Attorneys
Last Updated: 8/1/2024
When a doctor releases an injured worker, it can lead to a stoppage of payments on the workers' compensation claim. The outcome depends on various factors, including whether the employee is released to regular job duties, light-duty work, or if the condition has reached a point of maximum medical improvement.
Effects of Doctors Releases on Workers’ Compensation Benefits: Designated as Healed
In many of these cases, the employee’s injury or illness eventually heals. For instance, a delivery truck driver is involved in a traffic accident that results in a broken arm and leg. After a few months, both fractures heal and the driver can get back to his/her regular job duties. Payments would then stop.
Doctor Release and Workman’s Comp Benefits: Put on Job Restriction
Another scenario arises when the employee is released to return to work but with certain restrictions. Job responsibilities might be adjusted, or the employee might work fewer hours. If treatment is ongoing, payments should continue during this period.
However, if the employee fails to adhere to the prescribed work restrictions, payments could potentially be stopped. For example, if a doctor advises light-duty assignments and the employee declines, this decision could impact eligibility for benefits.
Adapting to Changing Work Circumstances
If the worker receives a lower wage due to the injury, temporary total disability (TTD) benefits could transition to temporary partial disability (TPD) benefits. Unlike TTD, which provides 80% of average spendable earnings, TPD pays two-thirds of the difference between the pre-injury wages and the reduced wages.
You should receive your TTD (total temporary disability) check on a weekly basis. If you don’t receive it on time, contact the insurance adjuster to request an explanation. If you have an attorney then your attorney or their staff will contact the insurance company on your behalf. The insurance company can ultimately be subject to paying penalty benefits up to 50% for late checks.
Furthermore, a physician might determine that the employee has reached maximum medical improvement (MMI). This is common in cases like spinal cord injuries, where the condition has plateaued, and additional improvement is unlikely. However, ongoing treatment might still be necessary.
Benefit Availability Based on Injury Nature
The availability of benefits depends on the nature of the injury. For instance, if an individual has a permanent impairment, healing period benefits could be accessible during recovery. Once a doctor concludes that significant improvement is unlikely and releases the worker, healing period benefits cease, and permanent disability benefits might begin.
Even if they are cleared to work despite a permanent disability resulting from the injury, they might qualify for permanent partial disability (PPD) benefits. Alternatively, if the physician deems they are unable to return to work at all, permanent total disability (PPD) benefits could be applicable.
Right to a Second Opinion
Under Iowa law, you always have the right to seek medical treatment on your own. Still, usually it will be at your own expense unless you are able to win a petition for alternate medical care.
Basically, if the insurance company is offering you medical care, you should attend and fully cooperate with the care and treatment they offer. If their doctors do not have any further medical care to offer you and you go see a doctor who does have medical care that he or she thinks will help, then you may want to file a petition for alternate medical care.
Keep in mind that there are specific requirements for this process and it is usually best to seek the help of a qualified Iowa workers' compensation attorney. Our office handles alternative medical care matters at no additional cost to our clients and we are willing to discuss your medical care issues.
As an alternative to the alternative medical care process, once the company doctor has evaluated you for a permanent impairment rating, you have the right to a second opinion (sometimes called an IME- Independent Medical Examination) with a doctor that you choose. Iowa Code § 85.39 provides that the insurance company has to pay for a one-time IME with a doctor of your choice. Here are some tips when having an IME:
1. Choosing the right doctor to conduct the IME is very important and should not be taken lightly. There are both good IME doctors and bad ones so it is important that you choose the right one. Some IME doctors work almost exclusively with the insurance companies and will likely give an opinion in your case which helps them, not you. Unfortunately, there are not a lot of good qualified IME doctors in the State of Iowa.
2. The insurance company should pay for your roundtrip mileage, the time you miss from work, and the fees associated with both the examination and any testing that your IME doctor orders.
3. If the IME doctor recommends additional medical care to treat your work injuries, then you can proceed with the alternative medical care process to try to force the insurance company to provide you with the recommended treatment.
When It Might Be Necessary to Seek Advice from an Attorney
When payments for workers’ comp stop, it’s important to understand if they stopped for the right reasons. It could be that they prematurely ended and the employer is attempting to deny benefits that an employee has every right to receive. Or it could be that the types of benefits change, depending on the employee’s injury status.
One of the best ways to protect a workers’ compensation claim is to seek legal counsel. An attorney can explain eligibility for benefits and how the severity and extent of the injuries may affect benefits. To learn more, contact an attorney at Walker, Billingsley & Bair in Des Moines: 641-792-3595, contact us online, or Chat Here Now.
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