A driver who admitted rear-ending a truck near Des Moines owed the injured motorist nothing - because she chose surgery over recommended therapy. 

That was the outcome of an August 19, 2026 ruling from the Court of Appeals of Iowa, which upheld a jury verdict that gave the injured driver no recovery despite the other driver admitting fault for the November 2019 crash. The deciding factor was a defense claims professionals know well - failure to mitigate. 

The injured driver had struggled with her right hip for years. She was born with two underlying conditions and had three surgeries dating back to 2010, then went six years without hip treatment before the collision. She called the impact "severe." The other driver called it "[m]inor. Airbags didn't go off." 

Her doctors urged conservative care first - a corticosteroid injection, followed by eight weeks of physical therapy twice a week. The injection cut her pain by about 60%. She stopped therapy after three weeks and pressed for surgery instead, even after her own surgeons flagged only a "50-60% chance of improvement" given her earlier operations. 

The surgery ran four hours. Surgeons cut her femur in half, rotated it, and secured it with a custom metal plate and eight screws. Recovery took months. The bills for the surgery and related care came to more than $56,000 - over 90% of her total medical claim. Barely $3,200 went to the conservative treatment she cut short. 

Her treating surgeon and the defense expert agreed the three problems fixed in surgery all predated the crash. The defense expert said conservative treatment "absolutely" could have eased her pain, and that he would not have recommended the operation. 

Jurors found the at-fault driver caused some damage but put 75% of the fault on the injured driver for failing to mitigate. In Iowa, a plaintiff more than half at fault recovers nothing - and she did not. 

On appeal, she argued the mitigation defense lacked evidence and that jurors should have been told patients may pick between reasonable treatments. The court disagreed on both points, finding solid evidence for the defense and holding that her proposed instruction would have misstated the law. 

The ruling is an appellate decision and may still face further review.