (2018), 

https://dir.nv.gov/uploadedFiles/dirnvgov/content/WCS/TrainingDocs/First

%20Responder%20White%20Paper_Final%20(2).pdf [https://perma.cc/7VYNA9X9] (describing firefighters develop PTSD at 7% to 15% and police officers 

develop PTSD at 28% higher than the general population); Substance Abuse & 
31

Mental Health Servs. Admin., First Responders: Behavioral Health Concerns, 

Emergency Response, and Trauma 3 (2018), 

https://www.samhsa.gov/sites/default/files/dtac/supplementalresearchbullet

in-firstresponders-may2018.pdf [https://perma.cc/B8NZ-75D4] (“It is 

estimated that 30 percent of first responders develop behavioral health 

conditions including, but not limited to, depression and posttraumatic stress 

disorder (PTSD), as compared with 20 percent in the general population.” 

(citation omitted)). Some studies believe the disparity between PTSD diagnoses 

with first responders as compared to PTSD diagnoses in the general population 

is much higher due to underreporting. Lewis-Schroeder, 26 Harv. Rev. 

Psychiatry at 217.

911 dispatchers, like Tripp, have an especially important duty in the 

“rescue chain.” 

[911 dispatchers] play a key role in allocating the right resource to 

patients in emergencies and they must communicate vital 

information during critical phases of operations. Errors in 

communications, for example, a wrong treatment priority, will 

compromise safe and effective patient care. Dispatchers’ failures 

may lead to a delay in care and may contribute to the patient’s 

death. Therefore, although the dispatchers are not at the forefront 

of the “hands on” rescue, they bear high work-related responsibility. 

Marcus Oldenburg et al., Job-related Stress and Work Ability of Dispatchers in a 

Metropolitan Fire Department, 9 J. Occupational Med. & Toxicology 31, 31 (2014) 

(endnote omitted). In recognition of the work performed by 911 dispatchers, the 

Iowa Legislature recently classified 911 dispatchers as “first responders.” 2020 

Iowa Acts ch. 1077, § 2 (codified at Iowa Code § 80B.11C (2021)). Additionally, 

911 dispatchers are also subject to higher rates of PTSD than the general public. 
32

Anna Raskin, PTSD and Emergency Telecommunicators, J. of Emergency 

Dispatch (July 6, 2016) https://www.iaedjournal.org/ptsd-in-911-

communications-qa [https://perma.cc/D8M8-2999] (detailing the rate of PTSD 

among 911 dispatchers at between 18% and 24%). 

As the majority mentions, several states have enacted a wide variety of 

legislation to address the higher rates of PTSD among first responders. See

Caitlin Dryden, Putting Mental Health on the Frontline: Why Mental Injuries in 

First Responders Should be Covered through Workers Compensation, Drexel L. 

Rev. Blog (Sept. 11, 2020), 

https://drexel.edu/law/lawreview/blog/overview/2020/September/puttingmental-health-on-the-front-line/ [https://perma.cc/46R2-GRKK]. For example, 

Minnesota has a presumption that PTSD is a personal injury that was caused 

by the first responder’s job. Minn. Stat. § 176.011, subd. 15(e) (“If, preceding the 

date of disablement or death, an employee who was employed on active duty as: 

[a first responder] . . . is diagnosed with [PTSD] . . . , and had not been diagnosed 

with the mental impairment previously, then the mental impairment is 

presumptively an occupational disease and shall be presumed to have been due 

to the nature of employment.”); id. at § 176.66, subd. 1 (“The disablement of an 

employee resulting from an occupational disease shall be regarded as a personal 

injury within the meaning of the workers’ compensation law.”). However, that 

presumption can be rebutted by “substantial factors brought by the employer or 

insurer.” Id. at § 176.011, subd. 15(e).
33

Some states do not have a presumption that PTSD was caused by the first 

responder’s job. Texas allows first responders to recover for PTSD as a 

compensable injury if it is “caused by one or more events occurring in the course 

and scope of the first responder’s employment” and “the preponderance of the 

evidence indicates that the event or events were a producing cause of the 

disorder.” Tex. Lab. Code Ann. § 504.019(b). In Washington, “claims [that are] 

based on mental conditions or mental disabilities caused by stress” are not an 

occupational disease. Wash. Rev. Code § 51.08.142(1). However, a specific 

exclusion is set aside for first responders, including public safety 

telecommunicators, who may bring occupational disease claims resulting from 

PTSD. Id. § 51.08.142(2)(a), (d). Florida’s and Nevada’s statutes specifically 

delineate certain triggering events that allow for compensation for a PTSD 

diagnosis among first responders. Fla. Stat. § 112.1815(5)(a)(2)(a–k) (providing a 

list of triggering incidents); Nev. Rev. Stat. § 616C.180(4)(a–b) (allowing a first 

responder to recover for stress if the employee witnessed “the death, or the 

aftermath of the death, of a person as a result of a violent event” or “an injury, 

or the aftermath of an injury, that involves grievous bodily harm of a nature that 

shocks the conscience” if it was during the scope of employment”). Notably, 

Florida’s statute contains several triggering incidents related to the death of 

minors. Fla. Stat. § 112.1815(5)(a)(2)(a–e). 

Ohio has gone even further by creating a state post-traumatic trust fund 

for its first responders outside of the worker’s compensation scheme. See Ohio 

Rev. Code Ann. § 126.65. This fund allows first responders diagnosed with PTSD 
34

to receive lost wages and medical bills if PTSD was during the “course of, and 

arising out of, employment as a public safety officer but without an 

accompanying physical injury.” Id. § 126.65(B). 

To me, Minnesota’s rebuttable-presumption framework provides more 

comprehensive protection to our first responders who are more likely to face 

traumatic events while exhaustively serving our communities and enforcing our 

laws. Alternatively, the legislature can look at the other mentioned legislative 

statutes, and unmentioned ones, to further address the problem of PTSD among 

first responders. 
35

#21–0841, Tripp v. Scott Emergency Commc’n Ctr.

WATERMAN, Justice (dissenting).

I respectfully dissent. I would apply our longstanding precedent to affirm 

the district court judgment that upheld the workers’ compensation 

commissioner’s fact-bound determination denying Mandy Tripp’s mental injury 

claim. The majority overrules our caselaw that required employees claiming 

purely mental injuries to show that the triggering event was sudden, traumatic, 

and unexpected in their occupation. Substantial evidence supported the 

commissioner’s factual determination that Tripp’s phone call with the hysterical 

mother was not an unexpected event for an emergency dispatcher, as other 

witnesses testified. We are required to affirm the agency’s determination under 

our deferential standard of review. The majority’s ill-advised change to the legal 

causation element in mental injury claims opens the floodgates to fraudulent 

claims that are difficult to disprove and will drive up the cost of doing business 

in Iowa. 

I. The Commissioner’s Decision Should Be Affirmed Under Controlling 

Law.

In Dunlavey v. Economy Fire & Casualty Co., 

we adopt[ed] an objective standard of legal causation for purely 

mental injury claims and place[d] the burden on the employee to 

establish that the mental injury was caused by workplace stress of 

greater magnitude than the day-to-day mental stresses experienced 

by other workers employed in the same or similar jobs, regardless of 

their employer.

526 N.W.2d 845, 858 (Iowa 1995) (emphasis added). The majority misreads 

Brown v. Quik Trip Co. as abandoning that “same or similar job” requirement;
36

Brown did no such thing. See 641 N.W.2d 725, 728 (Iowa 2002). To the contrary, 

Brown described its single-trauma test as “consistent with Dunlavey.” Id.

Normally, when we abandon a proof requirement, we say so explicitly.

Shortly after we decided Dunlavey, we extended it to cover accidental 

disability claims by police officers claiming purely mental injuries from specific 

traumatic incidents in Moon v. Board of Trustees of the Municipal Fire & Police 

Retirement System of Iowa, 548 N.W.2d 565, 568 (Iowa 1996). There, a police 

officer suffered from a panic disorder with agoraphobia and sought “accidental 

disability benefits from the Municipal Fire and Police Retirement System of Iowa” 

codified in Chapter 411. Id. at 567. 

Moon allege[d] that his disability was caused by two incidents 

that took place while on duty. In 1980, as a member of an 

intelligence unit, Moon confronted a man suspected of armed 

robbery. The suspect attempted to escape, but Moon did not shoot 

at him because he was afraid his partner would be caught in the 

crossfire. He soon began having nightmares about the incident. In 

1985 a young officer who served under Moon committed suicide, 

and Moon was called to the scene. Shortly before the suicide, Moon 

had disciplined the officer, and Moon stated that he felt guilty for 

not having identified the officer’s problems.

Id. Moon had testified that the incidents were not typical for police officers but 

admitted that police work “can become very dangerous, in a split second” and 

“[t]here’s a lot of stress associated with the job.” Id. at 569. Another officer 

testified that “police work is more stressful on a day-to-day basis than the 

average occupation,” and the chief of police testified that he did not consider the 

two incidents “exceptionally stressful” for police officers. Id. at 569–70. On our 

review, we reiterated that the Dunlavey standard is occupation-focused and, in 

this context, required “the stress be ‘of greater magnitude than the day-to-day
37

mental stress experienced by other [police] officers.’ ” Id. at 569 (alteration in 

original) (quoting Dunlavey, 526 N.W.2d at 857). We concluded that “[t]here [wa]s 

substantial evidence in the record to support the board’s conclusion that the two 

incidents that allegedly caused Moon’s disability were no more than the 

day-to-day stresses commonly associated with police departments.” Id. at 569. 

Whether the occupation-specific legal causation standard is met in a 

particular case is a question of fact that must be affirmed on appeal when that 

determination is supported by substantial evidence—notwithstanding whether 

benefits were denied or awarded. Two years after Moon, we affirmed the board’s 

award of mental disability benefits to a police officer who “witness[ed] a person 

burning to death” and “confront[ed] an armed person alone.” City of Cedar 

Rapids v. Bd. of Trs. of the Mun. Fire & Police Ret. Sys. of Iowa, 572 N.W.2d 919, 

925–26 (Iowa 1998). Applying our deferential standard of review, we affirmed, 

stating, “Based on testimony from [the police captain and the operations chief], 

the board could have found against [officer] Cornish on the legal causation issue. 

That fact, however, does not mean there was insubstantial evidence to support 

the ruling the board made.” Id. As this case shows, benefits for purely mental 

injuries triggered by specific traumatic incidents have been available to first 

responders under Dunlavey’s occupation-specific standard in Iowa for several 

decades. 

Indeed, the Iowa Workers’ Compensation Commissioner has repeatedly 

awarded first responders and corrections personnel workers’ compensation 

benefits for purely mental injuries, applying the occupation-focused standard. 
38

See Christensen v. Pottawattamie County, Iowa Workers’ Comp. Comm’n 

No. 5051440, 2017 WL 1161144, at *7 (Dec. Mar. 23, 2017) (Grell, Arb.) (finding 

legal causation based on unexpected, gruesome nature of inmate’s suicide 

attempt); Schuchmann v. Dep’t of Transp., Iowa Workers’ Comp. Comm’n 

No. 5035676, 2012 WL 2371481, at *7 (Dec. June 20, 2012) (Hedberg, Arb.) 

(finding legal causation when a department of transportation vehicle 

enforcement officer viewed charred human remains at highway accident scene); 

Everhart v. Clarinda Corr. Facility, Iowa Workers’ Comp. Comm’n No. 5007651, 

2005 WL 2465835, at *3 (Dec. Sept. 30, 2005) (Trier, App.) (finding legal 

causation when a prison guard was hit with bodily fluids and feared he 

contracted HIV). 

These determinations on purely mental injury claims are made by the 

agency case by case, subject to our deferential standard of review. We are bound 

by the commissioner’s findings of fact that are supported by substantial 

evidence. Asmus v. Waterloo Cmty. Sch. Dist., 722 N.W.2d 653, 657 (Iowa 2006). 

And we are bound by the commissioner’s application of law to the facts unless it 

is “irrational, illogical, or wholly unjustifiable.” Brewer-Strong v. HNI Corp., 

913 N.W.2d 235, 242 (Iowa 2018) (quoting Westling v. Hormel Foods Corp., 

810 N.W.2d 247, 251 (Iowa 2012)); Iowa Code § 17A.19(10)(m) (2019). Applying 

these standards, I find no reversible error in the agency’s determinations.

Tripp had the burden “to show by a preponderance of the evidence that 

the injury arose out of and in the course of [her] employment.” Dunlavey, 

526 N.W.2d at 849. To do so, she had to prove both medical and legal causation. 
39

Asmus, 722 N.W.2d at 657; Brown, 641 N.W.2d at 727; Dunlavey, 526 N.W.2d 

at 853. For medical causation, “[w]hether an injury has a direct causal 

connection with the employment or arose independently thereof is essentially 

within the domain of expert testimony.” Dunlavey, 526 N.W.2d at 853. “Legal 

causation, on the other hand, presents a question of whether the policy of the 

law will extend responsibility to those consequences that have in fact been 

produced by the employment.” Asmus, 722 N.W.2d at 657. The Scott County 

Emergency Communications Center (SECC) and its insurer conceded Tripp 

established medical causation. The fighting issue in this case was legal 

causation, a question of fact on this record.

The majority’s discussion of the record is incomplete. Tripp testified she 

had taken three infant death calls before the September 30, 2018 phone call at 

issue. She admitted that she “never know[s] what’s on the other end of the 

phone.” Specifically, she testified:

[DEFENSE COUNSEL:] Now, throughout your training, 

throughout your experience it is typical to deal with people who are 

distraught; is that fair to say? 

[TRIPP:] That’s fair. 

[DEFENSE COUNSEL:] Yeah. 

Because in cases of emergency, who are people to call?

[TRIPP:] Me. 

[DEFENSE COUNSEL:] That’s right. 

That’s your job, correct? 

[TRIPP:] Correct. 
40

[DEFENSE COUNSEL:] And you never know what’s coming 

your way, do you? 

[TRIPP:] I do not.

Tripp admitted that handling 911 calls where the caller is crying, almost 

incoherently, is potentially an everyday occurrence for a 911 operator. 

A 911 dispatcher for MEDIC Ambulance, Jill Cawiezell, who took over the 

September 30 phone call after Tripp transferred it, testified that she handles 

distraught callers daily. She has over twenty-four years of experience and has 

personally handled twelve infant death calls. She testified that infant death calls 

are not unusual or sudden and that death, distraught callers, and trauma are 

common in her job. Denise Pavlik, the former director of the SECC, testified that 

she heard the September 30 phone call and did not consider that call to be 

unusual, sudden, or unexpected. She explained that over ten people were 

involved with that call. Pavlik has answered fifteen calls throughout her career 

where children had died, including three calls where the caller has said “my baby 

is dead.” She testified that life-and-death calls are an everyday occurrence for 

911 operators. Tracey Sanders, the current deputy director of the SECC, with 

over twelve years of experience as a dispatcher, also testified. She, too, reviewed 

the September 30 phone call and opined that it was not unusual, unexpected, 

or sudden for their occupation. She testified that the average 911 dispatcher 

takes twenty calls a day and Tripp was no exception.

The deputy commissioner entered an Arbitration Decision that determined 

Tripp was unable to meet the legal causation requirement:
41

Legal causation involves a determination of whether the work 

stresses and tensions the employee experienced, when viewed 

objectively and not as the employee perceived them, were of greater 

magnitude than the day to day mental stresses workers employed 

in the same or similar jobs experience routinely regardless of their 

employer.

The deputy commissioner found that “there [was] considerable evidence in the 

record that [911] dispatchers, like [Tripp], routinely take calls involving death 

and traumatic injury” and that “taking a call regarding a dying or dead infant 

cannot be said to be an unexpected cause or an unusual strain.” 

Tripp filed a motion for rehearing urging the deputy commissioner to 

expressly find that Tripp “suffers from PTSD and that she proved medical 

causation” and to reverse the decision on legal causation because Tripp satisfied 

the requirements of Brown. Alternatively, Tripp requested Brown be overruled. 

The SECC and its insurer resisted. The deputy commissioner denied Tripp’s 

motion, confirming his finding that Tripp had not demonstrated legal causation 

because the September 30 phone call was not unexpected “given the nature of 

the [911] dispatcher’s job.” Tripp filed an intra-agency appeal. 

After additional briefing by the parties, the workers’ compensation 

commissioner entered an appeal decision. On de novo review, the commissioner 

affirmed and adopted the deputy’s decision on Tripp’s rehearing request as the 

agency’s final decision. The commissioner elaborated: 

[T]he question of what qualifies as an unexpected cause or an 

unusual strain is specific to the individual and must be addressed 

on a case-by-case basis. What can be expected by an individual in 

the workplace, is, in part, dependent upon their occupation. It 

stands to reason that an individual’s occupation would be a factor 

to consider.
42

Tripp filed a petition for judicial review. On June 11, 2021, after further 

briefing and oral argument, the district court affirmed the commissioner’s 

decision. The court declined to defer to medical experts offering nonmedical 

conclusions about working conditions. The district court ruled the commissioner 

properly considered the job responsibilities of emergency dispatchers in applying 

the Brown test:

In determining whether a particular event is unexpected or unusual, 

the Commissioner must first establish a baseline of what is expected 

or usual. As every individual’s day-to-day life is unique, this baseline 

seems to be most appropriately drawn by looking to the unique 

features of each particular claimant’s experiences—including their 

ordinary workplace activities. Accordingly, the Court finds that it 

was not error for the Commissioner to consider the regular job 

responsibilities of [Tripp] in evaluating whether her harm was the 

result of an unexpected cause or unusual strain.

The district court determined the agency decision was supported by substantial 

evidence because life-and-death emergency calls are relatively common for 911 

operators. On this record, the district court correctly affirmed the 

commissioner’s denial of mental disability benefits to Tripp. We should affirm.

II. The Majority’s Decision to Overrule Longstanding Caselaw is 

Contrary to Principles of Stare Decisis and Not Well Reasoned.

I respectfully dissent from the majority’s decision to overrule our 

longstanding precedents. Stare decisis considerations counsel against the 

majority’s radical break with existing law. Further, our prior decisions were well 

reasoned and correctly decided, and the majority’s justification for overruling 

these precedents is wanting.

“Stare decisis alone dictates continued adherence to our precedent absent 

a compelling reason to change the law.” Book v. Doublestar Dongfeng Tyre Co., 
43

860 N.W.2d 576, 594 (Iowa 2015). Ever since we decided Dunlavey, Moon, and

Brown decades ago, the commissioner has consistently applied an 

occupation-specific test to determine whether the triggering event is sudden, 

traumatic, and unexpected for workers in the same or similar jobs. The 

legislature, which has quickly amended chapter 85 when it disagrees with our 

interpretation,4 has left Moon, Brown, and Dunlavey intact and declined to relax 

the proof required for purely mental injuries under Iowa Code chapters 85 and 

411. “The rule of stare decisis ‘is especially applicable where the construction 

placed on a statute by previous decisions has been long acquiesced in by the 

legislature, by its continued use or failure to change the language of the statute 

so construed . . . .’ ” Brewer-Strong, 913 N.W.2d at 249 (omission in original) 

(quoting In re Est. of Vajgrt, 801 N.W.2d 570, 574 (Iowa 2011)). Presumably, the 

legislature was unwilling to open the floodgates to mental injury claims as they 

are difficult to disprove and increase insurance costs while inhibiting job 

creation. 

The majority’s rationale for breaking with our longstanding law is not 

well-supported. First, the majority’s new holding today begs the question: 

“unexpected” compared to what? As the district court noted, “the Commissioner 

must first establish a baseline of what is expected or usual” by looking to the 

claimant’s occupation. What is expected or unexpected necessarily varies by 

 

4See, e.g., Bluml v. Dee Jay’s, Inc., 920 N.W.2d 82, 90–92 (Iowa 2018) (allowing recovery 

for idiopathic fall on level floor), abrogated by 2019 Iowa Acts 38, § 1 (codified at Iowa Code 

§ 85.61(7)(c) (2020)) (modifying definition of “personal injury arising out of employment” to 

exclude “[p]ersonal injuries due to idiopathic or unexplained falls from a level surface onto the 

same level surface”).
44

occupation. Witnessing a death on the job would be unexpected for most 

occupations; not so for a hospice nurse. A threatening tiger is routine for 

Siegfried and Roy; not so for the Las Vegas ticket taker outside the cage. Police, 

firefighters, and medics routinely face life-threatening emergencies as part of the 

job; other occupations, such as the convenience store clerk in Brown, do not. 

Telemarketers and 911 operators should not be equated when determining 

whether a particular phone call is traumatic or unexpected.

Second, the majority and special concurrence rely on a flawed premise: 

that first responders can’t recover for their purely mental injuries under 

Dunlavey because stressful emergencies are part of the job. The majority wants 

an easier path for mental disability benefits for emergency workers, including 

911 operators who are not physically present at the crime or accident scene. To 

me, that is a policy determination for the legislature, which for decades has left 

the Dunlavey same-or-similar-job proof requirement intact. And as noted above, 

agency fact finders applying Dunlavey have repeatedly allowed first responders 

to recover for purely mental injuries triggered by specific events. The bar is not 

set too high.

Third, the majority reads Brown in a vacuum in a manner inconsistent 

with the larger body of law in this area. When Brown is read together with 

Dunlavey and Moon, it is clear we did not abandon the same-or-similar-job 

requirement for traumatic events. In Dunlavey, we “establish[ed] a standard for 

legal causation” for “a worker’s pure nontraumatic mental injury.” 526 N.W.2d 

at 854. We reviewed three options: a “subjective causal nexus” test, a “broad 
45

causation” test, and an “unusual stress” test. Id. at 855. The “subjective test 

focuses on the employee’s own perception of reality in that if the claimant 

honestly perceives that there is some work related stimuli causing a mental 

disability the employee is entitled to recover.” Id. This test was adopted by 

Michigan and later repudiated by statute. Id.; see also Mich. Comp. Laws 

§ 418.301(2) (1985). “The ‘broad causation’ test allows a worker to be 

compensated for normal work related stress as long as the worker’s mental injury 

is causally connected to the employment.” Dunlavey, 526 N.W.2d at 855. “This 

approach is premised on the view that the basic purpose of a workers’ 

compensation system mandates that a worker disabled as a result of work 

related stress receive treatment identical to a worker disabled by a work related 

physical injury.” Id. (quoting Candelaria v. Gen. Elec. Co., 730 P.2d 470, 477 

(N.M. Ct. App. 1986), superseded by statute as stated in Jensen v. N.M. State 

Police, 788 P.2d 382, 384 (N.M. Ct. App. 1990)). We declined to adopt either the 

subjective-causal-nexus test or broad-causation test because neither 

“correspond[s] to our statutory goal of making sure the mental injuries are 

causally connected to the worker’s employment.” Id. at 856. 

We instead adopted an occupation-specific unusual-stress test for 

nontraumatic mental injuries. Id. at 858. The test “requires the employee to show 

that the work stress which led to the [mental] injury was unusual.” Id. at 855. 

The unusual-stress test was “developed . . . as a response to the difficulties in 

the evaluation of psychological injuries, such as the ease with which such claims 

may be feigned and the difficulty with which fraudulent claims can be detected.” 
46

Id. The unusual-stress requirement helps ensure that “mental injuries are 

causally connected to the worker’s employment” and “furthers the intent of the 

legislature to compensate those workers who suffer bona fide ‘personal injuries’ 

caused by their employment.” Id. at 856.

The unusual-stress test reflects that the workers’ compensation system 

provides a remedy for industrial accidents and is not a general mental health 

insurance system. See id. at 856. We chose the unusual-stress test mindful of 

the “ ‘slippery slope’ argument that once ‘mental[-]mental’ claims are deemed 

compensable, employees will increasingly make fraudulent claims which the 

courts will not be able to detect and which will ultimately force employers out of 

business.” Id. Because the test “places the burden on the employee to prove that 

the work stress suffered is unusual, [it] is an effective means of evaluating 

employees’ claims.” Id.

We deliberately chose to adopt Wyoming’s occupation-specific standard for 

our unusual-stress test in Dunlavey instead of Wisconsin’s broader standard 

that merely required proof of stress “greater than that endured by all other 

workers” in any field. Id. at 855–57. We concluded that the Wyoming standard 

is preferable because it “provides the employees with compensation for legitimate 

work related injuries while at the same time limits the employers’ liability to 

injuries caused by its industry”5 and avoids the confusion of what is meant by 

 

5It might be considered modern and forward looking for worker’s compensation to 

be expanded to provide full coverage health insurance. But that was not its 

intended purpose, and it would be unfair to the employer who pays premiums on 

the assumption that they cover only injuries caused by [its] industry. 
47

“all workers.”6 Id. at 857. We approvingly quoted the Wyoming Supreme Court’s 

explanation of the benefits of the occupation-specific-unusual-stress test:

Unlike the “fellow employees” test, this test could be used in 

cases where the worker has no fellow employee holding the same job 

in his company. Moreover, under the same or similar job standard, 

an employer who puts excessive stress on several employees could 

not avoid the payment of benefits by simply making that excessive 

stress equal for all employees. The stress on [its] workers would be 

compared to the stress suffered by those holding similar jobs in 

other companies.

. . . .

The objective test based on workers with the same or similar 

jobs is also superior to a test based on the working world at large. It 

is impossible to determine, except in the broadest fashion, the stress 

to which the working world at large is exposed. In every worker’s 

compensation case heard under this test, the parties could call 

witnesses whose job related stress is either significantly greater or 

significantly smaller than the stress suffered by the worker seeking 

compensation. The standard would be too amorphous to be 

practical.

Dunlavey, 526 N.W.2d at 857–58 (alteration and omission in original) (quoting 

Graves v. Utah Power & Light Co., 713 P.2d 187, 193 (Wyo. 1986), superseded 

by statute as stated in Sechrist v. State ex rel. Wyo. Workers’ Safety & Comp. Div., 

23 P.3d 1138 (Wyo. 2001)). We found these justifications persuasive. Id. at 858. 

We also noted states were increasingly enacting statutes requiring proof 

 

Graves v. Utah Power & Light Co., 713 P.2d 187, 190 (Wyo. 1986), superseded by statute as 

stated in Sechrist v. State ex rel. Wyo. Workers’ Safety & Comp. Div., 23 P.3d 1138 (Wyo. 2001).

6The objective “all employees” standard could be based upon three different 

groups. First, “all employees” could consist of a worker’s “fellow employees” 

employed in the same or similar jobs by the same employer. Second, it could 

consist of workers in the same or similar jobs, including those who work for other 

employers. Finally, it could consist of the “working world at large.”

Graves, 713 P.2d at 192.
48

comparing the claimant’s stress to those in similar jobs rather than workers 

generally:

[T]hose states which have had experience with “mental[-]mental” 

claims are increasingly enacting statutes which require proof that 

the employee’s stress is greater than that of similarly situated 

employees. See, e.g., Alaska Stat. § 23.30.265(17)(A) (1990) (work 

stress must be “extraordinary and unusual in comparison to 

pressures and tensions experienced by individuals in a comparable 

work environment”); Colo. Rev. Stat. Ann. § 8–41–301(2)(a)–(d) (West 

Supp. 1994) (the psychologically traumatic event must be “generally 

outside of a worker’s usual experience and would evoke significant 

symptoms of distress in a worker in similar circumstances”); N.M. 

Stat. Ann. § 52–1–24(A) (Michie 1978 & Supp.1994) (same).

Id. 

In Brown, we addressed mental injuries attributed to a store clerk’s 

specific on-the-job traumatic events. 641 N.W.2d at 727–28. Brown was far from 

a professional first responder. He was working alone at night in his employer’s 

convenience store and witnessed a customer inside get shot in the leg. Id. at 726. 

Brown was not physically injured, but he had to clean up the blood from the 

shooting. Id. Six days later, he was working alone again and was the victim of a 

robbery. Id.

The robber grabbed Brown by the arm, swung him around, stuck an 

object that Brown thought to be a gun in Brown’s back, and 

demanded all of the money, which Brown gave to him. Brown was 

told to get down, and he did. The robber left but returned and said, 

“I told you to get the . . . down or I’m going to blow your . . . head 

off.” Brown laid spread-eagle on the floor until the phone rang; it 

was the security organization calling in response to a silent alarm 

that Brown had triggered.

Id. (omissions in original). Brown was diagnosed with delayed PTSD and his 

doctor opined that “the additional trauma of the robbery aggravated the effect of 

the shooting, so the cumulative effect was more traumatic than the sum of the 
49

two events.” Id. at 726–27. The deputy commissioner found Brown had 

established both medical and legal causation, but the commissioner reversed, 

finding Brown failed to establish legal causation because “he had not shown his 

stress was greater than that of other workers employed in the same or similar 

jobs.” Id. at 727–28. “Quik Trip contended this was fatal to his claim, and the 

industrial commissioner and district court agreed.” Id. at 728. 

We reversed, concluding that “[w]hen a claim is based on a manifest 

happening of a sudden traumatic nature from an unexpected cause or unusual 

strain, the legal-causation test is met irrespective of the absence of similar stress 

on other employees.” Id. at 729. Our colleagues in the majority misread this 

statement as eliminating Dunlavey’s requirement to compare the claimant’s 

stress to others in the same or similar jobs. To the contrary, we stated that “[t]his 

conclusion is consistent with Dunlavey, which did not involve a readily 

identifiable stress factor such as in this case.” Id. at 728. We were addressing a 

failure of proof claim and concluded, from the very nature of the two incidents, 

that the evidence was sufficient to establish the store clerk’s mental injury claim, 

without testimony of other witnesses, to prove that an Iowa convenience store 

employee in Iowa did not routinely experience shootings and armed robberies. 

The majority effectively overrules Moon, where we had confirmed that the 

compensability of a first responder’s mental injury triggered by one or two 

specific incidents is determined under Dunlavey by reference to the claimant’s 

occupation as a police officer. Moon, 548 N.W.2d at 569–70. In my view, Moon 
50

and Dunlavey remained good law for first responders. This is confirmed by a 

careful reading of Brown and the authorities cited in that opinion.

In Brown, we again relied on Wyoming precedent and agreed that:

Where a mental injury occurs rapidly and can be readily 

traced to a specific event, . . . there is a sufficient badge of reliability 

to assuage the Court’s apprehension. Where, however, a mental 

injury develops gradually and is linked to no particular incident, the 

risk of groundless claims looms large indeed.

Id. at 728 (omission in original) (quoting Graves, 713 P.2d at 192). Noting both 

Graves and Dunlavey involved nontraumatic-gradual-onset mental injuries, we 

went on to discuss another Wyoming case more directly on point as involving a 

mental injury from an on-the-job accident. Id. at 728–29 (citing Johnson v. State 

ex rel. Wyo. Worker’s Comp. Div., 798 P.2d 323, 326 (Wyo. 1990)).

In Johnson v. State ex rel. Wyoming Worker’s Compensation Division, the 

employee was an over-the-road truck driver involved in two accidents. 798 P.2d 

at 324. In the first accident, “Johnson had bruised his back but did not seek 

medical treatment.” Id. In the second, “As [Johnson] rounded a curve, the wind 

hit the truck and spun it around 180 degrees. The truck came close to colliding 

with another vehicle but missed. The highway patrol stated the road should have 

been closed at the time the accident occurred.” Id. “The psychiatrist determined 

that Johnson was suffering from depression and [PTSD]” as a result of the second 

accident. Id. The Wyoming Supreme Court held Johnson satisfied the legal 

causation requirement without presenting evidence of similarly situated 

employees. Id. at 325–36. 
51

In Brown, after discussing the facts and holding of Johnson, we 

approvingly quoted this passage applying a same or similar job test: 

The accident also satisfies the requirement that the mental injury 

resulted from a situation or condition that is of greater magnitude 

than the day-to-day stresses and tensions all employees usually 

experience. While it may be normal for and expected of over-the-road 

truck drivers to encounter hazardous, wintery driving conditions on 

Wyoming highways, involvement in an accident when driving in those 

conditions or any weather conditions falls beyond any day-to-day 

stress and tensions. It was the accident and not the driving in 

hazardous conditions that caused Johnson’s injuries.

Brown, 641 N.W.2d at 728–29 (emphasis added) (quoting Johnson, 798 P.2d at 

326).7 Importantly, the focus of this test is on what is “normal for and expected 

of” the claimant’s occupation—such as over-the-road truck driving in Johnson. 

We endorsed that approach. Id. at 729. Thus, we held the shooting and robbery 

satisfied the legal causation requirement because “[t]hese events were sudden, 

traumatic, and unexpected” and “Quik Trip, in fact, d[id] not contend otherwise.” 

Id. Given the nature of the traumatic incidents in Brown and Johnson, the 

workers’ compensation claims were reinstated despite the claimant’s failure to 

introduce baseline evidence of the stress of other workers in the same or similar 

jobs. 

Other states take different approaches. Some states allow no relief under 

any circumstances for purely mental injury claims. See 4 Arthur Larson et al., 

 

7After we decided Brown, the Wyoming legislature amended its workers’ compensation 

statutory definition of “injury” to exclude compensation for mental injury unless it is “[c]aused 

by a compensable physical injury, it occurs subsequent to or simultaneously with, the physical 

injury and it is established by clear and convincing evidence.” Wyo. Stat. Ann. 

§ 27-14-102(a)(xi)(J) (West 2009). This reflects a subsequent policy choice by the Wyoming 

legislature.
52

Larson’s Workers’ Compensation Law § 56.06[1][b], at 56-50, & 56.06[4], at 

56-55 (2021) [hereinafter Larson] (“[F]ifteen states and the [federal] Jones Act 

have expressly ruled out liability in any kind of mental-mental case.” (footnotes 

omitted)). Iowa was in the middle in allowing recovery in a mental-mental case 

where an unusual stress triggered the mental injury. See id. § 56.06[6], at 56-57. 

There is also a lack of uniformity on what is considered “unusual.” This noted 

commentator observed:

To summarize: there can thus be identified four answers to 

the question: “unusual compared with that?” These are: 

(1) Unusual compared with this employee’s normal strains. 

(2) Unusual compared with other, similarly situated 

employees’ strains in the normal work environment. 

(3) Unusual compared with the strains of employment life 

generally. 

(4) Unusual compared with the wear and tear of everyday 

nonemployment life. 

Unfortunately, most opinions in this area—and statutes as 

well—only use the word “unusual” without specifying which of these 

comparisons is intended. 

3 Larson, § 44.05[4][d], at 44-43 (footnotes omitted). Until today, Iowa fit in this 

treatise’s second category, comparing the claimant’s stress with workers “in the 

same or similar jobs.” Dunlavey, 526 N.W.2d at 858. 

I am not persuaded by cases from jurisdictions that use a more lenient 

test for legal causation such as Diaz v. Illinois Workers’ Compensation 

Commission, 989 N.E.2d 233, 240 (Ill. App. Ct. 2013) (determining whether 

stress of police officer threatened with a gun exceeded “that of the general 
53

public”). Comparing the claimant to the “working world at large” is an approach 

we rejected as “too amorphous to be practical.” Dunlavey, 526 N.W.2d at 

857–58 (“In every worker’s compensation case heard under this test, the parties 

could call witnesses whose job related stress is either significantly greater or 

significantly smaller than the stress suffered by the worker seeking 

compensation.” (quoting Graves, 713 P.2d at 193)). The proper comparison is to 

workers in the same or similar jobs. Id. Diaz is directly contrary to our decision 

in Moon, where we emphasized that Dunlavey’s legal causation test is to be 

applied with reference to the claimant’s occupation as a police officer—not 

workers in general. Moon, 548 N.W.2d at 569.8

Arizona recently adopted an approach similar to Dunlavey in France v. 

Industrial Commission of Arizona, 481 P.3d 1162 (Ariz. 2021). In France, two 

deputy sheriffs were dispatched to perform a welfare check for a man threatening 

to kill himself with a shotgun. Id. at 1163. The man advanced toward Deputy 

Sheriff France and “point[ed] a shotgun two to three feet away from [France’s] 

chest and face.” Id. at 1164. The deputies shot the man several times and 

 

8The majority relies on Sparks v. Tulane Medical Center Hospital & Clinic, 546 So. 2d 138 

(La. 1989), but that case did not involve a first responder or a single traumatic incident. Rather, 

that court allowed recovery for a hospital “exchange card supervisor’s” mental injury triggered 

by a series of death threats, vandalism, and harassment by her fellow employees spanning years. 

Id. at 140–41. The Sparks court recognized purely mental injury claims for the first time in that 

state, over the dissent of three justices. Id. at 148–49; id. at 149 (Marcus, J., dissenting) (“I do 

not consider . . . plaintiff’s work-related stress to be an ‘injury’ ” under Louisiana’s Worker’s 

Compensation Act); id. (Hall, J., dissenting) (concluding that the statute did not allow recovery 

for “mental-mental” injuries and stating, “Any change should come from the legislature and not 

the court. Even under the new interpretation of the law enunciated in the majority opinion, I 

would hold that this plaintiff is not entitled to benefits because her mental condition, as real and 

as unfortunate as it is, was not precipitated by an accident, i.e., an unexpected and unforeseen 

event that occurred suddenly or violently. It was the result of several years of work-related 

stress”). I agree with Justice Hall’s dissent in Sparks that it is the legislature’s role to expand 

recovery for purely mental injuries, not the court’s.
54

watched him die. Id. France developed PTSD and sought workers’ compensation 

benefits, which were denied. Id. For mental injuries from a single work-related 

event, the Supreme Court of Arizona interpreted “the central inquiry” of its 

workers’ compensation statute as “whether the work-related event itself imposed 

stress on the employee that was ‘unexpected, unusual or extraordinary.’ ” Id. at 

1167 (quoting Ariz. Rev. Stat. Ann. § 23-1043.01(B) (2017)). The court further 

explained that

not all mental injuries caused by violent encounters experienced by 

law enforcement officers in the line of duty are compensable. As a 

preliminary matter, an officer must first establish that his 

work-related stress was a substantial contributing cause of his 

mental injury. Unlike the present case, many claims may not satisfy 

this initial hurdle. Additionally, a court must examine the 

stressfulness of any such incident from the standpoint of a 

“reasonable person” with the same or similar job duties as the 

claimant, e.g., another law enforcement officer. Thus, applying this 

standard, officers may be involved in many encounters in the line of 

duty that produce expected, common, and ordinary stress.

Id. (emphasis added) (vacating agency ruling that denied benefits under wrong 

legal standard). 

New York courts previously took the position our court adopts today, 

determining whether mental injures were compensable by looking at the 

“emotional strain or tension . . . to which all workers are occasionally subjected.” 

Wilson v. Tippetts-Abbott-McCarthy-Stratton, 253 N.Y.S.2d 149, 150 (App. Div. 

1964). New York courts then saw the light and now require claimants to 

“demonstrate that the stress that caused the claimed mental injury was greater 

than that which other similarly situated workers experienced in the normal work 

environment.” Casey v. United Refin. Comp. of Pa., 149 N.Y.S.3d 309, 311 
55

(App. Div. 2021) (emphasis added). Whether stress is unusual is based on the 

complainant’s occupation. See, e.g., Rivenburg v. County of Albany, 131 N.Y.S.3d 

431, 432–33 (App. Div. 2020) (affirming a denial workers’ compensation benefits 

to a correctional officer personally threatened by a colleague and whose family 

was threatened by an inmate because “[g]iven the nature of the work required of 

correction officers and the character of the individuals under confinement, the 

stress created by dealing with the inmates was no different for claimant than it 

was for other correction officers”).

Missouri courts likewise apply an objective standard to compare “the 

claimant’s level of stress with the level of stress faced by other employees in the 

same profession.” Mantia v. Mo. Dep’t of Transp., 529 S.W.3d 804, 810 (Mo. 2017) 

(en banc) (reversing an award of benefits because claimant failed “to present 

evidence the actual work events comprising the ‘same or similar conditions’ 

would have caused extraordinary and unusual stress to a reasonable highway 

worker”).9 The Iowa legislature can decide whether to restore the 

occupation-specific test for mental disability claims in our state. 

 

9Missouri’s Workers’ Compensation Act includes a special provision exempting 

firefighters from the requirement to prove work-related stress was objectively “extraordinary and 

unusual.” Mantia, 529 S.W.3d 810–11 & 811 n.2 (citing Mo. Rev. Stat. § 287.120.10 (2005)). This 

exception presumably was enacted “because the legislature believed stress is such a regular 

matter for firefighters that it would be difficult to show that stress was of an ‘extraordinary and 

unusual’ degree for those in that occupation.” Byous v. Mo. Loc. Gov’t Emps. Ret. Sys. Bd. of Trs., 

157 S.W.3d 740, 756 n.1 (Mo. Ct. App. 2005) (Smart, J., concurring in part and dissenting in 

part). The Iowa legislature has not enacted a similar provision in Iowa Code chapter 85 or chapter 

411, and I wouldn’t create one in the guise of interpretation. The legislature is the proper 

audience for Tripp’s request for a change in the law to relax proof requirements for work-related 

PTSD or other mental injuries suffered by emergency dispatchers or first responders. 
56

III. Conclusion.

For these reasons, I would affirm the district court judgment upholding 

the agency ruling denying Tripp’s mental injury claim based on its factual 

determination that the stress of her phone call was not unusual or unexpected 

for an emergency dispatcher.

Mansfield and McDonald, JJ., join this dissent.