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The Importance of Proving “Causation” in Workers’ Compensation Cases


Workers’ compensation benefits in Iowa depend on “causation”–that is, whether or not you can prove that your injury arose out of your employment. The mere fact you are injured does not, in and of itself, establish causation. For example, if you suffer from a degenerative condition, the Iowa Workers’ Compensation Commission may determine that–not any work-related accident–is the cause of your symptoms and deny you benefits. However, even if you suffer from a pre-existing condition, such as a degenerative condition, if your pre-existing condition becomes aggravated or worsened in the course of employment, it is treated the same as if it were a new injury, and you may be entitled to workers’ compensation benefits.

Workers’ Comp Officials Believe Doctors Over Injured Worker Regarding Chronic Pain

Take this recent decision by the Iowa Court of Appeals. In this case, a former prep cook for a residential care facility in Johnston sought workers’ compensation benefits after she lost her job due to chronic back pain. The plaintiff said she was injured on the job in 2013 while moving a heavy cart. She immediately reported the injury to her supervisor, but did not seek medical treatment until two months later. At that time, a doctor approved by the employer placed the plaintiff on restricted work duty. Shortly thereafter, the employer fired the plaintiff.

Several months later, the plaintiff received an independent medical exam from a second doctor, who was also approved by the employer. This doctor believed the plaintiff was “exaggerating” her complaints of ongoing pain and that testing did not reveal any “physiologic” problem. At best, the doctor said the plaintiff “suffered an extremely minimum, if any, injury” to her back and that there was no reason to believe it was the cause of her current problems. The doctor also pointed to the plaintiff’s initial delay in seeking medical treatment as further proof the plaintiff was “malingering,” or fabricating her symptoms.

The plaintiff did eventually undergo back surgery. But the operating surgeon concluded the plaintiff suffered from a degenerative back problem and that “to the nearest degree of medical certainty, the causation of this injury is not related to work.” Based on these medical opinions, the workers’ compensation commissioner reversed an arbitrator’s earlier decision awarding the plaintiff weekly workers’ compensation benefits and future medical expenses.

The Court of Appeals upheld the commissioner’s decision. Rejecting the plaintiff’s appeal, the Court said this basically came down to an assessment of credibility. The commissioner decided the testimony of the two doctors was simply more believable than that of the plaintiff and other experts who supported her claim that the work-related injury caused her chronic back pain. The Court noted its role on appeal was not to reassess the commissioner’s credibility determinations, only to ensure that there was “substantial evidence” supporting the ultimate decision.

Seek Medical (and Legal) Assistance Following a Workplace Accident

If there’s one takeaway from this case, it is that you should always seek immediate medical attention following any workplace accident. Even if you do not immediately experience any serious pain or other symptoms, it is in your best interest to begin documenting your condition as soon as possible. “Working through the pain” is not a wise strategy, as it may be used against you as evidence that you are faking or exaggerating symptoms after-the-fact.

You should also seek legal advice from a qualified Iowa workers’ compensation attorney who understands the system and can help you seek the benefits you deserve. Contact the Noyes Law Office P.C. if you need to speak with someone right away.



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