BEFORE THE IOWA WORKERS’ COMPENSATION COMMISSIONER ______________________________________________________________________ : DIANA WINN, : : Claimant, : File Nos. 5035646 & 5035647 : vs. : ARBITRATION : PELLA CORPORATION, : DECISION : Employer, : Self-Insured, : Defendant. : Head Note Nos.: 1108; 1400; 1803 ______________________________________________________________________ STATEMENT OF THE CASES These are two proceedings in arbitration. Both files were filed on February 4, 2011. In File No. 5035646, claimant alleged on November 16, 2010, she sustained an overuse of the right shoulder due to a work related injury to the left shoulder causing injury to her right rotator cuff and a resulting cumulative injury. (Original notice and petition) In File No. 5035647, claimant alleged on June 1, 2010, she sustained a right shoulder injury due to a work related injury to the left shoulder, causing injury to the right rotator cuff in the form of a cumulative injury. (Original notice and petition) Defendants filed their respective answers on February 25, 2011. Defendants denied liability for the two alleged work injuries. (See: Answers.) The two cases were consolidated for purposes of the hearing. The hearing administrator scheduled the cases for hearing on February 16, 2012. The hearings were held in Des Moines, Iowa at the Iowa Department of Workforce Development in Des Moines, Iowa. The undersigned appointed Ms. Janice Doud as the certified shorthand reporter. She is the official custodian of the records and notes. A transcript of the proceedings was filed on March 19, 2012. Post-hearing briefs were ordered. Claimant filed his brief on March 30, 2012. Defendants filed their brief on March 27, 2012. The cases were deemed fully submitted on March 30, 2012. Claimant offered exhibits 1 through 20. Defendants offered exhibits A through T. All proffered exhibits were admitted as evidence in the hearing. Currently, claimant has another case pending with the same employer. The contested case is File No. is 5027519 and it is a case involving the left shoulder. Final WINN V. PELLA CORPORATION Page 2 agency action held claimant sustained a work-related injury on August 11, 2008 and there was a causal connection between the injury and the claimed medical expenses. A petition for judicial review was filed in the Iowa District Court in and for Polk County. On February 24, 2012, Arthur E. Gamble, Chief Judge of the Fifth Judicial District of Iowa affirmed the decision of the Iowa Workers’ Compensation Commissioner. On March 23, 2012, defendants filed a Notice of Appeal with the Iowa Supreme Court appealing the decision of the Iowa District Court. The matter is currently pending before the Supreme Court or the Court of Appeals. Claimant testified at her hearing. She was the sole witness to testify. File No. 5035647 (June 1, 2010) STIPULATIONS 1. There was the existence of an employer-employee relationship at the time of the alleged injury; 2. Temporary benefits are not at issue; 3. If permanency benefits are awarded, the benefits will result in an industrial disability; 4. If permanency benefits are awarded, the commencement date is July 13, 2010; 5. If permanency benefits are awarded, the weekly benefit rate is $450.00 per week; 6. Any payment for medical/hospitalization expenses will be determined by the parties; and 7. The parties can agree the costs to litigate are the filing fees. File No. 5035647 (June 1, 2010) ISSUES 1. Whether claimant sustained an injury on June 1, 2010 in the form of a cumulative injury or overuse type injury which arose out of and in the course of her employment; 2. Whether the alleged injury is a cause of a permanent disability; 3. If the alleged injury is a cause of a permanent disability, then there is the issue as to the extent of the permanent disability; 4. Whether claimant tendered timely notice to defendants pursuant to Iowa Code section 85.23; WINN V. PELLA CORPORATION Page 3 5. Whether claimant is entitled to medical expenses pursuant to Iowa Code section 85.27; and 6. Whether claimant is entitled to an independent medical examination pursuant to Iowa Code Section 85.39. File No. 5035646 (November 16, 2010) STIPULATIONS 1. There was the existence of an employer-employee relationship at the time of the alleged injury; 2. Temporary benefits are not at issue; 3. If permanency benefits are awarded, the benefits will result in an industrial disability; 4. If permanency benefits are awarded, the commencement date is November 16, 2010; 5. If permanency benefits are awarded, the weekly benefit rate is $443.43 per week; 6. All affirmative defenses have been waived by defendants; 7. There are no credits due to defendants; 8. The parties are able to agree the $100.00 filing fee was paid by claimant. File No. 5035646 (November 16, 2010) ISSUES 1. Whether claimant sustained an injury on November 16, 2010, the last day she worked for defendant-employer in the form of a cumulative injury due to overuse; 2. Whether the alleged injury is a cause of permanent disability; and 3. If the alleged injury resulted in a permanent disability, there is the issue as to the extent of permanency. FINDINGS OF FACT AND CONCLUSIONS OF LAW This deputy, after listening to the testimony of claimant at hearing, and after reading her deposition testimony, after judging the credibility of the witness, and after reviewing the evidence and the post-hearing briefs presented, makes the following findings of fact and conclusions of law: WINN V. PELLA CORPORATION Page 4 The party who would suffer loss if an issue were not established has the burden of proving that issue by a preponderance of the evidence. Iowa Rule of Appellate Procedure 6.14(6). Claimant is 61 years old and resides in Knoxville, Iowa. She is married and is the caregiver for her minor grandchild. She completed the eleventh grade at Knoxville, High School but dropped out before she graduated. She has no GED. For the most part, this deputy found claimant to be a credible witness. During the hearing proceedings, claimant’s behavior, demeanor and mannerisms were consistent with someone who appeared to be telling the truth to the best of her abilities. Claimant commenced her employment with the Pella Corporation on August 23, 1976. She remained continuously employed until she was suspended without pay on November 16, 2010 and ultimately terminated on December 1, 2010. (Claimant’s Exhibit 19, page 10) For the last ten years of her employment, claimant worked as a stock-keeper at the Pella Corporation. As a stock-keeper claimant placed tags on bundles of material as they arrived on trucks. She pushed a metal container known as a “coffin.” It was on wheels but weighed 500 pounds when it was empty. The task required claimant to push with her bilateral shoulders. Claimant also issued and received materials that traveled from the stock room to the production line. She did use a computer and had to make entries into the computer via a keyboard. Claimant testified she lifted material which weighed anywhere from 2 to 30 pounds. Claimant also testified she assisted other employees on various assembly lines when needed. She indicated whenever she assisted other workers on the other assembly lines she would repetitively load factory parts above shoulder height. Pushing and pulling were involved but on an occasional basis. Claimant worked for the company for 34 years. Prior to August of 2008, claimant had no permanent restrictions for either of her shoulders. She did sustain previous injuries and surgeries. In 1998 claimant underwent left and right carpal tunnel releases, as well as left and right tennis elbow releases. In 2002 claimant had arthroscopic surgery on her left knee. In 2003 claimant had treatment for a radial fracture of the left upper extremity. She was advised by at least one physician, to seek medical advice for possible arthritis and Ted Rooney, M.D., was recommended to her. There were numerous times when claimant did not want to comply with the treatment modalities suggested to her. Following treatment for the left shoulder in 2008, Lloyd Thurston, D.O., restricted claimant’s left shoulder as follows: 1) Sling through physical therapy. She is to wear this at work. She may DC it at home. WINN V. PELLA CORPORATION Page 5 .... 4) She is to wear the sling at work, 2 pounds lifting, pulling, pushing, with the left arm. (Cl. Ex. 5, p. 1) Claimant continued to work at the Pella Corporation following her left rotator cuff tear. She worked within the restrictions placed upon her by Dr. Thurston and she wore the sling on her left arm during work hours. She performed all of her regular duties with her right arm. (Transcript, p. 36) According to claimant’s testimony, her right shoulder gradually became painful especially in the front of the right shoulder. (Tr. pp. 39-40) Claimant testified she could not really provide an exact date when she first began to notice right shoulder pain. (Tr. p. 92) She testified it had been bothering her for several months before she obtained medical care. She testified she hoped the pain would just go away. (Tr. p. 92) It was on June 1, 2010, when claimant sought treatment for right shoulder pain. She had completed her normal eight-hour shift. (Def. Ex. T, p. 200) Then claimant presented to Katherine Todd, ARNP. She was claimant’s personal medical provider. Nurse Todd noted: Right shoulder pain is catching up with her. She is overusing it because they have not let her have her left rotator cuff surgery. It will be 2 years in September that she injured it at work. Apparently, she took them to court and the court said that she needed to have it done and they are supposed to do it, but now they have 20 days to file a motion to argue with it. She is extremely emotional today and crying. (Cl. Ex. 7, p. 3) On the same day, Nurse Todd found: Significant pain in the right shoulder and I can reproduce the numbness and paresthesia in the shoulder, elbow and wrist with manipulation. Significant pain throughout the right shoulder blade, does not produce paresthesia. (Cl. Ex. 7, p. 3) The nurse practitioner diagnosed claimant with “Right arm and neck pain, most likely due to overuse due to the fact she cannot use her left arm.” (Cl. Ex. 7, p. 3) Nurse Todd prescribed 800 mg of Ibuprofen, Ultram, and Lisinopril. (Cl. Ex. 7, p. 4) The nurse practitioner referred claimant to an orthopedic surgeon, Cassim Igram, M.D., due to claimant’s right shoulder pain. (Cl. Ex. 3, p. 2) Claimant WINN V. PELLA CORPORATION Page 6 complained of an aching and occasionally stabbing-type pain about the right shoulder. (Cl. Ex. 3, p. 2) In his examination of claimant, Dr. Igram found: She is wearing a sling on the left. Range of motion of the shoulder reveals elevation to almost 180 degrees. However, she does have obvious discomfort with this maneuver. She can internally rotate to about the L5 vertebral body; external rotation of about 20 degrees or so. She has obvious pain with these maneuvers, consistent with some sort of an impingement-type problem. Examination of the upper extremities reveals 5/5 strength with grip, as well as biceps. She has reproducible pain with abduction testing of the deltoids. The remainder of her exam is limited by shoulder pain. No obvious sensory deficit is noted in either upper extremity. However, she does have some pain around the 1st extensor compartment about the wrist on examination today. (Cl. Ex. 3, p. 3) Dr. Igram read EMG studies. The results for the right upper extremity were in the normal range. (Cl. Ex. 3, p. 3) Dr. Igram diagnosed claimant with “Right shoulder pain, question rotator cuff pathology.” (Cl. Ex. 3, p. 3) Dr. Igram opined claimant’s problems were coming from her right shoulder. (Cl. Ex. 3, p. 3) He ordered MRI testing. The testing demonstrated “A small full thickness rotator cuff tear.” (Cl. Ex. 3, p. 4) Per a referral from Dr. Igram, claimant went to see Scott Meyer, M.D., another orthopedic surgeon. Claimant reported to Dr. Meyer that she believed her right shoulder was related to her employment at the Pella Corporation. (Cl. Ex. 3, p. 5) Dr. Meyer reviewed the MRI test results. The orthopedist opined the results demonstrated the rotator cuff had a moderate tear that was more posterior than what was customarily found. (Cl. Ex. 3, p. 6) Dr. Meyer informed claimant surgery on the right shoulder was a viable solution to repair the condition. Defendant ordered surveillance. It was conducted on claimant. The surveillance occurred on October 25, 2010. (Def. Ex. C, p. 45) At the time, claimant was off work due to restricted duty from her nurse practitioner. Nurse Todd opined claimant was so emotionally distraught it would be difficult for her to work for one week. The surveillance depicted claimant holding her left arm close to her body for the duration of the recorded time. Claimant used her right arm to feed and water her horses, to gesture during conversations, and to point at landmarks. She did not lift heavy objects with her right arm or work above shoulder height. She did not engage in inappropriate activities, given she was removed from work due to her emotional state. The claimant has the burden of proving by a preponderance of the evidence that the alleged injury actually occurred and that it both arose out of and in the course of the employment. Quaker Oats Co. v. Ciha, 552 N.W.2d 143 (Iowa 1996); Miedema v. Dial Corp., 551 N.W.2d 309 (Iowa 1996). The words “arising out of” referred to the cause or WINN V. PELLA CORPORATION Page 7 source of the injury. The words “in the course of” refer to the time, place, and circumstances of the injury. 2800 Corp. v. Fernandez, 528 N.W.2d 124 (Iowa 1995). An injury arises out of the employment when a causal relationship exists between the injury and the employment. Miedema, 551 N.W.2d 309. The injury must be a rational consequence of a hazard connected with the employment and not merely incidental to the employment. Koehler Elec. v. Wills, 608 N.W.2d 1 (Iowa 2000); Miedema, 551 N.W.2d 309. An injury occurs “in the course of” employment when it happens within a period of employment at a place where the employee reasonably may be when performing employment duties and while the employee is fulfilling those duties or doing an activity incidental to them. Ciha, 552 N.W.2d 143. The claimant has the burden of proving by a preponderance of the evidence that the injury is a proximate cause of the disability on which the claim is based. A cause is proximate if it is a substantial factor in bringing about the result; it need not be the only cause. A preponderance of the evidence exists when the causal connection is probable rather than merely possible. George A. Hormel & Co. v. Jordan, 569 N.W.2d 148 (Iowa 1997); Frye v. Smith-Doyle Contractors, 569 N.W.2d 154 (Iowa App. 1997); Sanchez v. Blue Bird Midwest, 554 N.W.2d 283 (Iowa App. 1996). The question of causal connection is essentially within the domain of expert testimony. The expert medical evidence must be considered with all other evidence introduced bearing on the causal connection between the injury and the disability. Supportive lay testimony may be used to buttress the expert testimony and, therefore, is also relevant and material to the causation question. The weight to be given to an expert opinion is determined by the finder of fact and may be affected by the accuracy of the facts the expert relied upon as well as other surrounding circumstances. The expert opinion may be accepted or rejected, in whole or in part. St. Luke’s Hosp. v. Gray, 604 N.W.2d 646 (Iowa 2000); IBP, Inc. v. Harpole, 621 N.W.2d 410 (Iowa 2001); Dunlavey v. Economy Fire and Cas. Co., 526 N.W.2d 845 (Iowa 1995). Miller v. Lauridsen Foods, Inc., 525 N.W.2d 417 (Iowa 1994). Unrebutted expert medical testimony cannot be summarily rejected. Poula v. Siouxland Wall & Ceiling, Inc., 516 N.W.2d 910 (Iowa App. 1994). A personal injury contemplated by the workers’ compensation law means an injury, the impairment of health or a disease resulting from an injury which comes about, not through the natural building up and tearing down of the human body, but because of trauma. The injury must be something that acts extraneously to the natural processes of nature and thereby impairs the health, interrupts or otherwise destroys or damages a part or all of the body. Although many injuries have a traumatic onset, there is no requirement for a special incident or an unusual occurrence. Injuries which result from cumulative trauma are compensable. Increased disability from a prior injury, even if brought about by further work, does not constitute a new injury, however. St. Luke’s Hosp. v. Gray, 604 N.W.2d 646 (Iowa 2000); Ellingson v. Fleetguard, Inc., 599 N.W.2d 440 (Iowa 1999); Dunlavey v. Economy Fire and Cas. Co., 526 N.W.2d 845 (Iowa 1995); McKeever Custom Cabinets v. Smith, 379 N.W.2d 368 (Iowa 1985). An occupational disease covered by chapter 85A is specifically excluded from the definition WINN V. PELLA CORPORATION Page 8 of personal injury. Iowa Code section 85.61(4)(b); Iowa Code section 85A.8; Iowa Code section 85A.14. When the injury develops gradually over time, the cumulative injury rule applies. The date of injury for cumulative injury purposes is the date on which the disability manifests. Manifestation is best characterized as that date on which both the fact of injury and the causal relationship of the injury to the claimant’s employment would be plainly apparent to a reasonable person. The date of manifestation inherently is a fact based determination. The fact-finder is entitled to substantial latitude in making this determination and may consider a variety of factors, none of which is necessarily dispositive in establishing a manifestation date. Among others, the factors may include missing work when the condition prevents performing the job, or receiving significant medical care for the condition. For time limitation purposes, the discovery rule then becomes pertinent so the statute of limitations does not begin to run until the employee, as a reasonable person, knows or should know, that the cumulative injury condition is serious enough to have a permanent, adverse impact on his or her employment. Herrera v. IBP, Inc., 633 N.W.2d 284 (Iowa 2001); Oscar Mayer Foods Corp. v. Tasler, 483 N.W.2d 824 (Iowa 1992); McKeever Custom Cabinets v. Smith, 379 N.W.2d 368 (Iowa 1985). The premier case in Iowa regarding cumulative injuries is McKeever Custom Cabinets v. Smith, 379 N.W.2d 368, 374 (Iowa 1985). In McKeever, the Iowa Supreme Court, quoted Professor Larson and his definition of a cumulative injury as a disability that gradually develops over a period of time for which liability exists. McKeever, 379 N.W.2d at 373 (citing 1B A. Larson, Workmen’s Compensation Section 39.10 (1985)). Then there is the case cited by claimant in her brief, Hormel v. Jordan, 569 N.W.2d 148 (Iowa 1997). In Jordan, a cumulative injury to the shoulder was found to be compensable. More importantly, the Iowa Supreme Court determined in the Jordan case, the evidence supported the conclusion the date of injury in the case of claimant was not only when he had knowledge of impairment to his shoulder but the date claimant learned he would not recover from the cumulative injury to his shoulder. Id at 152. There are three medical experts who rendered opinions relative to medical causation. Dr. Meyer related the right rotator cuff tear to claimant’s employment at the Pella Corporation. (Cl. Ex. 3, p. 7) Dr. Meyer did not relate the SLAP tear to claimant’s employment, however. Dr. Meyer agreed with the subsequent statement to a reasonable degree of medical certainty that it was: 1. More probable than not, given her previous history of overuse injuries (bilateral carpal tunnel and bilateral lateral epicondylitis), that her rotator cuff tear on the right is causally related to the repetitive work activities and overuse of that arm and shoulder in her work at Pella Corp. Furthermore, it is certainly plausible that following her left rotator cuff tear she used her right arm more frequently and this would be a further WINN V. PELLA CORPORATION Page 9 contributing factor to her development of the overuse condition (right shoulder rotator cuff tear) in her right upper extremity. (Cl. Ex. 3, p. 7) Then there was the opinion of Jacqueline M. Stoken, D.O., P.C. Claimant selected Dr. Stoken as an independent medical examiner. She examined claimant on December 27, 2011, after claimant had completed a detailed medical questionnaire. Dr. Stoken reviewed medical records from Knoxville Hospitals and Clinics, Iowa Orthopaedic Center, and Mercy Medical Imaging. (Cl. Ex. 10, p. 9) Dr. Stoken provided the following opinion regarding the cause of claimant’s right shoulder condition: 2. Given her history of overuse injuries (bilateral carpal tunnel and bilateral lateral epicondylitis), Ms. Winn’s right rotator cuff tear, more probable than not, is causally related to the repetitive work activities and overuse of the right arm and shoulder in her work at Pella Corp for over 33 years. 3. After Ms. Winn suffered her rotator cuff tear, her use of her right arm more frequently constituted a significant contributing factor to her development of the overuse condition (right shoulder rotator cuff tear) in her right upper extremity. 4. Ms. Winn has sustained permanent partial impairment to the body as a whole as a result of this injury with the right rotator cuff tear. This is causally related to the repetitive work activities and overuse of the right and [sic] shoulder in her work at Pella Corp for over 33 years. Using the AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition, Chapter 16, figure 16-1b, page 437, she has 16% impairment of the Right Upper Extremity due to deficits in ROM. Using the Guides, Chapter 16, table 16-3, page 439, this converts to 10% Impairment of the Whole Person. (Cl. Ex. 10, pp. 13-14) Only John D. Kuhnlein, D.O., did not causally relate claimant’s right shoulder condition to her employment at the Pella Corporation. In his report of January 13, 2012, Dr. Kuhnlein opined: I am not able to relate the alleged June 1, 2010, cumulative right shoulder injury, an October 20, 2010 left shoulder injury, or a cumulative November 16, 2010, right shoulder injury to her work for Pella for a variety of reasons: (Def. Ex. A, p. 13) WINN V. PELLA CORPORATION Page 10 One of the main reasons Dr. Kuhnlein did not find causation was because he did not find claimant to be a credible historian. (Def. Ex. A, p. 13) Additionally, Dr. Kuhnlein emphasized the fact claimant worked as a “stock-keeper” both before and after her August 11, 2008 injury to the left shoulder. It is the conclusion of the undersigned; claimant sustained an injury to her right shoulder as a result of her 34 year employment with the Pella Corporation. Over the course of her employment history, claimant engaged in numerous activities involving both of her upper extremities and both shoulders. This deputy finds the date of the right shoulder injury was November 16, 2010. This is the date claimant discovered her condition was serious enough to have a permanent, adverse impact on her employment. Herrera, at 288. Claimant’s last day of work was November 16, 2010. On this date, members of management informed her she was placed on unpaid suspension. (Cl. Ex. 19, p. 5) Claimant discovered her right arm condition was serious enough to impact her employment. The same date is used as the starting date for the commencement of any weekly benefits due to claimant. Claimant’s cumulative injury occurred on November 16, 2010 and not on June 1, 2010. Because claimant’s injury did not occur on June 1, 2010, claimant takes nothing from File No. 5035647. The remainder of this decision will involve issues in File No. 5035646. The next issue for resolution is the matter of permanency. There is objective evidence to establish claimant has a torn rotator cuff. Dr. Stoken opined claimant has a permanent condition to her right shoulder. Dr. Stoken determined claimant had a ten percent permanent impairment to the body as a whole as a result of the right shoulder condition. In addition, Dr. Stoken imposed permanent work restrictions. The work restrictions listed were: Reasonable permanent work restrictions for Ms. Winn would be to avoid work at or above the shoulder level. She should avoid frequent lifting of any type with the right upper extremity and occasional 5 lbs. (Cl. Ex. 10, p. 14) When disability is found in the shoulder, a body as a whole situation may exist. Alm v. Morris Barick Cattle Co., 240 Iowa 1174, 38 N.W.2d 161 (1949). In Nazarenus v. Oscar Mayer & Co., II Iowa Industrial Commissioner Report 281 (App. 1982), a torn rotator cuff was found to cause disability to the body as a whole. Since claimant has an impairment to the body as a whole, an industrial disability has been sustained. Industrial disability was defined in Diederich v. Tri-City R. Co., 219 Iowa 587, 258 N.W. 899 (1935) as follows: "It is therefore plain that the legislature intended the term 'disability' to mean 'industrial disability' or loss of earning capacity and not a mere 'functional disability' to be computed in the terms of percentages of the total physical and mental ability of a normal man." WINN V. PELLA CORPORATION Page 11 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, experience, motivation, loss of earnings, severity and situs of the injury, work restrictions, inability to engage in employment for which the employee is fitted and the employer's offer of work or failure to so offer. McSpadden v. Big Ben Coal Co., 288 N.W.2d 181 (Iowa 1980); Olson v. Goodyear Service Stores, 255 Iowa 1112, 125 N.W.2d 251 (1963); Barton v. Nevada Poultry Co., 253 Iowa 285, 110 N.W.2d 660 (1961). Compensation for permanent partial disability shall begin at the termination of the healing period. Compensation shall be paid in relation to 500 weeks as the disability bears to the body as a whole. Section 85.34. Claimant testified at the time of the hearing she had no strength in her right arm. She stated it was difficult for her to pick up objects with her right hand and arm. She testified she must care for her own personal needs. She sweeps the floor with her right arm. She folds the laundry with her right hand, loads the dishwasher too but experiences pain when she lifts her right arm above her shoulder. Management terminated claimant on December 1, 2010. Claimant has sought other employment but has not found work. She testified she applied for positions at restaurants, factories and at a bank. She received unemployment insurance benefits after she was terminated so she had to apply for work in order to qualify for the weekly unemployment insurance benefits. Claimant is an older worker at the age of 61. She does not have a high school diploma or a GED. Retraining is not a viable alternative. Her prior work experiences outside of the Pella Corporation have been in food service. Claimant’s work restrictions are severe. There will be few employment opportunities available to her. After considering all of the factors involving industrial disability, it is the determination of the undersigned; claimant has a permanent partial disability in the amount of 80 percent. Defendants shall pay unto claimant 400 weeks of permanent partial disability benefits commencing from the date of November 16, 2010 and payable at the rate of $443.43 per week. ORDER THEREFORE, IT IS ORDERED: In File No. 5035647, claimant takes nothing in the form of benefits. In File No. 5035647, each party shall pay her/its/their own costs. In File No. 5035646, defendants shall pay unto claimant, four hundred (400) weeks of permanent partial disability benefits at the stipulated weekly benefit rate of four WINN V. PELLA CORPORATION Page 12 hundred forty-three and 43/100 dollars ($443.43) per week and said benefits shall commence from November 16, 2010. In File No. 5035646, accrued benefits shall be paid in a lump sum, together with interest, as allowed by law. In File No. 5035646, costs are assessed to defendants. In File No. 5035646, defendants shall file all requisite reports in a timely fashion. Signed and filed this _____19th_____ day of September, 2012. ______________________________ MICHELLE A. MCGOVERN DEPUTY WORKERS’ COMPENSATION COMMISSIONER Copies to: Fredd J. Haas Attorney at Law 5001 S.W. 9th St. Des Moines, IA 50315-4502 freddjhaas1954@gmail.com David L. Jenkins Attorney at Law 801 Grand Ave., Ste. 3700 Des Moines, IA 50309-2727 jenkins.david@bradshawlaw.com MAM/srs