Workers’ compensation benefits cover disability benefits as well as provide compensation for medical treatment required for an on-the-job injury. But what if an injury is so severe that workers can no longer perform the activities of daily living? In such cases, workers’ compensation insurance should also pay for assistance from life service providers.
Life Services Defined
Life services help care for a person who cannot care for him/herself, these can include services like:
- adult day care;
- assistive living support; and
- home health care support.
These services are geared toward helping patients complete the activities of daily living like cleaning oneself, eating food, and other common tasks.
Different types of work injuries can lead to a worker needing life services, including:
- spinal cord injuries;
- traumatic brain injury; and
- severe amputations.
Workers may require these services on a permanent basis, or they may only need them for a period of time while they recover from injury.
Are these services available in a workers’ compensation case?
Iowa's workers’ comp laws lay out a broad range of health services that employers, or their insurance company, must provide for work related injuries:
"The employer, for all injuries compensable under this chapter or chapter 85A, shall furnish reasonable surgical, medical, dental, osteopathic, chiropractic, podiatric, physical rehabilitation, nursing, ambulance and hospital services..." (Iowa Code Sec. 85.27(1)).
Many of the life services discussed above may be considered nursing services because they are needed to care for the injured worker. Some services, like physical therapy, qualify under the requirement to provide reasonable physical rehabilitation services.
Challenges to Life Services Claims
Often a workers’ compensation insurance provider contests life services and the types of work accidents that require these services. These services represent a long-term cost for the insurance company, and it has little incentive to be amicable to the injured worker. An insurance company may claim that certain life services are not a necessary and reasonable treatment for the worker's injury.
If an insurance company denies a service that the worker believes is necessary to treat his or her injuries, the worker can file a petition with the Iowa Workers’ Compensation Commissioner (IWCC). This may result in an arbitration hearing, which is like a trial in many respects. They include a discovery period where the opposing sides exchange questions and requests for evidence. Attorneys may also depose their client or witnesses during discovery.
Some of the evidence that may be helpful is:
- medical records;
- doctor's opinions; and
- employment records.
Having a workers’ compensation attorney can help the worker do a full investigation of his or her medical needs and present a strong case to the IWCC that the life services are necessary for the worker’s continued care.
The law firm Walker, Billingsley & Bair advocates for injured Des Moines workers pursuing workers’ comp benefits or appealing an insurance carrier’s decision or wrongful denial. Contact our office at (888) 435-9886 to set up your free consultation.