Last Updated: 11/2/2023
Under Iowa Code section 85.39 you have the right to a second opinion (also known as an independent medical examination) with a doctor of your choice once the insurance company doctors have given you an impairment rating based upon the AMA Guides 5th Ed. This is a very valuable thing and you do not want to just go see any doctor for your second opinion.
In fact, choosing the wrong doctor can make your case worse instead of better, so how do you choose?
1. You should probably be looking for a Board Certified Independent Medical Examiner.
These doctors have to pass a series of tests which include the AMA Guides 5th Edition which is the book used to determine your permanent impairment rating or also sometimes called your functional impairment rating. Often these doctors are also Board-Certified Occupational Health physicians whose specialty is dealing with the evaluation, treatment, and recommendations concerning work-related injuries. There are some surgeons and general practice doctors who hold themselves out at being able to do impairment ratings, but you should use caution and choose wisely as you are generally only allowed one 85.39 independent medical examination for your work injury.
Also, keep in mind that in 2017 the Iowa Legislature passed HF 518 which was signed into law by then Governor Branstad that drastically reduced the rights of and compensation paid to injured workers. One of the changes was to reduce the amount that insurance companies were required to reimburse injured workers for the 85.39 examinations. If you decide to try to get an 85.39 examination on your own without an attorney, be forewarned that you may be stuck with a significant portion of the bill should the insurance company decide they are only paying for the rating only and not for the other parts of the examination like reading the medical records, writing a detailed report, etc. Also, keep in mind that some doctors meet the qualifications discussed above who work for the insurance companies and employers 99% plus of the time. So you could end up choosing someone you think is qualified and end up with a defense doctor further damaging your case. At the very minimum, you should contact an Iowa workers’ compensation attorney and run the doctor's name by them before you spend your time and perhaps money to make your case worse.
2. If you are far enough into a workers’ compensation case that you have an impairment rating, but have not already spoke with a qualified Iowa workers’ compensation attorney then now is the time to do so.
Most experienced work comp attorneys have several different doctors that they will use depending upon where the injured worker lives and the types of injuries that they have sustained. For example, some independent medical examiners will evaluate a neck or back injury but will not evaluate a shoulder or hearing loss claim. It is important that you see a qualified doctor who can evaluate your work injuries and provide a detailed report supporting his or her conclusions about your impairment rating, causation, permanent work restrictions and recommend future medical care.
Not all independent medical examiners are the same. There are some that are more injured worker-friendly while others work almost exclusively for workers’ compensation insurance companies and self-insured employers. Choosing the wrong IME doctor for your case can have devastating effects. Keep in mind that very few independent medical examiners which will also provide you with medical care and treatment.
3. While your permanent impairment rating is important, what is more important is how that impairment rating is applied to your case
a. For example, maybe you have sustained a back injury and have returned to your same job but are now making less money because your employer will not let you work overtime. Are you to be compensated for your impairment rating only or should you receive industrial disability based upon 500 weeks of benefits owed?
b. Perhaps you sustained a work-related arm injury that prevents you from returning to your same job, but you had carpal tunnel surgery on your other hand before that was not work-related. Do you qualify for Iowa Second Injury Fund benefits? If so, how much and how do you try to get them.
c. Maybe you sustained a shoulder injury requiring surgery and after your FCE (functional capacity evaluation) your employer is telling you that they no longer have work for you within your now 20-pound weight restriction. The insurance company is likely going to pay you a percentage of 400 weeks of benefits. Is this really all that you are owed? Should you file for unemployment and if so when should you? Do you have another case for firing you because of your work injury?
These are a few fact scenarios, but there are hundreds of different situations that we have encountered during the past 25 plus years. If you are looking for additional information about Iowa’s workers’ compensation system (including 85.39 second opinions), how you are to be paid based upon your impairment rating and body part injured, employment law, and unemployment law along with much more than you should request a copy of our book entitled “Iowa Workers’ Compensation- An Insider’s Guide to Work Injuries”. We offer the book at no cost to you, and it includes the Injured Workers Bill of Rights and 7 Deadly Mistakes to Avoid if You are Hurt at Work. Get your copy now by clicking here or by Call Now 641-792-3595.
We offer our Iowa work comp. book at no cost, because he has seen too many hard-working Iowans throughout the state of Iowa, injured at work make common mistakes costing them thousands of dollars. Injured workers are beginning to realize that their employer and the workers' compensation insurance company are not there to help them. Finally, there is a book about Iowa workers' compensation that you can review in the comfort of your own home with no risk or pressure. For immediate assistance call 641-792-3595.