Medical Care and Benefits

Where the employer has accepted a claim as a work injury, or where the injured worker has received an award in his favor, then the employer is required to provide lifetime medical care relating to the work injury. The employer has the duty to provide the medical care promptly without undue inconvenience to the employee.

The employer’s duty to provide the medical care is very broad and includes paying for all reasonable doctor visits, testing, surgical care, hospital charges, medication expenses, osteopathic care, chiropractic care, physical therapy and rehabilitation. In addition, the employer has an obligation to provide prosthetic devices to replace body parts, hearing aids, prescription glasses, orthodontic devices, dentures, and braces.

Generally the employee should not be required to travel more than 50 miles to receive medical care. However, where closer medical care is not available, or a specialist is needed, then longer travel for the medical care is appropriate. The employer is required to pay for the injured worker’s mileage for traveling to and from medical care. To the extent that the medical care requires longer travel the employee is entitled to be paid for meals and lodging.

To the extent that an injured worker has to miss work as a result of his medical care Iowa law provides that the employer should pay the injured worker at his regular rate of compensation, and the employer should be reimbursed by the work comp insurance company.

Under Iowa workers’ compensation law the employer has the right to select the medical care providers. Therefore, it is very important that an injured worker makes sure that the medical care is authorized by the employer. Generally, if the employer does not authorize the medical care, then the employer does not have to pay for the medical care. In certain situations the employer will be required to pay for medical care for a work injury that was not authorized or approved. For example, in some situations the employer will be required to pay for emergency medical care. However, it is always best for the worker to try to get the medical care authorized before it is performed to make sure that the worker is not responsible for the charges.

If the employer is not willing to provide the medical care that the injured worker believes is necessary, the worker can file an alternate medical care petition. The injured worker has the burden of proof to show that the medical treatment being offered by the employer is not reasonably suited to treat the injury without undue inconvenience to the injured worker.

Prior to filing a petition for alternate medical care the employee is required to communicate the reason for their dissatisfaction to the employer in writing in an attempt to resolve the medical care dispute. The question of whether or not the offered medical care is reasonable is a question of fact to be decided by the Iowa Work Comp Commissioner. The employer or his counsel should arrange to obtain an expert opinion supporting the position that additional medical care is necessary.

As the Workers’ Compensation Commissioner frequently states in his alternate medical care decisions, mere dissatisfaction with the medical care offered is not sufficient grounds to grant an application for alternate medical care. Rather the injured worker has to show that the care chosen by the employer is unreasonable. Unreasonableness can be shown by establishing that the care was not offered promptly; that it was not reasonably suited to treat the injury; that it was unduly inconvenient to the injured worker; that it has not been effective; or that it is inferior and less extensive than other available care requested by the injured worker.

A frequent area of dispute that leads to alternate medical care petitions is when an authorized doctor makes a referral to a specialist or orders a test or other procedures that the employer does not agree with or does not want to pay for. Common examples of these kinds of disputes relates to things such as whether an MRI should be authorized, whether a surgical consult should be pursued, or whether arthroscopic surgery should be conducted to try to determine the specific injuries that a worker has suffered.

In most situations where an authorized physician has recommended additional care, the Workers’ Compensation Commissioner will ultimately rule in favor of the injured worker that the disputed care or referral should be authorized and paid for by the employer.

Unfortunately, work comp insurance companies will sometimes simply stop communicating about medical care needs. If your workers’ comp adjuster stops returning your calls this is frequently called abandonment. If the insurance company has abandoned your case, then a petition for alternate medical care is the proper way to get additional medical care authorized and paid for.

An alternate medical care petition can also be used to attempt to obtain a second opinion. In some situations the treating physicians authorized by the employer might run out of ideas for treatment, but the injured worker is still dealing with a lot of problems. In such a situation a fresh set of eyes from a new doctor can be helpful.

Once an alternate medical care petition is filed the dispute moves towards resolution fairly quickly. A telephone hearing will be scheduled, and a decision on the request for alternate medical care will be issued within 10 days of the Commissioner’s receipt of the alternate medical care petition.

Under Iowa law an employer can require the injured worker to attend a defense medical examination to assess the claimant’s condition. These defense medical exams are a little different than regular medical care, and there are no limitations on the distance that the employee can be required to travel for the assessment exam. The employer does have to pay for the injured worker’s transportation expenses and missed wages for any defense medical exam.

Defendants most typically use these assessment examinations to obtain impairment ratings or to get second opinions on whether or not the injured worker’s injuries were caused by his employment.

After the injured worker has reached maximum medical improvement and the employer has obtained an impairment rating, the employee then has the right to have an examination by a physician of his choice to evaluate the extent of the injury and provide a second impairment rating. The claimant’s independent medical exam is frequently called an IME. The IME is a crucial stage in work comp litigation. It is important to choose a physician that is familiar with performing impairment evaluations, is experienced in the Iowa workers’ compensation system, and is respected by the Deputy Workers’ Compensation Commissioners and the Workers’ Compensation Commissioner who will ultimately decide the case.

As part of the independent medical examination process our law firm works very hard and makes sure that all of the necessary underlying medical records are gathered and provided to the IME doctor. Our law firm also spends a great deal of time and effort in drafting questions for the IME doctor to answer. In addition to soliciting the IME doctor’s expert opinion on the extent of the permanent impairment from the work injury; each case also has special issues that need to be raised with the IME doctor. A high quality IME report from a doctor who has been given a complete picture of the injury and the relevant surrounding factors helps obtain full and fair compensation.

We would be happy to answer any questions you have about medical care in Iowa workers’ compensation cases, or any other issue in an Iowa work comp claim. Call or email us now without charge or obligation.