In the Iowa Supreme Court
No. 24–1991
Submitted February 18, 2026—Filed May 29, 2026
Jerry Hayes,
Appellant,
vs.
Christian Retirement Homes, Inc., d/b/a Ridgecrest Senior Living Center, and West Bend Mutual Insurance Co.,
Appellees.
On review from the Iowa Court of Appeals.
Appeal from the Iowa District Court for Polk County, Jeffrey Farrell, judge.
A claimant seeks further review of a court of appeals decision that affirmed
the district court’s decision upholding the workers’ compensation
commissioner’s denial of workers’ compensation benefits. Decision of Court of
Appeals Affirmed in Part and Vacated in Part; District Court Judgment
Affirmed.
Waterman, J., delivered the opinion of the court, in which all justices
joined.
Nicholas L. Shaull and Bryant A. Engbers of Spaulding & Shaull, P.L.C.,
Des Moines, for appellant.
Michael S. Roling and Morgan R. Todd Borron of Peddicord Lillis, LLP,
West Des Moines, for appellees. 2
Waterman, Justice.
We granted further review in this case to address a recurring issue,
namely, when the workers’ compensation commissioner rules against a claimant
and necessarily rejects an argument without specifically discussing it, does the
claimant have to file a motion for rehearing to preserve error on that argument
for appellate review? At every level, from the deputy commissioner to our court,
the claimant in this case argued that his employer as a matter of law should be
bound by the opinion of the employer’s chosen treating physician in deciding
whether his on-the-job accident caused a permanent disability. The employer
obtained and relied on a second medical opinion to dispute permanency, and the
commissioner, as factfinder, relied on that second opinion to deny benefits
without addressing the claimant’s legal argument. The district court affirmed.
The court of appeals determined that the claimant failed to preserve error on that
legal argument by not filing a motion for rehearing to elicit a specific ruling on
it. The court of appeals, determining that the decision was supported by
substantial evidence, affirmed the agency’s denial of the claim.
On our review, we hold that the claimant preserved error at the agency
level when he argued that the employer was bound by the findings of its treating
physician. The agency necessarily rejected that legal argument when it relied on
another physician’s opinion to deny benefits. A motion for rehearing was not
required. On the merits, we hold that employers are not necessarily bound by a
causation opinion of a treating physician they select when another medical
expert who examined the claimant provides a contrary opinion. We affirm the
commissioner’s decision as supported by substantial evidence. 3
I. Factual and Procedural Background.
The employer, Christian Retirement Homes, Inc., doing business in
Davenport as Ridgecrest Senior Living Center (Ridgecrest), hired Jerry Hayes in
July 2021 to work as a dishwasher. Among other duties, the written job
description stated that the position entailed:
Routinely engag[ing] in light to medium physical activity associated with moving foodstuffs, pushing and pulling carts and racks, lifting institutional size cooking equipment, and operating kitchen equipment. Routinely lift[ing] up to 25 lbs. Occasionally lift[ing] up to 50 lbs. while moving bulk food items and pushing/pulling loaded food carts and racks.
Before he began working for Ridgecrest, Hayes underwent a physical
examination with Dr. Christopher Crome, and Hayes filled out an employee
health examination record form. On that form, Hayes noted that he had “a little
back pain.”
In fact, Hayes had a long history of back pain, including a back injury that
required surgery in 1999, preexisting lumbar disc disease and chronic neck and
back pain, a back injury attributable to a 2014 car accident, leg and back pain
resulting from a fall down stairs in 2015, additional back pain with radiating
pain into his legs attributable to a 2017 car accident, a head injury and back
pain from a 2018 car accident, a permanent lifting restriction of twenty pounds,
degenerative anterolisthesis of the L5 vertebra, and bulging discs. After
Dr. Crome cleared him for work, Hayes, then age sixty-seven, started at
Ridgecrest on July 29, 2021.
On September 12, Hayes was taking out the garbage when he tripped and
fell onto his back. Initially, Hayes rebounded and felt no pain, but eight days
later, he filled out an incident report and was sent to Genesis Hospital for 4
treatment. X-rays of Hayes’s lower spine showed no new injuries, and Genesis
referred Hayes for physical therapy.
On October 1, Hayes returned to Ridgecrest, where he was assigned “light
duty.” A few days later, Hayes underwent a computed tomography (CT) scan,
which showed anterolisthesis, foraminal stenosis (compression of the spinal
nerves caused by a narrowing of the neural canals), and bulging discs.
On November 10, Hayes, still suffering from lumbar and leg pain, sought
further treatment. Ridgecrest directed Hayes to Dr. Michael Dolphin at
Orthopedic Specialists in Davenport. Dr. Dolphin is a board-certified orthopedic
surgeon. Dr. Dolphin reviewed Hayes’s recent medical history, ordered a CT
myelogram (a scan of the spinal nerves), and instructed Hayes to stop working.
Just over a week later, Dr. Dolphin permitted Hayes to return to work, with a
ten-pound lift limit. Hayes attempted to work but said it exacerbated his
symptoms, and on November 23, Dr. Dolphin took Hayes off work altogether.
On December 16, Hayes underwent the CT myelogram recommended by
Dr. Dolphin. Dr. Dolphin reviewed the results with Hayes on December 28. The
scan showed herniation of Hayes’s spinal discs, foraminal stenosis, and
degenerative disc disease. Dr. Dolphin recommended that Hayes undergo back
surgery, specifically a fusion of the L4 and L5 vertebrae and a posterior
laminectomy of the L3, L4, and L5 vertebrae.
Before authorizing the surgery, Ridgecrest requested that Dr. Cassim
Igram perform an independent examination of Hayes. Dr. Igram is a
board-certified orthopedic surgeon practicing at the University of Iowa Hospitals
and Clinics. On April 27, 2022, Dr. Igram reviewed Hayes’s complete medical
history, compared his CT scans from 2019 to those from 2021, and opined that
Hayes suffered from chronic lower back pain, which was temporarily inflamed 5
by his September fall. But according to Dr. Igram, that temporary injury was
resolved, and any further treatment was related to Hayes’s preexisting chronic
back pain.
Dr. Dolphin and Dr. Igram issued dueling letters opining as to the cause
of Hayes’s injury. Dr. Dolphin stated that Hayes’s September fall “more likely
than not represented a substantial causal, contributing or aggravating factor in
[Hayes’s] severe low back pain.” Dr. Igram, on the other hand, concluded that
Hayes did not need additional treatment for the September 12, 2021, fall and
attributed no permanent disability to that fall.
Dr. Dolphin again evaluated Hayes on June 28; again, he recommended
surgery. On September 12, Hayes underwent surgery. The cost of the surgery
was paid for by Hayes’s health insurance because the workers’ compensation
insurer for Ridgecrest disputed causation. On April 11, 2023, Dr. Dolphin
opined that Hayes had a 23% whole-body impairment rating.
Hayes applied for workers’ compensation benefits. Ridgecrest stipulated
that Hayes sustained a work-related injury that caused a temporary disability.
The parties disputed whether Hayes’s fall on September 12, 2021, caused a
permanent disability. Hayes relied on Dr. Dolphin’s medical opinions to argue
that he had sustained a permanent work-related injury that entitled him to an
award of permanent partial disability benefits, alternative medical care, payment
of his reasonable medical expenses, and reimbursement for costs incurred for
Ridgecrest’s independent medical exam. Undergirding Hayes’s position was his
argument that Ridgecrest was bound by the medical conclusions of its chosen
treating physician, Dr. Dolphin. Ridgecrest relied on the opinions of Dr. Igram.
Hayes’s case was fully submitted to the workers’ compensation commission on
June 13. 6
On December 6, a deputy commissioner issued an arbitration decision
denying Hayes’s claim for permanent disability benefits. The deputy, who heard
Hayes testify live, specifically found that he lacked credibility because he
minimized his prior back problems and had not been forthcoming about his
medical history. The deputy also found Dr. Igram’s testimony “more reliable”
because he “had full knowledge of claimant’s medical history,” which Dr. Dolphin
lacked, and because Dr. Igram relied on CT scans taken before Hayes fell at
Ridgecrest, which Dr. Dolphin also lacked. The deputy described Dr. Igram’s
findings on the CR scans, causation, diagnosis, and maximum medical
improvement (MMI):
[Dr. Igram] compared both pre- and post-injury CTs which showed no structural difference. The large disk herniation at L4-L5 was present on both pre- and post-September 12, 2021, CT scans. It was the disk herniation that necessitated the surgery. Dr. Igram diagnosed claimant with chronic back pain with underlying degenerative disease and set claimant’s MMI date as of April 27, 2022, with no ratable injury.
(Citation omitted.) The deputy relied on Dr. Igram’s opinion on medical causation
to deny Hayes’s claim for permanent disability benefits. The deputy did not
specifically address Hayes’s legal argument that Dr. Dolphin’s opinion should
control because Ridgecrest chose him to treat Hayes.
Hayes pursued an intra-agency appeal, requesting that the commissioner
overturn the decision of the deputy commissioner. The commissioner affirmed
the deputy’s decision without discussing Hayes’s argument that Dr. Dolphin’s
opinion was binding on Ridgecrest. Hayes filed this action for judicial review of
the agency’s decision.
On judicial review, Hayes argued that the commissioner erred by not
holding Ridgecrest to the opinion of its chosen treating physician, Dr. Dolphin.
The district court acknowledged Hayes’s argument, rejected it, and upheld the 7
commissioner’s denial of benefits as supported by substantial evidence. Hayes
appealed, and we transferred the case to the court of appeals.
The court of appeals panel affirmed the district court’s decision. The
panel’s decision rested on two pillars: (1) Hayes did not preserve error on his
argument that Ridgecrest was bound by Dr. Dolphin’s opinions because he did
not file a petition for rehearing at the agency for a specific ruling on that point,
and (2) the district court correctly determined that substantial evidence
supported the commissioner’s decision. Hayes applied for further review, which
we granted.
II. Standard of Review.
Hayes seeks reversal of the commissioner’s decision on the issue of
medical causation. “Our decision is controlled in large part by the deference we
afford to decisions of administrative agencies.” Cedar Rapids Cmty. Sch. Dist. v.
Pease, 807 N.W.2d 839, 844 (Iowa 2011). “Medical causation presents a question
of fact that is vested in the discretion of the workers’ compensation commission.”
Id. “We will therefore only disturb the commissioner’s finding of medical
causation if it is not supported by substantial evidence.” Id. at 845.
The Code defines substantial evidence as: “the quantity and quality of
evidence that would be deemed sufficient by a neutral, detached, and reasonable
person, to establish the fact at issue when the consequences resulting from the
establishment of that fact are understood to be serious and of great importance.”
Iowa Code § 17A.19(10)(f)(1) (2024). “Evidence is not insubstantial merely
because different conclusions may be drawn from the evidence.” Pease,
807 N.W.2d at 845. “[E]vidence may be substantial even though we may have
drawn a different conclusion as fact finder.” Id. “Our task, therefore, is not to
determine whether the evidence supports a different finding; rather, our task is 8
to determine whether substantial evidence, viewing the record as a whole,
supports the findings actually made.” Id.
“We review the commissioner’s ‘legal interpretations of Iowa Code
chapter 85 for errors at law rather than giving deference to those
interpretations.’ ” Mid Am. Constr. LLC v. Sandlin, 2 N.W.3d 838, 846 (Iowa 2024)
(quoting Gumm v. Easter Seal Soc’y of Iowa, Inc., 943 N.W.2d 23, 28 (Iowa 2020)).
III. Analysis.
We must decide whether Hayes preserved error on his claim that
Ridgecrest was bound by the medical opinions of its chosen treating doctor, and
whether the commission’s decision was supported by substantial evidence. We
determine that Hayes preserved error, and, on the merits, we reject his claim
that Ridgecrest was bound by Dr. Dolphin’s medical opinions. We then
determine that substantial evidence supports the commissioner’s decision.
A. Error Preservation. The contested issue at the agency was whether
Hayes sustained a permanent disability because of his fall at Ridgecrest. One
argument Hayes made at the agency in support of his position was that
Ridgecrest must be bound by Dr. Dolphin’s opinion on causation because
Ridgecrest selected him to treat Hayes. The agency did not expressly address
that argument in its written decision. But the agency implicitly and necessarily
rejected that argument when it denied Hayes’s claim for permanent disability
benefits by relying instead on the conflicting opinions of Dr. Igram.
Hayes renewed his argument in district court. The district court
acknowledged that argument, rejected it as legally unsound, and went on to
affirm the agency decision as supported by substantial evidence. When Hayes
renewed his argument on appeal, Ridgecrest did not argue that he failed to
preserve it; rather, its appellate brief agreed Hayes preserved error on the 9
contested issues of “causation and, compensability regarding alleged permanent
disability.” The court of appeals, on its own, determined that Hayes failed to
preserve error because he did not file a motion for rehearing at the agency to get
a specific ruling on his argument that Dr. Dolphin’s opinion was binding on
Ridgecrest. We disagree that such a motion was needed to preserve error on that
point.
“We have held a party preserves error on an issue before an agency if a
party raises the issue in the agency proceeding before the agency issues a final
decision and both sides have had an opportunity to address the issue.” Staff
Mgmt. v. Jimenez, 839 N.W.2d 640, 647 (Iowa 2013). That happened here. Hayes
raised the issue of whether his September 2021 fall caused a permanent
disability, and Ridgecrest had an opportunity to address that issue, including
Hayes’s supporting argument that Ridgecrest was bound by the causation
opinion of the treating physician it selected.
A party must file a motion for rehearing only when it raises an issue before
the agency, and the agency fails to rule on that issue. As we put it:
When an agency fails to address an issue in its ruling and a party fails to point out the issue in a motion for rehearing, we find that error on these issues has not been preserved. Our respect for agency processes in administrative proceedings is comparable to that afforded to district courts in ordinary civil proceedings. Just as we do not entertain issues that were not ruled upon by the district court and that were not brought to the district court’s attention through a proper posttrial motion, Meier v. Senecaut, 641 N.W.2d 532, 540 (Iowa 2002), we decline to entertain issues not ruled upon by an agency when the aggrieved party failed to follow available procedures to alert the agency of the issue.
KFC Corp. v. Iowa Dep’t of Revenue, 792 N.W.2d 308, 329 (Iowa 2010). But here,
the issue to be decided by the agency was whether Hayes suffered a permanent 10
disability. The agency decided that issue. Hayes lost and was entitled to renew
his supporting arguments on judicial review, and he did so.
Our cases distinguish “between the situation where error was preserved
even though ‘the record or ruling on appeal contains incomplete findings or
conclusions,’ and the situation where the issue was ‘not considered by’ the
district court and thus error was not preserved.” Lamasters v. State, 821 N.W.2d
856, 864 (Iowa 2012) (quoting Meier v. Senecaut, 641 N.W.2d 532, 539–40
(Iowa 2002)). In our view, this case falls in the former category: the agency’s
decision denying benefits “contains incomplete . . . conclusions,” id., in that it
failed to specifically reject in writing Hayes’s argument that Ridgecrest was
legally bound by the permanency opinion of its chosen physician. But the agency
necessarily rejected that argument when it relied instead on the opposing
opinion of Dr. Igram. Cf. Meier, 641 N.W.2d at 539 (“[W]e assume the district
court rejected each defense to a claim on its merits, even though the district
court did not address each defense in its ruling.”). The court of appeals applied
our error preservation rules too narrowly. See State v. Childs, 898 N.W.2d 177,
181 (Iowa 2017) (collecting cases explaining that error is preserved when the
district court necessarily rejects an argument without discussing it).
We conclude error was preserved. A contrary holding would trigger
unproductive motions for rehearing any time the agency failed to specifically
address every supporting argument made by the party losing an issue.
B. Was Ridgecrest Bound by Dr. Dolphin’s Medical Opinions? Because
we determine that Hayes preserved error, we now address the merits of his
argument that Ridgecrest, by referring Hayes to Dr. Dolphin for treatment, was
bound by Dr. Dolphin’s opinions. 11
Hayes primarily relies on prior agency decisions applying Iowa Code
section 85.27(4) (2021) governing alternate medical care. For example, he cites
the agency decision in Gardner v. Menards, Inc., which concluded that the
employer is not authorized “to interfere with the medical judgment of its own
treating physician.” Iowa Workers’ Comp. Comm’n No. 5054642.03, 2024
WL 5154673, at *3 (Dec. 10, 2024). But section 85.27(4) and agency decisions
applying it are inapplicable to this contested case proceeding. Section 85.27(4)
provides an expedited procedure to determine the course of treatment when the
employer does not contest liability. See Iowa Admin. Code r. 876—4.48. By
contrast, in contested case arbitration hearings, the employer may contest
causation, and the commissioner, as trier of fact, “has a duty to weigh the
evidence and measure the credibility of witnesses.” Pease, 807 N.W.2d at 845.
Medical causation is a question of fact vested in the discretion of the
commissioner. Id. at 844–45. Hayes’s position would interfere with the
commissioner’s factfinding role by requiring approval of the opinion of the
employer’s chosen treating physician, regardless of the conflicting opinions of
another examining physician.
In any event, Iowa courts are not bound by the legal conclusions in agency
decisions. Rather, “[t]he controlling legal standards are those set out in the
workers compensation statutes and in this court’s opinions, not in prior agency
decisions.” Finch v. Schneider Specialized Carriers, Inc., 700 N.W.2d 328,
331–32 (Iowa 2005) (per curiam); see also Keystone Nursing Care Ctr. v.
Craddock, 705 N.W.2d 299, 304 n.2 (Iowa 2005) (“[T]he commissioner’s final
decision is judged against the backdrop of the workers’ compensation statute
and the Iowa appellate cases interpreting it, not previous agency decisions.”). 12
Hayes also relies on our cases recognizing the obligation of workers’
compensation insurers to act in good faith. See, e.g., Thornton v. Am. Interstate
Ins., 897 N.W.2d 445, 461 (Iowa 2017). Hayes suggests that an employer cannot
in good faith disavow the causation opinion of the doctor it hired to treat its
injured employee. But Hayes did not bring a bad-faith claim,1 nor did the
commissioner award penalty benefits. Ridgecrest prevailed on the merits of
Hayes’s claim for permanent disability benefits, and bad-faith cases such as
Thornton are inapposite.
Hayes cites no on-point Iowa appellate court decision holding that an
employer in a contested case proceeding is bound by the causation opinion of
the physician the employer selected to treat its employee. And we find no
controlling statutory provision requiring that result in contested case hearings.
Hayes argues that Iowa Code section 85.39(1), governing independent
medical examinations, supports his view. We disagree. Section 85.39(1) provides
in relevant part,
After an injury, the employee, if requested by the employer, shall submit for examination at some reasonable time and place and as often as reasonably requested, to a physician or physicians authorized to practice under the laws of this state or another state, without cost to the employee; but if the employee requests, the employee, at the employee’s own cost, is entitled to have a physician or physicians of the employee’s own selection present to participate in the examination.
(Emphasis added.) Nothing in section 85.39(1) binds the employer to the medical
causation opinion of the treating physician that the employer chose earlier. To
1“To establish a first-party bad-faith claim against a workers’ compensation insurer, the
plaintiff must show ‘(1) that the insurer had no reasonable basis for denying benefits under the policy and, (2) the insurer knew, or had reason to know, that its denial was without basis.’ ” Thornton, 897 N.W.2d at 461–62 (quoting McIlravy v. N. River Ins., 653 N.W.2d 323, 329 (Iowa 2002)). Hayes had no viable bad-faith claim against Ridgecrest or its workers’ compensation insurer because there was a reasonable basis for denying benefits based on the opinion of Dr. Igram. 13
the contrary, section 85.39(1) confirms that the employer and claimant alike may
seek another opinion from a qualified physician. It is up to the commissioner, as
factfinder, to determine which medical opinions are more persuasive.
We hold that the employer in a contested case proceeding is not bound by
the medical causation opinion of the employer’s chosen treating physician when
a contrary medical opinion is supported by the record.
C. Substantial Evidence. Finally, we turn to Hayes’s fact-bound
argument that the commissioner’s decision was not supported by substantial
evidence. The court of appeals and district court determined that substantial
evidence supported the commissioner’s decision. We agree.
The deputy commissioner relied on Dr. Igram’s medical opinions over
Dr. Dolphin’s. According to Dr. Dolphin’s notes, Hayes reported having lumbar
surgery in 1999 but denied any recent injuries. Hayes also informed Dr. Dolphin
about his previous heart attack and about a car crash injury from January 2018.
Hayes testified that he never told Dr. Dolphin about the lifting restrictions that
Dr. Crome had imposed.
Dr. Igram had the more complete picture of Hayes’s medical history. He
reviewed all the relevant records, including the following entries: (1) Hayes’s
1999 back surgery, (2) Hayes’s 2003 struggles with chronic back and leg pain,
(3) Hayes’s injuries from a 2014 car accident, (4) Hayes’s injuries from a January
2015 fall down the stairs, (5) Hayes’s injury from a March 4, 2015, slip and fall,
(6) Hayes’s struggle to walk due to lower back pain in November 2016, (7) Hayes’s
injuries from a 2017 car crash, (8) Hayes’s injuries from a January 2018 car
crash, (9) Hayes’s permanent work restrictions—imposed by Dr. Crome—in
December 2018, (10) Hayes’s April 2019 reports of chronic pain in his left knee, 14
(11) Hayes’s prescriptions—written by Dr. Crome—for medications to combat his
chronic back pain. Most of that history was not disclosed to Dr. Dolphin.
The deputy commissioner who heard Hayes testify made detailed
credibility findings. As the district court noted,
The deputy found that Hayes lacked credibility with some of the reports he made on his medical history, particularly minimizing back pain prior to this fall on September 12, 2021. She also noted that he was not forthcoming regarding his health history when hired by the employer. Her overall assessment of his credibility led to a finding that his testimony was “troubling.”
Dr. Igram also studied the CT scans of Hayes’s spine taken in 2019 and
compared them to the CT scans taken after Hayes’s fall at Ridgecrest. The
herniated disc that Dr. Dolphin opined required surgery because of the 2021 fall
at Ridgecrest was already present on the scan in 2019. Dr. Igram saw no
structural change in those scans. Dr. Dolphin never saw the 2019 CT scans.
Dr. Igram’s opinions were well-supported by a review of Hayes’s complete
medical history and CT scans before and after the September 2021 fall.
Dr. Dolphin did not have the complete picture. The deputy commissioner
credited Dr. Igram’s testimony and denied Hayes’s request for permanency
benefits. The commissioner adopted her findings and conclusions in the agency’s
final decision.
On our review, we do not ask whether we would have made the same
decision as the commissioner; we only ask whether the evidence in the record
supports the decision made. City of Des Moines v. Emp. Appeal Bd., 722 N.W.2d
183, 195 (Iowa 2006). And, as our court of appeals has aptly noted: “A case
reversing final agency action on the ground the agency’s action is unsupported
by substantial evidence or is irrational, illogical, or wholly unjustifiable is the
Bigfoot of the legal community—an urban legend, rumored to exist but never 15
confirmed.” McComas-Lacina Constr. v. Drake, No. 15–0922, 2016 WL 2744948,
at *1 (Iowa Ct. App. May 11, 2016) (McDonald, J.). The commissioner could rely
on Dr. Igram’s opinion to deny Hayes’s claim for permanent disability benefits.
His medical opinion provided substantial evidence supporting the agency’s
decision. We affirm the decision of the court of appeals and the district court’s
judgment upholding the agency decision. We agree with the court of appeals that
Hayes’s claims for additional relief lack merit.2
IV. Conclusion.
For the foregoing reasons, we affirm in part and vacate in part the decision
of the court of appeals. We affirm the district court judgment that upheld the
commissioner’s decision.
Decision of Court of Appeals Affirmed in Part and Vacated in Part;
District Court Judgment Affirmed.
2Hayes seeks reimbursement for the costs of his independent medical examination. But
the employer is “only liable to reimburse an employee for the cost of an examination . . . if the injury for which the employee is being examined is determined to be compensable under this chapter.” Iowa Code § 85.39(2). Because we affirm the commissioner’s denial of benefits, Ridgecrest is not liable to reimburse Hayes.