Unfortunately, unpaid medical bills are very common in Iowa workers’ compensation cases. The laws are different if your claim has been accepted and your medical care is being directed by your employer and/or their workers’ compensation insurance company compared to if your claim has been denied. We will discuss the various loss for these different situations below.
If your claim has been accepted, then chances are that your employer and/or their workers’ compensation insurance company is sending you to their medical providers. However, even though your employer and their insurance company have the right to direct your medical care, injured workers often receive unpaid medical bills. You should know that as part of sending you to their medical providers, they are required under Iowa law to pay for the medical care. However, sometimes the workers’ compensation insurance company will pay a reduced amount leaving the injured worker owing a balance.
This is not the way it is supposed to work so what can you do as an injured worker?
1. If you get a bill don’t ignore it. You should send a copy of the bill to the workers’ compensation insurance adjustor and follow up with a call a few days later.
2. You should call the medical provider and inform them that this is a work injury and the dispute concerning how much to be paid on the bill is between them and the medical provider that Iowa Code section 85.27(4) requires the employer to hold claimant harmless for any care which was chosen by the employer. Hatayama v. Select Specialty Hospital, No. 5068839 (App. Dec. 1/28/2022 citing Ramirez-Trujillo v. Quality Egg and Selective Ins. Co., 878 N.W.2d 759 (Iowa 2016), which held that an "employer who authorizes care is responsible for the cost of care" until the claimant is notified that care is no longer authorized, the commissioner reverses the deputy's decision and finds that the employer was responsible for the cost of the authorized care.
3. If you continue to receive medical bills and/or are not satisfied with how you are being treated, then it may be time to call a qualified Iowa Workers’ Compensation attorney.
There are also laws that provide some protection for injured workers when a work comp claim has been denied. However, often insurance companies, bill collectors, and employers ignore these laws because they either don’t know them or are trying to take advantage of injured workers without legal representation. Also, it is important that you have a copy of the denial letter as you may need it to get your bills paid. If they have not sent a denial letter, then you should call the insurance company or their lawyer if they are represented in order to get one.
There are a few different scenarios that we see in denied workers’ compensation cases here in Iowa:
1. Refusal to submit the claim to health insurance.
Sometimes medical providers (often chiropractors) will tell the injured worker they are not allowed to submit their bills to health insurance when someone has been hurt at work. This is rarely true. Instead, the medical provider would like to receive the full amount of their charges instead of the reduced amount that health insurance companies pay for payment in full. If your medical provider is refusing to submit your medical bills to your health insurance company, then it may be time to call an attorney to discuss if it makes sense to change medical providers or get assistance with the case to make sure that the bills are paid.
2. Denial for payment by your health insurance company.
This is common when a person has been hurt at work or in another personal injury accident like a car crash. Your health insurance would prefer to not pay for your bills, but under Iowa code section 85.38(2)(a) they are required to pay for work injury-related medical care when the claim has been denied. The statute specifically states the following:
“If an employer denies liability under this chapter . . . for payment for any medical services received by an employee with a disability, and the employee is a beneficiary under either an individual or group plan for non-occupational illness, injury, or disability, the non-occupational plan SHALL NOT deny payment for the medical services on the basis that the employer's liability for the medical services under this chapter . . . is unresolved.”
Therefore, if your claim has been denied you are going to need to look at in detail the EOBs (explanation of benefits) that you received from your health insurance company to see if your bills are being paid or not. (Note: Iowa code section 85.38 (2)(b) applies the same way to short-term disability or other disability benefits that may be available to you. If your work comp claim is denied, then they are not allowed to deny payment of benefits because it was work-related).
3. Subrogation by your health insurance company.
If your health insurance does end up paying for your work injury-related medical bills, then they will likely send out a subrogation notice. This may come from a company like Rawlings Company or one of the various other subrogation collection companies. However, if your health insurance plan is through your employer where you were injured, then they likely do not have a valid subrogation claim in your case. Iowa code section 85.38(2) which provides credit for an employer sponsored health plan such that if you were required to pay subrogation, the workers’ compensation insurance company would make a double recovery leaving you with fewer benefits. (Note: If your company is large and is self-insured for health insurance matters then they may be covered by ERISA which can create problems because there is a conflict between Iowa and federal laws.)
If your health insurance plan is not provided through your employer, then the subrogation interest is probably valid under Iowa’s general subrogation laws.
If you or a loved one are dealing with a workers’ compensation claim that is either admitted or denied and you are having issues with medical bills and/or subrogation issues then it is probably time to call an experienced Iowa workers’ compensation attorney before you make a costly mistake. We offer a no cost, no risk review of your Iowa work comp. case. We will answer your questions and even tell you if you need an attorney or if this is something you can handle on your own. Just call our office at 641-792-3595 to speak with our experienced workers’ compensation team at or use our Live Chat feature by clicking here 24 hours a day/7 days per week. Your information will remain confidential.
If you are not ready to speak with an attorney but would like to learn more about the Iowa workers’ compensation system and the laws that affect you then request a copy of our Iowa Work Injury Comprehensive Guide which includes How to Avoid 7 Costly Mistakes in your Iowa workers compensation case. The book is available at no cost because we have seen way too many hard-working Iowans make costly avoidable mistakes.
How Medical Bills Are Paid For Iowa Workers Comp
How does medical payments coverage help in the event of a serious injury?