Bradley Ciha was assigned as the on-call maintenance supervisor for the Memorial Day weekend. After completing call-in service at the employer's plant, he returned home by a scenic, less direct route, and was seriously injured in a motorcycle accident. Quaker Oats, the employer, believed it was not responsible for the injuries of an employee going or coming to work; but if an exception existed for a special errand, the employer believed Ciha deviated from this errand by taking the indirect route home. Quaker Oats did not believe that "reasonable appliances" under the workers' compensation law included modifications costing $20,788 to Ciha's home and a van conversion costing $24,509, nor did it believe Ciha's wife should be paid for nursing care expenses.

Finally, the employer did not believe that Ciha was 80 percent "permanent partial" disabled, as the employer modified the workplace and continued to provide full-time employment for Ciha. The matter was appealed from the industrial commissioners' office to the district court to the state supreme court.] McGIVERIN, C. J.... Ciha first returned to work at Quaker Oats in January 1992 in a new position as materials supervisor. In this position, he works at a computer (with the aid of an adaptive device and telephone headset) in the company's purchasing department. With the aid of a modified computer, Ciha analyzes inventory and makes purchases on behalf of Quaker Oats. Quaker Oats greatly aided in Ciha's return to work by adapting the workplace and position in order for Ciha to be able to perform the job.*

It is apparent Ciha has progressed well in the new position. In his position as materials supervisor, he receives the same base salary, not including raises, as that of an area maintenance supervisor. Ciha no longer has the same opportunity, however, to earn overtime as he had as an area maintenance supervisor.... In order to return to work, Ciha relied on the county's disabled persons transportation service to and from Quaker Oats. Based on the hours of the transportation service, however, Ciha was not able to return to work full-time. Ciha was readmitted to Craig for one week in March 1992 for a comprehensive evaluation. At the time of his readmittance, Ciha did not own a van and did not drive. While at Craig, Ciha had his driving potential assessed. A driving specialist from the hospital concluded Ciha would need to purchase a specially modified van in order to be able to drive independently.

At some time thereafter, Ciha purchased the recommended van. After considering all arguments raised by the parties, we believe substantial evidence supports the commissioner's conclusion that Ciha was on a special errand at the time of his injury.... ... The fact that Ciha was contacted on Sunday while he was on 204 duty was truly "special:" it was unusual, sudden, and unexpected... Notwithstanding our conclusion that the special errand exception to the going and coming rule applies in the present case, Quaker Oats contends Ciha had "deviated" from his trip home from the plant to such an extent that he abandoned his employment at the time of the accident. The commissioner and district court rejected this argument, and we do the same... ...

In concluding Ciha did not deviate from his special errand, the commissioner stated: [Ciha] testified that he often took [the Ellis road] route home because it was more scenic, it had less traffic, it had fewer stop lights, and the actual difference in miles between this route and the more direct route was minimal. [Ciha's] call to his wife from the plant to start the grill for their meal shows that his purpose was to return home, and that he had no other destination other than to return to his residence. The record does not show a deviation from the course of the employment. ... Of the expenses awarded by the commissioner under Iowa Code section 85.27, Quaker Oats only challenges the award of costs for home modifications, van conversion, and home nursing services. The commissioner and district court found the home modification and van conversion expenses to be reasonable "appliances" under section 85.27.

In addition, the commissioner found the claimed expenses for home nursing services and the claimed value of those services to be reasonable. Iowa Code section 85.27 provides in pertinent part: The employer, for all injuries compensable under this chapter or chapter 85A, shall furnish reasonable surgical, medical, dental, osteopathic, chiropractic, podiatric, physical rehabilitation, nursing, ambulance and hospital services and supplies therefor and shall allow reasonably necessary transportation expenses incurred for such services. The employer shall also furnish reasonable and necessary crutches, artificial members and appliances... ...

Quaker Oats does not dispute that the cost of Ciha's wheelchair is compensable under section 85.27; therefore, the question becomes whether the home modifications and van conversion completed to accommodate an admittedly covered appliance (a wheelchair) are compensable under the same statute. An "appliance" is defined as hearing aids, corrective lenses, orthodontic devices, dentures, orthopedic braces, or any other artificial device used to provide function or for therapeutic purposes. Appliances which are for the correction of a condition resulting from an injury ... are compensable under Iowa Code section 85.27....

We begin with the unusually strong medical evidence of necessity and of the record that [the claimant's] family status and past lifestyle reveal no other use for the van. That evidence refutes any contention that the van is a frill or luxury and reveals what can be described as an appliance, not greatly different from crutches or a wheelchair. The point is that a van is necessary in order to make [the claimant's] wheelchair fully useful... Under the unique facts of the present case, we conclude substantial evidence supports the commissioner's ruling that the home modifications and van conversion were reasonable appliances under Iowa Code section 85.27.

In addition to the claimed home modification and van conversion expenses, Ciha also sought $58,447 in home nursing services performed by his wife after his return home from the hospital in Colorado. At the arbitration hearing, Quaker Oats unsuccessfully contended the claimed home nursing services were not reasonable expenses under section 85.27, and also that the claimed amount of the services set forth in an affidavit prepared by Kim Ciha was unreasonable.

On appeal, Quaker Oats does not dispute that it had a duty under Iowa Code section 85.27 to provide reasonable nursing services to Ciha if his injury was compensable (which we have concluded it is). In addition, Quaker Oats agrees the services performed by Kim were "nursing" services as contemplated by section 85.27. Quaker Oats contends, however, that $58,447 in home nursing expenses claimed by Ciha is unreasonable.

The commissioner and district court disagreed and we must affirm this decision if supported by substantial evidence. In ordering Quaker Oats to pay Ciha's home nursing services, the commissioner stated the following: The record shows that [Ciha's] wife received special training to perform the functions of a nurse for her husband, including digital manipulation to stimulate a bowel movement. ... In the instant case, [Ciha's] spouse, although not a nurse or LPN, did have to receive special training to perform the services. The services themselves are clearly medical nursing services and not general care services such as dressing, bathing, feeding, etc. [Ciha's] spouse's nursing services are held to be compensable under Iowa Code section 85.27.... ...

We believe the affidavit and Kim's testimony establish the reasonableness of the claimed home nursing care expenses by a preponderance of the evidence. We conclude substantial evidence supports the commissioner's finding on this issue.

As a final issue, Quaker Oats contends the commissioner erred in ruling that Ciha had sustained an eighty percent permanent partial industrial disability. Quaker Oats argues Ciha's disability is only fifty to sixty percent because it, Ciha's employer, went to great lengths to accommodate claimant and also that claimant has suffered no loss of earnings. As we have stated on many occasions, "[i]ndustrial disability measures an injured worker's lost earning capacity." ... Factors that should be considered include the employee's functional disability, age, education, qualifications, experience, and the ability of the employee to engage in employment for which the employee is fitted....

As a result of the accident and resulting quadriplegia, Ciha is wheelchair-bound, cannot control his bowel functions, and his lifestyle has been severely limited from that prior to the injury. He requires extensive, daily care and attention by his wife, relatives, and co-workers as he no longer has the ability to perform many basic daily living functions. Also, as a thirty-eight year old man, it cannot be reasonably disputed that Ciha's employability outside of the Quaker Oats workforce has been significantly and negatively affected by his injury.

Although we applaud the efforts of Quaker Oats in modifying the workplace to accommodate Ciha's disability, such efforts are not determinative of Ciha's industrial disability rating. See Thilges v. Snap-On Tools Corp., 528 N.W.2d 614, 617 (Iowa 1995) ("[W]e are satisfied that the commissioner was correct in viewing loss of earning capacity in terms of the injured worker's present ability to earn in the competitive job market without regard to the accommodation furnished by one's present employer."). In finding eighty percent industrial disability, the commissioner concluded the following: [D]efendant [Quaker Oats] has gone to great effort to accommodate claimant's [Ciha's] devastating disability. Defendant has set up a team of five co-employees to assist claimant, installed a special elevator, etc. These efforts are very appropriate, and defendant is to be commended for putting claimant back to work under difficult circumstances.

However, defendant also obtains an advantage by doing so in that claimant's disability is reduced from what it otherwise would be.

Although claimant's position is not a "make work" job and involves a significant contribution to his employer, nevertheless if claimant were to be suddenly thrust into the job market, his ability to compete with other workers for positions would be limited in the most extreme sense. Clearly, without the accommodation, claimant's disability would be permanent and total. Claimant's industrial disability is found to be [eighty] percent. We conclude there is substantial evidence to support the commissioner's decision on this issue. Affirmed.

Case Questions

1. Assess the extent of the accommodations the employer made to allow Ciha to be able to return to work.

2. Because Bradley Ciha suffered no loss of earnings, how can he be considered 80 percent permanent partial disabled?

3. Under Section 85.27, "The employer shall also furnish reasonable and necessary crutches, artificial members, and appliances ..." Did the legislature authorize a home modification ($20,788) and a van conversion ($24,509) under the term appliances?