File No. 957007
         CLOW CORPORATION,     
                                               A P P E A L
                                             D E C I S I O N
              Insurance Carrier,    
         The record, including the transcript of the hearing before the 
         deputy and all exhibits admitted into the record, has been 
         reviewed de novo on appeal.  The Arbitration Decision filed 
         February 26, 1992 and the Remand Decision filed October 27, 1992 
         are affirmed and are adopted as the final agency action in this 
         Defendants shall pay the costs of the appeal, including the 
         preparation of the hearing transcript.
         Signed and filed this ____ day of September, 1993.
                                           BYRON K. ORTON
                                      INDUSTRIAL COMMISSIONER
         Copies To:
         Mr. Harold B. Heslinga
         Attorney at Law
         118 North Market St.
         Oskaloosa, Iowa 52577
         Mr. E. J. Kelly
         Attorney at Law
         2700 Grand Ave., Ste 111
         Des Moines, Iowa 50312
                                           5-1803; 3701; 4000.2
                                           Filed September 24, 1993
                                           BYRON K. ORTON
            RAYMOND LANGSTRAAT,   
                                                File No. 957007
            CLOW CORPORATION,     
                                                 A P P E A L
                                              D E C I S I O N
                 Insurance Carrier,    
            5-1803; 4000.2
            Claimant awarded 30 percent industrial disability and 15 
            weeks of penalty benefits.  Although extent of permanency 
            could be reasonably disputed, the existence of some loss of 
            earning capacity could not.
            Defendants' characterization of surveillance evidence was 
            shown impossible by time-stamping on the photos in evidence.  
            Evidence was criticized in detail.
            Page   1
                     before the iowa industrial commissioner
            RAYMOND LANGSTRAAT,           :
                 Claimant,                :
            vs.                           :         File No. 957007
            CLOW CORPORATION,             :      A R B I T R A T I O N
                 Employer,                :         D E C I S I O N
            and                           :
            GAB,                          :
                 Insurance Carrier,       :
                 Defendants.              :
                              statement of the case
                 Claimant Raymond Langstraat seeks benefits under the 
            Iowa Workers' Compensation Act upon his petition in 
            arbitration against employer Clow Corporation and GAB 
            Business Services, Inc.  Mr. Langstraat sustained a back 
            injury arising out of his employment on July 17, 1990, and 
            alleges resultant temporary and permanent disability.
                 This cause came on for hearing in Ottumwa, Iowa, on 
            December 19, 1991.  Claimant, Denise Spurgeon, Mary 
            Langstraat and Victor Laughlin testified at hearing.  The 
            record also contains joint exhibits 1 through 5.  Several 
            pages of electrocardiogram tracings were accidently inverted 
            when they were placed in a ring binder holding exhibits.  
            This did not affect the result here, since any possible 
            relevance of those and many other pages of evidence remains 
            a mystery.
                 The parties have stipulated that claimant sustained an 
            injury arising out of and in the course of his employment on 
            July 17, 1990, to the rate of compensation ($284.96 per 
            week), that medical benefits are not in dispute and that 
            certain benefits have been voluntarily paid.
            Page   2
            Issues presented for resolution include:
                 1.  Whether there exists a causal relationship between 
            the injury and temporary and/or permanent disability;
                 2.  The extent of each; and,
                 3.  Whether claimant is entitled to penalty benefits 
            under Iowa Code section 86.13.
                                 findings of fact
                 The undersigned deputy industrial commissioner finds:
                 Raymond Langstraat, 47 years of age at hearing, has 
            lived his entire life in the state of Iowa.  He is a 1962 
            high school graduate with no further education.  His life 
            has been largely devoted to hard physical labor.  Mr. 
            Langstraat has worked as a farmer and farm hand, a livestock 
            hauler, and as a concrete and road worker.  Beginning in 
            February 1988, he commenced employment with Clow 
            Corporation, a manufacturer of heavy water valves.  Claimant 
            worked as a bench grinder, a job requiring the use of hand 
            tools weighing up to perhaps 15 pounds to grind excess 
            materials and castings from water valves weighing up to 500 
                 Prior to beginning work with Clow Corporation, claimant 
            had no history of chronic back complaints.  However, he 
            testified to having a "vertebra slip" at age 18 for which he 
            saw a doctor in Ottumwa 3-5 times.  No surgery was 
            performed, but he wore a corset while working as a farm hand 
            that summer.  Later, claimant became a partner in the farm 
            with his father and used his back constantly without 
            problems for many years.  Although medical records, 
            especially including Mahaska County Hospital, are to some 
            extent difficult to read, this deputy has not found any 
            record of lumbar complaints.  If they exist, they are well 
            camouflaged among many pages of irrelevant evidence.  He 
            underwent a preemployment physical at the behest of Clow 
            Corporation on February 12, 1988.  This included x-rays of 
            the lumbar spine, read as negative.
                 On July 16, 1990, claimant developed a twinge in his 
            back while manipulating a 275-pound water valve on his 
            workbench.  Lumbar pain developed progressively during the 
            rest of his shift to the extent that, after showering at 
            work, he proved unable to bend down to pick up clothes.
                 After claimant returned home, his wife arranged an 
            immediate visit with Terry Wolfswinkel, D.C.  Claimant was 
            seen immediately.  Chart notes reflect complaints of back 
            pain radiating down the right leg to the ankle and 
            tenderness at L5.  According to claimant, Dr. Wolfswinkel 
            refused to employ chiropractic manipulation because "this 
            isn't good."
            Page   3
                 Claimant was next seen at the Mahaska County Hospital 
            at 2:14 a.m. on the morning of July 17.  Chart notes of 
            difficult legibility reflect a history of developing 
            discomfort while twisting at work increasing in the lower 
            back without relief after use of ice at home.  Complaints 
            were of right lower back pain radiating down the right leg 
            with tingling foot.  Claimant stated his leg had given out 
            on him that night.
                 On July 23, still with symptoms, claimant was seen by 
            another chiropractor, Thomas H. Stanzel, D.C.  Dr. Stanzel 
            was given a similar history as to development of symptoms.  
            Claimant was treated on six occasions from July 23 to July 
            30, but did not respond, following which he was referred for 
            magnetic resonance imaging, then to an orthopaedic surgeon, 
            William R. Boulden, M.D.
                 Dr. Stanzel examined claimant again on November 7, 
            1991.  Claimant reported that two days earlier, "his low 
            back pain became so severe while getting up out of a chair 
            that it made him pass out from 3:30 p.m. until 11:30 p.m."  
            Examination revealed marked nodularity and fibrosis 
            accompanied by pain especially at L5-S1.  Range of motion of 
            the lumbar spine was mildly restricted.  Findings were 
            similar and consistent to those of July 23, 1990, except 
            slightly less back pain and improved lumbar range of motion 
            were reported.  Diagnosis was of chronic lumbo-sacral 
            myofascial pain syndrome complicated by dysfunctional spinal 
            mechanics along with pain and numbness into the legs with 
            mild central disc herniation.  Dr. Stanzel assigned a ten 
            percent body as a whole impairment rating.  However, no 
            restrictions were suggested.
                 Magnetic resonance imaging studies were done by J. J. 
            Gleich, M.D., on August 1, 1990.  Impression was of mild 
            degenerative disc disease not unusual for claimant's age, 
            but a small central herniation at L3-4.  Dr. Gleich also 
            found spondylolysis (deterioration) with spondylolisthesis 
            (displacement) at L5-S1.
                 Claimant was first seen by Dr. Boulden on August 15, 
            1990.  Complaints of buttock and leg pain on the right side 
            were worse than lumbar complaints.  Dr. Boulden was given a 
            history similar to claimant's testimony.  Dr. Boulden 
            reviewed x-rays showing claimant to have three levels of 
            degenerative disc disease and spondylolysis at L5 causing a 
            grade I spondylolisthesis along with significant foraminal 
            stenosis.  Impression was of aggravation of underlying 
            spinal stenosis (narrowing) secondary to the 
            spondylolisthesis at L5-S1.  Conservative treatment was 
            recommended, including epidural steroid injections, although 
            these were refused.  Dr. Boulden did not find claimant 
            suitable to return to work at that time.
                 Chart notes of August 30 were essentially unchanged.  
            On September 13, Dr. Boulden wrote that standing and walking 
            could be expected to be a problem and claimant should stand 
            Page   4
            or walk no more than 30-45 minutes before alternating 
            position.  On September 18, Dr. Boulden suggested starting 
            restrictions including a 25-pound weight limit, only four 
            hours of work a day with alternating sitting, standing and 
            walking with a maximum of 30 minutes at each activity and 
            made an unclear reference to bending and twisting of the 
            back; whether claimant would progress from that point was 
                 On October 2, claimant was seen again.  He had just 
            begun working six hours per day and Dr. Boulden suggested 
            that when he reached eight hours, he should maintain that 
            level for approximately a month before progressing to the 
            ten-hour shift normally worked on light duty.  "I think his 
            duty needs to be permanent light duty.  I don't see any way 
            he will get back to doing heavy work in the future.  This 
            includes if surgery is ever considered."
                 Another incident occurred on or about October 20, 1990.  
            While sitting at home watching TV that night, claimant's 
            back "went out" on him when he tried to get up.  He needed 
            assistance to get off the couch and found it hard to walk.  
            The next day, he called Denise Spurgeon, safety coordinator.  
            According to Ms. Spurgeon, claimant made reference to having 
            washed windows and cleaned house that day, although claimant 
            in his testimony minimized the amount of work he had 
            actually been doing.  On October 30, he sought treatment at 
            the Family Medical Center where chart notes of that date 
            indicate he had "reinjured" his back.  The treating 
            physician recommended he again be off work.  Claimant did 
            not return to work this time until February 25, 1991.
                 On October 26, 1990, an unsigned note in the personnel 
            file indicates claimant had called to request a leave of 
            absence, stating that the pain was "different than before."
                 Dr. Boulden was next seen on November 13.  His notes 
            appear to show that little had changed.  On January 7, 1991, 
            Dr. Boulden wrote that, in his opinion, claimant had "at 
            best" aggravated a preexisting degenerative disc disease at 
            the back.  The meaning of "at best" is ambiguous.  He also 
            believed that claimant could "more than likely continue 
            light duty within the general restrictions" he had 
            previously outlined.
                 On February 20, 1991, claimant was seen by Dr. Boulden 
            for the last time.  He recommended that symptoms could be 
            kept under better control if claimant remained within his 
            restrictions of no bending or twisting with the back and 
            alternating sitting every 30-45 minutes.  Since the doctor 
            would "still stand by the restrictions previously sent," it 
            appears that the 25-pound weight restriction was to remain 
            in effect.
                 On November 18, 1991, Dr. Boulden wrote again relative 
            causation.  Based on a history of having a vertebra slip in 
            his back years ago, Dr. Boulden suggested this needed to be 
            Page   5
            investigated further to see if there were chronic complaints 
            since then.  If there was a chronic history of back 
            complaints, Dr. Boulden would feel that claimant had only 
            aggravated his back once again; if, however, there had been 
            a significant period of time since this problem during which 
            he had been able to perform his customary work, the majority 
            of disability would be placed on the work injury at issue.
                 Claimant is currently working again for Clow 
            Corporation, although at a light-duty job as lead locker 
            room attendant.  Defendant is to be commended for providing 
            continued employment within medical restrictions.  However, 
            he has suffered a reduction in wages from $9.00 per hour 
            with irregular but significant overtime and incentive pay to 
            $6.73 per hour.  He currently complains of variable daily 
            pain, generally less severe than at the time of the work 
            injury.  This back pain sometimes radiates down the leg.
                 Defendants have directly attacked claimant's 
            credibility on the basis of surveillance conducted by Victor 
            Laughlin, a private investigator.  Laughlin attempted 
            surveillance on eight or nine occasions, sometimes 
            unsuccessfully, between December 28, 1990, and July 31, 
            1991.  Testimony and photographs relative the latter date 
            are particularly significant.  Defendants maintain in their 
            brief that claimant was photographed and seen working 
            extensively with a rototilling machine, attempting to 
            vigorously pull-start the machine for at least 15 or 20 
            minutes before acquiring a second machine and spending 
            approximately the same length of time attempting to start 
            it, following which he was seen rototilling a garden for at 
            least 10-20 minutes.  This is generally consistent with this 
            deputy's understanding of Laughlin's testimony, except that 
            he understood Laughlin to testify that claimant rototilled 
            for only approximately five minutes.
                 Defendants strenuously and repeatedly insist that 
            Laughlin's testimony is uncontroverted.  On the contrary 
            though, it is directly controverted by the associated 
            time-stamped photographs.  To avoid reaching very unpleasant 
            conclusions indeed, it must be assumed that this deputy and 
            defense counsel both misunderstood Laughlin's testimony.
                 At 19:03 (hours), claimant is pictured relaxing and 
            drinking a beverage.  At 19:15, he is seen entering a shed.  
            The next photo, at 19:29, shows claimant again at the door 
            to the shed, apparently standing there or leaving.  
            Beginning at 19:30, claimant is seen in a different location 
            attempting to pull-start a Rototiller.  This continues until 
            19:31.  At 19:33, he is seen walking to another building and 
            apparently checking a mailbox.  The next photograph shows 
            him carrying a pail or fuel container towards the original 
            shed at 19:52.  At 19:54, he is walking across a road.  At 
            19:55, he appears at the front or side door of a house.  At 
            Page   6
            19:56, he is seen pushing a Rototiller away from that house.  
            At 19:57, he is seen fueling the Rototiller.  From 19:59 
            until 20:02, he is seen attempting to pull-start the 
            machine.  At 20:05, he is seen pushing the Rototiller up to 
            a road.  At 20:08, he is seen descending an incline next to 
            the road, apparently while tilling.  At 20:09, he is seen 
            ascending the same incline and then adjusting the machine.  
            At 20:10, he is seen pushing the Rototiller in multiple 
            photographs.  It is unclear whether he is actually tilling 
            at that time, although it is noted that the tines are in 
            focus and do not appear to be in motion.  Because the 
            surveillance photographs were taken with a telephoto lens, 
            which normally entails a relatively large F-stop (narrower 
            aperture), it is probable that a relatively slow shutter 
            speed was employed; thus, the tines would likely be blurred 
            if in motion.  At 20:12, claimant is pictured carrying a 
            beverage can and another item, but is not thereafter seen in 
            association with either Rototiller in photographs of 20:19 
            and 20:20.
                 Defendants would have us believe that claimant spent 40 
            minutes attempting to vigorously pull-start two Rototillers 
            and 10-20 minutes rototilling.  From the photographic 
            evidence, this is impossible.  Claimant is pictured 
            attempting to start Rototillers only from 19:30 to 19:31 and 
            again from 19:59 to 20:02.  There is a time gap from 19:15 
            to 19:29 when claimant was presumably in the shed, although 
            no photographs are offered.  In order to avoid the 
            unpleasant conclusions mentioned earlier, it will be assumed 
            that claimant spent some of that time attempting to start 
            the first Rototiller (even though all photos showing 
            attempts to start the machine are in a different location).  
            Thus, this process occupied 16 minutes at maximum.  Attempts 
            to start the second Rototiller are shown only from 19:59 to 
            20:02.  Claimant is seen actually rototilling at most from 
            20:08 to 20:11.
                 Other surveillance photographs show claimant carrying a 
            small child on his hip and carrying pop bottles and sacks of 
            groceries.  Nothing pictured appears to exceed the 25-pound 
            weight restriction imposed by Dr. Boulden.
                 This observer emphatically does not find the 
            surveillance evidence to be such a devastating blow to 
            claimant's case as defendants maintain.  Nonetheless, it can 
            be fairly inferred that on at least some days claimant is 
            able to engage in limited vigorous activity for a few 
            minutes at a time attempting to pull-start a Rototiller.  
            This is not particularly significant, given his testimony 
            that his pain level varies from day to day.  The medical 
            restrictions imposed by Dr. Boulden are significant, but do 
            not suggest that Mr. Langstraat is totally disabled or that 
            he should spend the rest of his life bedridden.
            Page   7
                 Denise Spurgeon suggests that claimant's gait and 
            general stiffness were more severe at hearing than is the 
            case on a day-to-day basis at work.  This may be so, but it 
            is not inconsistent with claimant simply having a bad day at 
            hearing.  Still, it is not unreasonable to suppose that 
            claimant took few steps to minimize his apparent discomfort 
            at trial.
                                conclusions of law
                 The parties stipulate that claimant sustained an injury 
            arising out of and in the course of employment, but dispute 
            causal relationship to either temporary or permanent 
                 The claimant has the burden of proving by a 
            preponderance of the evidence that the injury of July 17, 
            1990, is causally related to the disability on which he now 
            bases his claim.  Bodish v. Fischer, Inc., 257 Iowa 516, 133 
            N.W.2d 867 (1965).  Lindahl v. L. O. Boggs, 236 Iowa 296, 18 
            N.W.2d 607 (1945).  A possibility is insufficient; a 
            probability is necessary.  Burt v. John Deere Waterloo 
            Tractor Works, 247 Iowa 691, 73 N.W.2d 732 (1955).  The 
            question of causal connection is essentially within the 
            domain of expert testimony.  Bradshaw v. Iowa Methodist 
            Hosp., 251 Iowa 375, 101 N.W.2d 167 (1960). 
                 However, expert medical evidence must be considered 
            with all other evidence introduced bearing on the causal 
            connection.  Burt, 247 Iowa 691, 73 N.W.2d 732.  The opinion 
            of experts need not be couched in definite, positive or 
            unequivocal language.  Sondag v. Ferris Hardware, 220 N.W.2d 
            903 (Iowa 1974).  However, the expert opinion may be 
            accepted or rejected, in whole or in part, by the trier of 
            fact.  Id. at 907.  Further, the weight to be given to such 
            an opinion is for the finder of fact, and that may be 
            affected by the completeness of the premise given the expert 
            and other surrounding circumstances.  Bodish, 257 Iowa 516, 
            133 N.W.2d 867.  See also Musselman v. Cent. Tel. Co., 261 
            Iowa 352, 154 N.W.2d 128 (1967).
                 While a claimant is not entitled to compensation for 
            the results of a preexisting injury or disease, the mere 
            existence at the time of a subsequent injury is not a 
            defense.  Rose v. John Deere Ottumwa Works, 247 Iowa 900, 
            908, 76 N.W.2d 756, 760-61 (1956).  If the claimant had a 
            preexisting condition or disability that is aggravated, 
            accelerated, worsened or lighted up so that it results in 
            disability, claimant is entitled to recover.  Nicks v. 
            Davenport Produce Co., 254 Iowa 130, 115 N.W.2d 812, 815 
                 Temporary disability shall be first discussed.  
            Claimant seeks temporary disability benefits only for the 
            time he was off work following the incident at home on 
            October 20, 1990.  No medical opinion appears of record 
            Page   8
            causally relating this incident to the original work injury.  
            Although claimant had worked a half shift the day before, he 
            also was engaged in activity at home on October 20 and he 
            further reported that the pain was somewhat different in 
            location.  It is held that claimant has failed to meet his 
            burden of proof in establishing entitlement to additional 
            healing period or temporary total disability.
                 Medical opinion shows without contradiction that the 
            aggravation of claimant's underlying condition, previously 
            asymptomatic or at least nondisabling, is causally related 
            to the work incident of July 17, 1990.  According to Dr. 
            Boulden, resulting disability should be considered causally 
            related if claimant has not shown a history of chronic back 
            complaints.  The extensive medical history placed into 
            evidence shows no such chronic complaints.  Dr. Stanzel also 
            relates the impairment to the work injury.  No contrary 
            medical opinion appears of record.  Claimant has clearly met 
            his burden of proof in establishing a causal nexus between 
            the work injury and his current disability.  The incidents 
            of October 20, 1990, and November 5, 1991, have not been 
            shown causative of additional permanent impairment.  Dr. 
            Boulden's suggested limitations precede both incidents.
                 Functional impairment is an element to be considered in 
            determining industrial disability which is the reduction of 
            earning capacity, but consideration must also be given to 
            the injured employee's age, education, qualifications, expe
            rience and inability to engage in employment for which he is 
            fitted.  Olson v. Goodyear Service Stores, 255 Iowa 1112, 
            125 N.W.2d 251 (1963).  Barton v. Nevada Poultry, 253 Iowa 
            285, 110 N.W.2d 660 (1961).
                 A finding of impairment to the body as a whole found by 
            a medical evaluator does not equate to industrial disabil
            ity.  This is so as impairment and disability are not syn
            onymous.  Degree of industrial disability can in fact be 
            much different than the degree of impairment because in the 
            first instance reference is to loss of earning capacity and 
            in the latter to anatomical or functional abnormality or 
            loss.  Although loss of function is to be considered and 
            disability can rarely be found without it, it is not so that 
            a degree of industrial disability is proportionally related 
            to a degree of impairment of bodily function.
                 Factors to be considered in determining industrial dis
            ability include the employee's medical condition prior to 
            the injury, immediately after the injury, and presently; the 
            situs of the injury, its severity and the length of healing 
            period; the work experience of the employee prior to the 
            injury, after the injury and potential for rehabilitation; 
            the employee's qualifications intellectually, emotionally 
            and physically; earnings prior and subsequent to the injury; 
            age; education; motivation; functional impairment as a 
            Page   9
            result of the injury; and inability because of the injury to 
            engage in employment for which the employee is fitted.  Loss 
            of earnings caused by a job transfer for reasons related to 
            the injury is also relevant.  These are matters which the 
            finder of fact considers collectively in arriving at the 
            determination of the degree of industrial disability.
                 There are no weighting guidelines that indicate how 
            each of the factors are to be considered.  There are no 
            guidelines which give, for example, age a weighted value of 
            ten percent of the total value, education a value of fifteen 
            percent of total, motivation - five percent; work experience 
            - thirty percent, etc.  Neither does a rating of functional 
            impairment directly correlate to a degree of industrial 
            disability to the body as a whole.  In other words, there 
            are no formulae which can be applied and then added up to 
            determine the degree of industrial disability.  It therefore 
            becomes necessary for the deputy or commissioner to draw 
            upon prior experience, general and specialized knowledge to 
            make the finding with regard to degree of industrial dis
            ability.  See Christensen v. Hagen, Inc., Vol. 1 No. 3 State 
            of Iowa Industrial Commissioner Decisions 529 (App. March 
            26, 1985); Peterson v. Truck Haven Cafe, Inc., Vol. 1 No. 3 
            State of Iowa Industrial Commissioner Decisions 654 (App. 
            February 28, 1985).
                 Medical restrictions imposed by Dr. Boulden include a 
            25-pound weight restriction, restrictions against bending 
            and twisting with the back and require alternating sitting 
            and standing every 30-45 minutes.  These restrictions in all 
            likelihood foreclose possible employment as a farmer, 
            livestock hauler or concrete and road worker.  Thus, 
            employment with Clow Corporation is the only work claimant 
            has ever done which is not now barred by medical 
            restrictions, and even that is light-duty work tailored to 
            accommodate those restrictions.  It cannot be assumed that 
            another employer would be so accommodating.  The industrial 
            disability awarded in this decision would be very much 
            greater but for defendant's commendable efforts to keep Mr. 
            Langstraat working.  Nonetheless, he has suffered both a 
            substantial decrease in actual earnings and an even more 
            substantial diminution of earning capacity.  In essence, it 
            is loss of earning capacity that is measured in assessing 
            industrial disability.  Second Injury Fund v. Hodgins, 461 
            N.W.2d 454 (Iowa 1990).  Claimant is 47 years of age and 
            should be in the prime of his earning years.  Although he 
            has a high school education, he has no experience in white 
            collar professions.  His actual loss of earnings is in 
            excess of 25 percent, not counting substantial overtime and 
            incentive pay.
                 Considering then these matters in particular and the 
            record otherwise in general, it is held that claimant has 
            Page  10
            sustained a permanent industrial disability equivalent to 30 
            percent of the body as a whole, or 150 weeks.  As claimant's 
            recovery was complicated by the home incident on October 20, 
            1990, the parties' stipulation shall be accepted:  the 
            commencement date for permanent partial disability is 
            February 25, 1991.
                 Claimant also seeks penalty benefits under Iowa Code 
            section 86.13, which provides:
                 If a delay in commencement or termination of 
                 benefits occurs without reasonable or probable 
                 cause or excuse, the industrial commissioner shall 
                 award benefits in addition to those benefits 
                 payable under this chapter, or chapter 85, 85A, or 
                 85B, up to fifty percent of the amount of benefits 
                 that were unreasonably delayed or denied.
                 Defendants have paid no permanent disability benefits 
            on a voluntary basis.  That claimant sustained an injury 
            arising out of and in the course of employment is admitted.  
            The medical evidence establishes without contradiction that 
            the injury caused permanent impairment and resulted in 
            permanent medical restrictions.  The suggestion that the 
            restrictions (none) proposed by Denise Spurgeon should be 
            preferred over those imposed by Dr. Boulden is emphatically 
            rejected.  Dr. Boulden is a qualified physician; Spurgeon is 
            not.  The standard in assessment of penalty benefits is 
            whether the claim and defense are fairly debatable.  In this 
            case, the question of whether claimant sustained some 
            permanent industrial disability resulting from the admitted 
            work injury is not fairly debatable, although the extent is.  
            Nonetheless, defendants' failure to pay permanency benefits 
            is not as egregious as in some cases seen by this agency.  A 
            full 50 percent penalty shall not be imposed.  In the 
            discretion of the agency, a penalty of 15 weeks is assessed.
                 THEREFORE, IT IS ORDERED:
                 Defendants shall pay unto claimant one hundred fifty 
            (150) weeks of permanent partial disability benefits at the 
            stipulated rate of two hundred eighty-four and 96/100 
            dollars ($284.96) per week commencing February 25, 1991.
                 All accrued weekly benefits shall be paid in a lump sum 
            together with statutory interest pursuant to Iowa Code 
            section 85.30.
                 Defendants shall pay unto claimant fifteen (15) weeks 
            of penalty benefits at the stipulated rate of two hundred 
            eighty-four and 96/100 dollars ($284.96) per week effective 
            the filing date of this decision.
                 Costs are assessed to defendants pursuant to rule 343 
            IAC 4.33.
            Page  11
                 Defendants shall file claim activity reports as 
            requested by the agency pursuant to rule 343 IAC 3.1.
                 Signed and filed this ______ day of ____________, 1992.
                                          DAVID RASEY
                                          DEPUTY INDUSTRIAL COMMISSIONER
            Copies To:
            Mr. Harold B. Heslinga
            Attorney at Law
            118 North Market Street
            Oskaloosa, Iowa  52577
            Mr. E. J. Kelly
            Attorney at Law
            Suite 111, Terrace Center
            2700 Grand Avenue
            Des Moines, Iowa  50312
                                               5-1803; 3701; 4000.2
                                               Filed February 26, 1992
                                               DAVID RASEY
            before the iowa industrial commissioner
            RAYMOND LANGSTRAAT,           :
                 Claimant,                :
            vs.                           :         File No. 957007
            CLOW CORPORATION,             :      A R B I T R A T I O N
                 Employer,                :         D E C I S I O N
            and                           :
            GAB,                          :
                 Insurance Carrier,       :
                 Defendants.              :
            5-1803; 4000.2
            Claimant awarded 30 percent industrial disability and 15 
            weeks of penalty benefits.  Although extent of permanency 
            could be reasonably disputed, the existence of some loss of 
            earning capacity could not.
            Defendants' characterization of surveillance evidence was 
            shown impossible by time-stamping on the photos in evidence.  
            Evidence was criticized in detail.
            RAYMOND LANGSTRAAT,           :
                 Claimant,                :
            vs.                           :
                                          :      File No. 957007
            CLOW CORPORATION,             :
                                          :        R E M A N D
                 Employer,                :
                                          :      D E C I S I O N
            and                           :
            GAB,                          :
                 Insurance Carrier,       :
                 Defendants.              :
                              STATEMENT OF THE CASE
                 Claimant Raymond Langstraat suffered a work related 
            back injury on July 17, 1990.  Following hearing, the 
            undersigned deputy issued an arbitration decision on 
            February 26, 1992, awarding industrial disability equivalent 
            to 30 percent of the body as a whole along with penalty 
            benefits.  Defendants appealed.  On March 20, 1992, 
            defendants made application for additional evidence based 
            upon the sworn statement of Mary Ellen Langstraat, 
            claimant's estranged wife.  At the arbitration hearing, Ms. 
            Langstraat had testified that claimant came home from work 
            on July 17, 1990 complaining of a back injury sustained at 
            work that day.  In her sworn statement (dated March 12, 
            1992), Ms. Langstraat claimed that Mr. Langstraat had 
            confessed to her that he had faked the work injury, having 
            actually hurt himself lifting a lawn mower at home.
                 On April 24, 1992, the industrial commissioner remanded 
            the case to receive additional evidence limited to the 
            matters raised in defendants' application.
                 The cause first came on for remand hearing before the 
            undersigned on September 16, 1992.  Remand exhibits 1, 2 and 
            4-8 were received.  Remand exhibit 3, the statement of Mary 
            Langstraat, was offered but objected to by claimant, since 
            Ms. Langstraat failed to appear at hearing.  Ruling was 
            reserved.  Because other evidence submitted made it appear 
            possible that Mary Langstraat had been subjected to threat 
            or coercion, the case was continued to October 12, 1992.
                 On the morning of October 12, the undersigned entered 
            into a telephone conference hearing with claimant's attorney 
            and Jane Van Werden, appearing for defendants.  Counsel 
            advised that Mary Langstraat's deposition had been taken on 
            October 8, that there was no objection to the admissibility 
            Page   2
            of the deposition and that neither party desired to submit 
            additional evidence.  Later that day, the deposition was 
            filed marked as defendants' exhibit 8.  The undersigned has 
            re-marked the exhibit as remand exhibit 9.  It is hereby 
            received, along with remand exhibit 3.  The case was deemed 
            submitted on October 12, 1992.
                 The issue presented is whether the new evidence 
            requires a reconsideration of the original arbitration 
                                 FINDINGS OF FACT
                 The undersigned deputy industrial commissioner finds:
                 About Mary Langstraat:  She lies.  She does so when she 
            is under oath and when she is not.  She does so when 
            motivated by vindictiveness and vengefulness, even when 
            against her own pecuniary interest.  She has no credibility 
                 The arbitration hearing was held on December 19, 1991.  
            A decision in claimant's favor was filed on February 26, 
            1992.  On February 24, Mary Langstraat initiated a telephone 
            call to George L. Lind, a licensed attorney who testified by 
            deposition on June 4, 1992.  Mr. Lind was then representing 
            Raymond Langstraat in pending divorce proceedings, but had 
            represented the family, including Mary, with respect to a 
            number of legal matters over a period of years.  Mr. Lind 
                    A.  Mary advised me that Ray, her husband, had 
                 lied regarding his workman's compensation case and 
                 that he was hurt moving a lawn mower in the car 
                 and that he had told her this one month ago, which 
                 would have been late this January that he would 
                 told her.
                    Q.  Of '92?
                    A.  Of '92.
                    And that she then told me she had found Ray 
                 drunk and with a woman the evening before, which 
                 would have been February 23 of '92, and that this 
                 caused her to feel it necessary to -- I've got 
                 here to cleanse her soul, period.
            (Lind Deposition, Pages 5-6).
                 Mr. Lind also described Mary Langstraat's frame of mind 
            at the time of that conversation:  "Very, very mad.  Very, 
            very emotionally upset."
                 George Lind also described Mary Langstraat, based upon 
            his personal experience, as vindictive, vicious, even 
            "sick."  More significantly, he is familiar with her 
            reputation for veracity in the community:
            Page   3
                    A.  I don't mean to be harsh on anybody.  
                 Suffice it to say, E. J., if you mention the name 
                 Mary Langstraat in our courthouse with anybody who 
                 is familiar with what goes on, any lawyer, any 
                 judge, any prosecutor, it's -- it's -- the name is 
                 going to be responded to with a chuckle and laugh 
                 and an inquiry of what the heck is she in to now?  
                 If you were to say I'm going to use her as a 
                 witness in my case, they truly will have a belly 
                 laugh over it.  She has no credibility whatever in 
                 the community with anybody that I deal with, okay?  
                 I don't mean to be overly harsh.  I'm tying (sic) 
                 to paint the picture as it is.
            (Lind Depo., page 12).
                 In her October 8 deposition, Mary Langstraat recanted 
            her March 12 statement, claiming it had all been a lie.  She 
            was a hostile and evasive witness and admitted to destroying 
            evidence prior to the deposition.  After refusing several 
            times to disclose details of what had motivated her to lie, 
            she eventually testified as follows:
                    Q.  Did you tell Mr. Heslinga that you were mad 
                 at Ray because you had gone to Ray's house and 
                 found him with another woman?
                    A.  It wasn't because of the other woman.
                    Q.  What was it because of then?  Will you 
                 please repeat the question?
                    (Thereupon, the prior answer and question on 
                 Page 18, Lines 4-6, were read back by the Court 
                    Q.  Was it because a woman named Dixie told you 
                 that Ray was not going to set up a $3,000 trust 
                 fund for your son?
                    A.  Yeah.
                    Q.  Tell me about this?  Are you refusing to 
                    A.  Yes, I am.  I'm starting to get my point 
                    Q.  So if Ray recovers in the Worker's 
                 Compensation hearing, then your son stands to 
                 gain; correct?
                    A.  I don't know ---
                    Q.  I have no further----
                    A.  --'til I talk to a lawyer.
            (Mary Langstraat Depo., page 18).
            Page   4
                 Earlier, she had testified that Ray "had gotten a 
            girlfriend and was drinking around the baby and everything 
            so I -- out of revenge, I lied on him."  (Id. p. 5).
                 We know from Mr. Lind's testimony that some extraneous 
            force moved Mary Langstraat to accuse her husband of 
            workers' compensation fraud.  She told Lind that having 
            "found Ray drunk and with a woman the evening before," was 
            her motivation for coming forward to "cleanse her soul."  
            Obviously, there can be no claim that she had been motivated 
            by a sense of justice or good citizenship, since she also 
            told Lind that Raymond Langstraat had supposedly "confessed" 
            the month before.  In her first sworn statement, Mary 
            Langstraat testified that Raymond Langstraat admitted this 
            fraud on February 11.  Even this is thirteen days before she 
            called Lind.  She also testified that she could be specific 
            as to the date, as she had written it down.  The 
            significance of this point will be considered again.
                 Mary Langstraat's grudging admission that her actions 
            were inspired by "Dixie" telling her that claimant was not 
            going to set up a $3,000.00 trust fund for their son rings 
            true: perhaps the sole particle of her testimony about which 
            this might be said.  In context, that question with those 
            very specific facts came out of the blue.  The immediate 
            answer constitutes an admission, one that she could not help 
            but realize reflected adversely on her character.  
            Therefore, the most likely explanation of Mary Langstraat's 
            accusations is that they were motivated by disappointed 
                 However, this fact alone is dispositive of nothing.  
            Given Mary Langstraat's character as disclosed by the 
            evidence, it is equally consistent that she (1)  knowingly 
            participated in her husband's fraud right from the very 
            beginning, or (2)  that the claim is legitimate and she 
            acted wholly out of spite.
                 Now it will be recalled that Mary Langstraat was very, 
            very emotionally upset when she called Mr. Lind.  There is 
            no question but that she was bent on doing harm (not 
            "cleansing her soul").  If she had in fact recorded her 
            husband's supposed confession on a calendar on February 11, 
            it is inconceivable that she would not have shared this 
            information with Lind.  Instead, she told him that the 
            conversation had occurred one month before.  Obviously, she 
            later manufactured evidence in the form of a calendar 
            notation, evidence which she has now destroyed: 
                    Q.  Where are those notes today?
                    A.  They're burned.
                    Q.  You burned those notes?
                    A.  I had a right to, they were mine.
                    Q.  Tell me what the notes said?
            Page   5
                    A.  I don't remember anymore.
                    Q.  You have absolutely no recollection of what 
                 your notes said on March 12, 1992, that you had 
                 taken from your calendar?
                    A.  No.  That's the reason why I make notes so 
                 I don't have to try and remember.
                    Q.  Why did you burn your notes?
                    A.  Because I wanted to.  I was cleaning house 
                 and moving.
                    Q.  That's the only reason you burned your 
                    A.  Yeah.  I burn a lot of garbage.
            (Mary Langstraat Deposition, Page 10).
                 It is concluded that Ray Langstraat did not confess 
            fraud as his wife originally claimed.
                 The testimony of Mary Langstraat is entitled to no 
            weight whatsoever.  Defendants also challenged Raymond 
            Langstraat's credibility on the basis of his criminal 
            Page   6
            record.  Claimant has been convicted of drunken driving, 
            driving under suspension and assault, but these crimes do 
            not indicate dishonesty or untruthfulness.  Defendants' 
            brief invites this deputy to conclude that claimant is a 
            thief and liar as "substantiated" by evidence that he 
            currently has charges pending against him for theft in the 
            fifth degree.  Ignoring the presumption of innocence that 
            attaches in criminal cases, they assert that these charges 
            directly relate to claimant's character for truthfulness and 
            honesty.  This invitation is emphatically rejected.  A 
            conviction of theft is proper impeachment evidence; an 
            unproven charge is not.
                                CONCLUSIONS OF LAW
                 This case is before this deputy to consider additional 
            evidence.  It is not really defendants' burden to prove 
            anything, but the evidence presented should be considered 
            together with the evidence at the arbitration hearing.  It 
            is now clear that the evidence given by Mary Langstraat at 
            that hearing is totally unreliable.  But, the decision does 
            not rest on that part of the evidence.  After all, she makes 
            no claim to have actually seen the injury, whether it was at 
            home or at work.  Her testimony that her husband came home 
            complaining of a work injury supports claimant's version of 
            events but was not critical to the result, only 
            corroborative.  Yet-unproven criminal charges do not reflect 
            adversely on claimant's credibility.
                 In particular, the evidence does not show that claimant 
            made any confession of workers' compensation fraud to his 
            wife, whether in late January or early February 1992.
                 No reason to further re-examine the arbitration 
            decision of February 26 appears of record.
                 THEREFORE, IT IS ORDERED:
                 The result of the arbitration decision filed February 
            26, 1992 shall not be modified.  This remand decision and 
            the arbitration decision filed February 26, 1992, shall 
            constitute final agency action on all issues in this case 
            unless further appeal is taken pursuant to rule 343 IAC 4.27 
            and 4.28.
                 Costs are assessed to the defendants.
                 Signed and filed this ____ day of October, 1992.
                                          DAVID R. RASEY
                                          DEPUTY INDUSTRIAL COMMISSIONER
            Copies To:
            Page   7
            Mr Harold B Heslinga
            Attorney at Law
            118 North Market Street
            Oskaloosa Iowa 52577
            Mr E J Kelly
            Ms Jane Van Werden
            Attorneys at Law
            Terrace Center Ste 111
            2700 Grand Avenue
            Des Moines Iowa 50312
                                            3700; 2904; 2901
                                            Filed October 27, 1992
                                            DAVID R. RASEY
                                              File No. 957007
            CLOW CORPORATION,   
                                               R E M A N D
                                             D E C I S I O N
                 Insurance Carrier,  
            3700; 2906; 2901
            Industrial Commissioner remanded for additional evidence 
            after defendants filed the sworn statement of claimant's 
            estranged wife to the effect that claimant had admitted that 
            his claim was fraudulent.
            Wife failed to appear at remand hearing, but some evidence 
            offered showed a possibility of threat or other coercion.  
            Hearing was continued.
            The case was then submitted upon the wife's deposition 
            without other testimony.  In the deposition, wife recanted 
            her earlier sworn statement.  Other evidence showed she is a 
            notorious liar.
            None of wife's testimony was given weight, except her 
            concession that her accusations were motivated by revenge.  
            This did not change the result of the arbitration award, 
            since wife's testimony then was only corroborative.
            Page   1
                     before the iowa industrial commissioner
            JAMES CLARK,                  :
                                          : File Nos. 957200 & 1013327
                 Claimant,                :
                                          :     A L T E R N A T E
            vs.                           :
                                          :      M E D I C A L 
            BRIGGS CORPORATION,           :
                                          :         C A R E  
                 Employer,                :
                                          :     D E C I S I O N
            and                           :
            KEMPER INSURANCE,             :
                 Insurance Carrier,       :
                 Defendants.              :
                              statement of the case
                 Claimant, James Clark, filed a petition for alternate 
            medical care under Iowa Code section 85.27 (rule 343 IAC 
            4.48) on January 28, 1993.  On February 2, 1993, defendants 
            filed a motion to dismiss claimant's petition.  Defendants' 
            motion to dismiss claimant's petition for alternate care was 
            denied by another deputy industrial commissioner and 
            claimant's request for an in-person hearing was granted.  
                 This matter came on for hearing before the undersigned 
            deputy industrial commissioner on February 11, 1993, in Des 
            Moines, Iowa.  Claimant appeared in person and was 
            represented by his attorney, Mr. Philip F. Miller.  Ms. 
            Deborah Dubik appeared on behalf of employer and insurance 
            carrier.  The documentary evidence identified in the record 
            consists of claimant's exhibits 1 through 7 and defendants' 
            exhibit pages 1 through 10.  
                              stipulation and issue
                 The parties agree that claimant sustained a back injury 
            arising out of and in the course of employment with employer 
            on March 7, 1990.  However, defendants deny a causal 
            connection between claimant's neck problems and his work 
                 The issue to be determined is whether defendants have 
            reasonably refused to authorize neck surgery and aftercare 
            with Alexander Lifson, M.D.  
            Page   2
            findings of fact
                 The undersigned has carefully considered all the 
            testimony given at the hearing, arguments made, evidence 
            contained in the exhibits, and makes the following findings:
                 Before any benefits can be ordered, including medical 
            benefits, compensability of the claim must be established, 
            either by admission of liability or by adjudication.  The 
            summary provisions of Iowa Code section 85.27, as more 
            particularly described in rule 343 IAC 4.48, are not 
            designed to adjudicate disputed compensability of a claim.  
            Therefore, because defendants have disputed compensability 
            of claimant's neck claim, the undersigned cannot order 
            defendants to provide surgical intervention.  However, 
            defendants are barred from asserting a "lack of 
            authorization" defense to any medical expenses incurred by 
            claimant, if they are otherwise compensable.  Defendants 
            cannot deny liability and simultaneously direct the course 
            of treatment.  Barnhart v. MAQ, Inc., I Iowa Industrial 
            Commissioner Report 16 (Appeal Decision 1981).
                 The parties stipulate that claimant sustained a back 
            injury arising out of and in the course of employment with 
            employer on March 7, 1990.  Initially, claimant was treated 
            conservatively.  Subsequently, he was diagnosed by Alexander 
            Lifson, M.D., with internal disc disruption of L4-5, L5-S1 
            and instability of L4-5, L5-S1.  He was admitted to Abbott 
            Northwestern Hospital in Minnesota on May 29, 1991, where he 
            underwent anterior/posterior lumbar fusion at L4-5, L5-S1.  
            An internal fixation devise was implanted.  He was 
            discharged on June 6, 1991, and advised to have x-rays taken 
            locally post-operatively and mailed to Dr. Lifson for 
            evaluation (defendants' exhibit pages 3 & 4).  
                 Defendants referred claimant to Daniel J. McGuire, 
            M.D., a Des Moines, Iowa, orthopedic surgeon, for aftercare.  
            Office notes dated August 23, 1991, state:
                    ...James is doing well from his back 
                 standpoint.  He is glad he had the operation and 
                 he is making progress.  He is active, he is 
                    His radiographs look excellent.  Really no 
                 motion on the flexion/extension views.  His 
                 posterior spinal fusion looks good, his hardware 
                 looks good.  The allograft bone anteriorly is in 
                 good position although I don't see much evidence 
                 of union.  
            (defendants' exhibit page 1)
                 For some reason the relationship between claimant and 
            Dr. McGuire deteriorated.  Claimant claims that Dr. McGuire 
            told him there was nothing more he could do for him.  
            Insurance carrier has not authorized follow-up care with Dr. 
            Lifson.  On June 24, 1991, Dr. Lifson reported to Mr. Randy 
            G. Hilbrant from Kemper Insurance company as follows, "Since 
            we used an internal fixation devise, I would like Mr. Clark 
            Page   3
            to see me every six months for two years following the 
            procedure.  In between these visits, he may see a physician 
            in his local area."  (claimant's ex. p. 5).
                 The record contains a letter dated June 15, 1992, from 
            Kate Nordquist, Clinical Studies Monitor, at Advanced Spine 
            Fixation Systems Incorporated.  She reported that, "Prior to 
            your surgery -- at the time you signed the patient consent 
            form -- you were notified that the device to be implanted on 
            your spine was an investigative device and that you would be 
            required to have a follow-up examination at six month 
            intervals for two years."  (def. ex. p. 5).
                 Ms. Nordquist further states that "If you are being 
            followed by another physician, please show him or her this 
            letter and request that information regarding your status as 
            a post spine surgery patient be sent to this office as soon 
            as possible."  (def. ex. p. 5).
                 At the hearing, claimant testified that he gave Ms. 
            Nordquist's letter to his attorney who then wrote to Dr. 
            Lifson.  On October 22, 1992, Dr. Lifson corresponded with 
            claimant's attorney and stated:
                    As you probably know, we went through enormous 
                 hurdles before we received authorization to 
                 proceed with surgery.  It was mutually understood 
                 when we asked Mr. Clark and his insurance carrier 
                 that he would have to be followed in our clinic 
                 for two years at six-month intervals, as is 
                 indicated in the letter from Advance Spinal 
                 Fixation, Inc.  These evaluations are extremely 
                 important not only for completion of the study but 
                 also for evaluation of Mr. Clark's condition.
            (claimant's exhibit page 6).
                                conclusions of Law
                 The employer shall furnish reasonable surgical, 
            medical, dental, osteopathic, chiropractic, podiatric, 
            physical rehabilitation, nursing, ambulance and hospital 
            services and supplies for all conditions compensable under 
            the workers' compensation law.  The employer shall also 
            allow reasonable and necessary transportation expenses 
            incurred for those services.  The employer has the right to 
            choose the provider of care, except where the employer has 
            denied liability for the injury.  Section 85.27; Holbert v. 
            Townsend Engineering Co., Thirty-second Biennial Report of 
            the Industrial Commissioner 78 (Review-reopen 1975).  
            Claimant has the burden of proving that the fees charged for 
            such services are reasonable.  Anderson v. High Rise 
            Construction Specialists, Inc., file number 850096 (Appeal 
            Decision July 31, 1990).
                 Claimant is not entitled to reimbursement for medical 
            bills unless claimant shows they were paid from claimant's 
            funds.  See Caylor v. Employers Mut. Casualty Co., 337 
            N.W.2d 890 (Iowa Ct. App. 1983).  
            Page   4
                 When a designated physician refers a patient to another 
            physician, that physician acts as the defendant employer's 
            agent.  Permission for referral from defendant is not 
            necessary.  Kittrell v. Allen Memorial Hospital, 
            Thirty-fourth Biennial Report of the Industrial Commissioner 
            164 (Arb. Decn. 1979) (aff'd by indus. comm'r).
                 An employer's right to select the provider of medical 
            treatment to an injured worker should be diagnosed, 
            evaluated, treated or other matters of professional medical 
            judgement.  Assman v. Blue Star Foods, Inc., file no. 866389 
            (declaratory Ruling, May 18, 1988).
                 Claimant's treating surgeon, Dr. Alexander Lifson, has 
            recommended that he be evaluated at the Institute for Low 
            Back Care in Minneapolis, Minnesota, for two years at 
            six-month intervals.  The recommendation is a matter of 
            professional medical judgment in which defendants cannot 
            appropriately interfere.  Although defendants provided 
            claimant with aftercare by Dr. McGuire, such care, for 
            whatever reason, has proved ineffective.  The tone of Dr. 
            McGuire's office note dated July 16, 1991, appears to 
            reflect an underlying reluctance to assume the follow-up 
            care of another physician's surgical patient.  He states, 
            "He has had his surgery somewhere else, I am nice enough to 
            assume his care here in town so he doesn't have to commute 
            back and forth to Minneapolis."  (def. ex. p. 1).
                 It appears that claimant's aftercare is better served 
            with Dr. Lifson and his medical judgment followed in this 
            instance.  Therefore, it is concluded that claimant has 
            established the right to care under section 85.27 with Dr. 
            Lifson at the low back institute in Minneapolis, Minnesota, 
            and defendants shall provide such care, including x-rays and 
            in-person evaluation, if determined to be necessary by Dr. 
                 THEREFORE, IT IS ORDERED:
                 That defendants provide claimant with x-rays and any 
            post-surgical care deemed necessary by Dr. Lifson.  
            Defendants shall also provide claimant with payment for any 
            transportation costs associated with attendance at the low 
            back institute.
                 Defendants shall pay costs of this proceeding.
                 The undersigned has been delegated the authority to 
            issue final agency action in this matter.  Appeal of this 
            decision, if any, would be by judicial review pursuant to 
            Iowa Code section 17A.19.
                 Signed and filed this ____ day of February, 1993.
            Page   5
                                          JEAN M. INGRASSIA
                                          DEPUTY INDUSTRIAL COMMISSIONER    
            Copies to:
            Mr. Philip F. Miller
            Attorney at Law
            309 Court Ave, STE 200
            Des Moines, Iowa  50309
            Ms. Deborah Dubik
            Attorney at Law
            600 Union Arcade Bldg
            111 E 3rd St. 
            Davenport, Iowa  52801
            Page   1
                      Filed February 16, 1993
                      Jean M. Ingrassia
            before the iowa industrial commissioner
            JAMES CLARK,   :
                      : File Nos. 957200  1013327
                 Claimant, :
                      :    A L T E R N A T E
            vs.       :
                      :     M E D I C A L 
                      :       C A R E  
                 Employer, :
                      :    D E C I S I O N
            and       :
            KEMPER INSURANCE,   :
                 Insurance Carrier,  :
                 Defendants.    :
            Found that medical provider's recommendation that claimant 
            receive follow-up care with treating surgeon was a matter of 
            professional medical judgment with which employer could not 
            appropriately interfere.
            Defendants ordered to provide recommended x-rays and 
            follow-up evaluation by treating surgeon if necessary.