Opinion ID: 2229709
Heading Depth: 1
Heading Rank: 1

Heading: Length of Healing Period Compensation as Fixed by Iowa Code Section 85.34(1) (1989).

Text: The payment of a healing period benefit is governed by Iowa Code section 85.34(1), which provides that, when a permanent partial disability is established, such weekly benefit shall begin on the date of injury and shall continue until the employee has returned to work or it is medically indicated that significant improvement from the injury is not anticipated or until the employee is medically capable of returning to employment substantially similar to the employment in which the employee was engaged at the time of the injury, whichever occurs first. Id. [1] In the present case, it appears without dispute that the claimant had not returned to work and was not able to return to substantially similar employment on a date some fifty-two months after his injury. As a result, the issue before the industrial commissioner, in applying the language of section 85.34(1), was when it became medically indicated that a significant improvement from the injury [was] not anticipated. There have been no decisions of this court concerning the length of the healing period under either the present statute or earlier versions of section 85.34(1). The lack of controversy in applying prior versions of the statute is perhaps explained by the fact that, under statutes in force from 1949 until 1973, the maximum length of time for which healing period benefits were payable was established as a fixed percentage of the period for which permanent partial disability benefits were payable. [2] Beginning in 1973, the healing period statute was altered by removing any reference to a statutory maximum and providing that the healing period was to run until the injured employee returned to work, was able to return to similar employment, or recuperated from the injury. 1973 Iowa Acts ch. 144, § 8. The court of appeals has decided two cases involving the length of the healing period after the statutory maximum was removed. In Armstrong Tire & Rubber Co. v. Kubli, 312 N.W.2d 60 (Iowa App.1981), that court indicated that [t]he healing period may be characterized as that period during which there is reasonable expectation of improvement of the disabling condition. Id. at 65. In Thomas v. William Knudson & Son, Inc., 349 N.W.2d 124, 125 (Iowa App.1984), the court of appeals determined that medical evidence of anticipated improvement may extend the healing period even if it is later demonstrated that the injury stabilized much earlier than anticipated. Id. at 126. The employer and insurance carrier in the present case argue that the proper time for ending the healing period is when the underlying back injury that produced the claimant's pain had stabilized. From that point on, they argue, pain management, although perhaps beneficial to the claimant in some respect, was not anticipated to change the extent of permanent industrial disability. In support of that contention, they refer to a leading workers' compensation treatise in which it is stated [t]he persistence of pain may not itself prevent a finding that the healing period is over ... provided that the underlying condition is stable. 1 C. Arthur Larson, The Law of Workmen's Compensation § 57.12(c) (1989). We are not persuaded that the persistence of pain after the underlying injury has stabilized may in no instance extend the healing period. We believe that the stability of condition referred to in Larson's treatise is a stability in industrial disability. Consequently, an anticipated improvement in continuing pain or depression, if medically indicated, may extend the length of the healing period if a substantial change in industrial disability is also expected to result. If, however, it is not likely that further treatment of continuing pain, however soothing to the claimant, will decrease the extent of permanent industrial disability, then continued pain management should not prolong the healing period. The court of appeals' statement in Thomas, 349 N.W.2d at 126, that anticipated improvement of condition will extend the healing period even if the condition ultimately stabilizes sooner than anticipated, is only correct as it applies to hindsight correction of a medical prognosis that was sound when given. It should not be viewed as standing for the proposition that any medical opinion indicating anticipated improvement will extend the healing period in the face of credible contrary evidence. The court of appeals' conclusion in the present case, that substantial improvement in claimant's condition was anticipated, appears to have been based on the statements contained in the February 25, 1988 letter to claimant's counsel from Dr. Galbraith of Columbia Hospital pain clinic. That letter stated in part: We agree that [Larry Pitzer] is a very appropriate candidate for our program and the probability of successful rehabilitation is high. It is our opinion that this treatment is necessary either directly or indirectly because of the injury he sustained on May 3, 1984, and because of the subsequent treatments and inactivity.... We fail to understand the difficulty in getting authorization for treatment for this unfortunate gentleman. He has suffered a great deal and has become depressed, discouraged and angry. These factors may have complicated his treatment in the past but are natural consequences of what he has been through and will respond to appropriate treatment. The industrial commissioner could properly have viewed Dr. Galbraith's letter with some skepticism in view of the empirical data in claimant's clinical history at the University of Wisconsin pain clinic. After claimant's underlying back injury had stabilized on April 9, 1986, efforts were made at that clinic to further reduce his residual pain with an eye toward lessening his degree of permanent industrial disability. At the end of a six-month period, no noticeable progress towards that goal had been realized. The industrial commissioner chose to terminate the healing period at this point. We conclude that claimant's clinical history at the University of Wisconsin pain clinic constitutes substantial evidence in the record to support the industrial commissioner's finding that, after November 18, 1986, it was not medically indicated that he would obtain significant improvement in his industrial disability from future pain management programs. This conclusion is buttressed by the fact that it is not made clear in Dr. Galbraith's letter just how the Columbia Hospital program would benefit claimant. It is quite possible that claimant could have obtained some worthwhile benefits from that program through proposed coping strategies for residual pain, and yet not have lessened his degree of permanent industrial disability. All of this was for the industrial commissioner to sort out, and given the conflicting and uncertain evidence as to anticipated improvement in claimant's disability, the decision that he rendered may not be overturned on judicial review.