FAQs for Workers' Compensation
1. What qualifies as a workers’ compensation injury?
Answer: All injuries that arise out of and in the course of employment are covered under Iowa work comp law. As a general matter this means that any injury that occurs at work and is caused by work qualifies as a workers’ compensation injury. The legal and factual standards for what qualify as a work injury have been extensively litigated, and potential claims should be examined very carefully to determine whether or not they qualify as a work comp injury.
2. I have a pre-existing medical problem that has now gotten worse because of my job. Does this qualify as a workers’ compensation injury?
Answer: A pre-existing problem which was not originally caused by work, but which is substantially aggravated by work activities can end up being at least partly covered as a workers’ compensation injury.
3. There was not an accident at work that caused my problem, but I think years of doing the same job was the reason for my injury. Does this qualify as a workers’ compensation injury?
Answer: Workers’ compensation injuries can be caused by either a single traumatic event, or can be the result of cumulative trauma.
4. If I have suffered a work injury, what are the rules relating to medical care?
Answer: An injured worker is entitled to have all the medical care expenses relating to the work injury paid by the employer or insurance carrier. The employer has the right to select the medical care providers. The employer has the duty to provide medical care in a prompt and convenient fashion.
5. If I suffer a work injury, and I can’t work at all, or I can’t do my regular job, am I entitled to monetary compensation?
Answer: If a worker is injured and unable to work he is entitled to receive healing period (HP) or temporary total disability (TTD) benefit payments while he is off work. If the employer is able to provide appropriate light duty work while the worker is recovering, the worker is not entitled to receive HP or TTD payments.
6. How is my weekly rate of compensation determined?
Answer: The weekly rate of compensation for an injury is determined by looking at the worker’s average earnings for the first 13 weeks of representative earnings prior to the injury. Certain types of payments to the worker are not used in calculating the weekly rate including fringe benefits, reimbursement of expenses, or regular bonuses, and the value of overtime above the straight time rate.
The average of the prior 13 representative weeks is then calculated, and that average weekly wage is applied to the Iowa Workers’ Compensation Commissioner’s “rate book.” The Commissioner’s rate book takes the average weekly wage, the worker’s marital status, the number of exemptions the worker is entitled to, and based on these factors indicates the weekly rate at which the worker should be paid. The weekly rate is usually roughly equal to a worker’s net after tax weekly income.
7. How many weeks of benefits am I entitled to because of the permanent lingering effects of my work injury?
Answer: Once a worker’s post-injury medical condition has reached maximum medical improvement, then his eligibility for HP or TTD payments ends. Instead the worker is entitled to receive permanent partial disability (PPD) benefits to compensate him for the permanent effects of the work injury.
The Iowa Workers’ Compensation system has two main types of injuries: scheduled injuries or unscheduled injuries.
The different types of scheduled injuries and the maximum amount of PPD benefits that a worker can receive for those injuries is as follows:
- Leg. . . 220 weeks of PPD benefits.
- Foot . . . 150 weeks of PPD benefits.
- Arm . . . 250 weeks of PPD benefits.
- Hand. . . 190 weeks of PPD benefits.
- Eye . . . 140 weeks of PPD benefits.
- Loss of the second eye. . . 200 weeks of PPD benefits.
- Loss of hearing in one ear. . . 50 weeks of PPD benefits.
- Loss of hearing in both ears. . . 175 weeks of PPD benefits.
- Thumb. . . 60 weeks of PPD benefits.
- Index fingers. . . 35 weeks of PPD benefits.
- Middle finger. . . 30 weeks of PPD benefits.
- Ring finger. . . 25 weeks of PPD benefits.
- Little finger. . . 20 weeks of PPD benefits.
- Big toe. . . 40 weeks of PPD benefits.
- Any other toe . . . 15 weeks of PPD benefits.
- Facial disfigurement . . . 150 weeks of PPD benefits.
- Loss of both arms, both hands, both legs or both feet, or any two thereof in a single accident . . . 500 weeks of PPD benefits.
Fortunately, most work injuries do not result in the complete loss of any of the body parts listed above. As a general matter, when a worker has suffered an injury that results in a partial disability to a body part, the amount of PPD to be paid is based on the percentage of functional loss to the body part according to the AMA Guides to the Evaluation of Permanent Impairment (5 th Edition).
For example, a worker could have a hand injury that is evaluated as a 20% functional impairment to the hand. Based on these facts the worker would be entitled to receive 38 weeks of PPD benefits. (Hand worth a maximum of 190 weeks x 20% functional impairment = 38 weeks of PPD benefits).
Injuries to parts of the body not listed in the schedule set out above are frequently called unscheduled or industrial disability injuries. Common unscheduled injuries include shoulder injuries, back injuries, neck injuries, head injuries, hip injuries, psychological injuries and chronic pain syndromes.
If a worker has suffered an unscheduled injury, the emphasis for determining damages shifts from only evaluating the physical functional impairment to instead determining the reduction in potential earning capacity. Assessing the loss of the potential earning capacity involves analyzing the totality of circumstances, including the injured employee’s age, education, qualifications, experience, motivation, loss of earnings, severity and location of the injury, work restrictions, inability to engage in employment for which the employee is fitted, and the employer’s offer of continuing work or failure to offer continuing work.
PPD benefits for unscheduled injuries are generally paid based on a maximum of 500 weeks. For example, if a worker is found to have suffered 50% industrial disability or loss of earning capacity, he is entitled to collect 250 weeks of PPD benefits.
8. If a worker is killed in a job accident, what benefits are his survivors entitled to?
Answer: If a worker dies as a result of a work injury, the employer and insurance carrier are liable for several types of benefits:
- The employer is responsible for any medical expenses relating to treatment of the injury that led to the employee’s death.
- The employer is responsible for burial expenses. The employer’s liability is limited to 12 times the statewide average weekly wage at the time of the worker’s death.
- The employer is responsible for paying the surviving spouse weekly compensation benefits for the life of the spouse, or until the spouse remarries.
- If there is not a spouse, the employer is responsible for paying weekly compensation benefits to the children or other dependents of the decedent. The benefits for the children or other dependents generally terminate when those parties reach the age of 18.
- Iowa law also provides for equitable apportionment of the weekly benefits between the spouse and other dependents.
9. Do I have any duties relating to reporting work injuries?
Answer: All workers’ compensation claims need to be reported to the employer within 90 days of the occurrence of the injury. The notice to the employer can be satisfied by a formal notice from the worker, or if the employer has actual notice of the injury. Iowa law does provide for extensions of this 90 day notice time limit under certain circumstances.
10. Are there time limits for filing a workers’ compensation Petition?
Answer: A worker must file a petition for workers’ compensation benefits within the statute of limitations time limit or lose their right to ever recover any weekly benefits.
There are two general statute of limitations:
- If the worker has not been paid any weekly benefits the petition must be filed within two years of the date of injury.
- If the worker has been paid weekly benefits, then the petition must be filed within three years of the last payment of weekly benefits.
Iowa law does provide for the extension of the statute of limitations time limit under certain circumstances.
11. I previously suffered an injury to my left hand, and I have now suffered an injury to my right hand. The combination of these two injuries makes it very difficult for me to work. Am I entitled to any special payments because of this combination of injuries?
Answer: Iowa workers’ compensation law does provide for special additional compensation in certain situations where a worker has suffered multiple injuries. The law concerning these Second Injury Fund claims is fairly complex, but generally works as follows:
- As a starting point a worker must have suffered a loss in the past involving a hand, arm, foot, leg, or eye. This starting loss can be either work or non-work related, and it can be traumatic or non-traumatic.
- The potential Second Injury Fund claim is then triggered where the worker suffers a workers’ compensation injury involving a different hand, arm, foot, leg, or eye.
- The employer is only responsible for the regular scheduled injury value of the work injury.
- However, the employee can also bring a claim against the Second Injury Fund which is administered by the State of Iowa. The Second Injury Fund is liable for the unscheduled or industrial disability value of the two combined injuries, less a credit for the scheduled value of the two injuries.
- For example, a worker may have suffered an old left hand injury that resulted in a 50% disability of the left hand. The worker then suffered a work injury to the right hand resulting in 50% disability to the right hand. For purposes of this example we will assume that the combined industrial disability effect of those two injuries is that the worker has a 60% industrial disability. Therefore, the Second Injury Fund valuation analysis is that since the worker has a 60% industrial disability that would entitle him to 300 weeks of PPD benefits. However, these 300 weeks of PPD must be reduced by the scheduled injury value of the two hand injuries. Each of those hand injuries is worth 95 weeks of PPD benefits, or a total of 190 weeks of PPD benefits. Therefore, the worker is entitled to 300 weeks of PPD benefits from the Second Injury Fund, less a reduction of 190 weeks of benefits for the scheduled value of the two hand injuries for a net recovery to the worker from the Second Injury Fund of 110 weeks of PPD benefits.
12. I previously settled my workers’ compensation case, and now the old injury is getting worse, is there anything I can do?
Answer: A review-reopening is a type of workers’ compensation claim for a worker who previously settled his claim, or received an award; and who has suffered a worsening of the original injury. In this situation the worker can bring a review-reopening action to try to obtain additional compensation based on the worsening of the original work injury. The worker has the burden of showing that the condition has worsened, and this can be done in several different ways. For a scheduled injury the worker needs to show that the functional disability has increased. For an unscheduled or industrial disability injury, the worker can show either the functional disability has increased, or that the worker’s ability to earn money has decreased because of the injury.
There is a time limit for all review-reopening claims. A petition to start the review-reopening action must be filed within three years of the last payment of weekly benefits by the defendants.
13. My employer classifies me as an independent contractor, and even had me sign an agreement that I was an independent contractor. I have now been injured, and my work comp claim is being denied because my employer says I am not an employee. Is there anything I can do?
Answer: Workers’ compensation protection applies to all employees, but not to independent contractors. However, an employer cannot avoid the obligation to provide workers’ compensation benefits by simply labeling an employee as an independent contractor. Even a signed written agreement that the worker is not an employee is not necessarily controlling. Iowa law provides for a multi-part test to determine whether or not an alleged independent contractor is actually an employee. There is also a special test for determining when owner-operators of trucks are independent contractors or employees.