If you or a loved one has been hurt at work in Iowa then you likely have an Iowa workers' compensation claim. The terminology used by the insurance company, your doctors and the nurse case managers can be confusing and difficult to understand. Also, as an injured worker you have certain rights and responsibilities that you should know so you can avoid making costly mistakes. We cover these items for you here in our guide to Iowa work injuries.
Definitions of Words and Abbreviations Used
You will likely see several different terms and abbreviations used during the course of your claim. We will define some of the most common ones here for you:
Medical Care: Under Iowa law your employer and/or their workers' compensation insurance company is allowed to direct your medical care to the doctors and other medical providers that they select. They are required to pay for the medical care in its entirety for your work injury related condition.
Keep in mind that you are always free to seek medical care and treatment on your own, but the workers' compensation insurance company will not pay for it. You will have to use your own health insurance or personal funds for treatment. Also, there can be issues with using your own health insurance depending upon your policy and the provisions contained in the policy. For example, we have seen cases over the years where the health insurance policy had a provision that allowed them to deny paying for medical care when the condition "could have been paid for" under workers' compensation.
It is possible to switch the medical care to other medical providers by using a process called a petition for alternate medical care, but there are specific things that must be done. For example, if the workers' compensation doctors have no more medical care to offer you, but you go see another doctor on your own who thinks that testing, surgery, therapy, etc. may help, then you may be able to change the medical care and require the insurance company to pay for treatment with your doctor. We devote an entire chapter to this issue in our Iowa workers' compensation book that we offer at no cost or obligation.
TTD: This stands for temporary total disability and is a weekly check that you should receive when you are unable to work or you have restrictions that your employer is not willing or able to accommodate. For example, if after a work injury the company doctor takes you completely off work, then you should receive a weekly check for TTD. Keep in mind that you will not receive compensation for the first 3 days (called the waiting period), unless you miss 14 or more days of work and then the insurance company should pay you for the first 3 days you missed.
PPD: This stands for permanent partial disability and is designed to compensate an injured worker for their permanent loss. How much the PPD compensation should be depends upon a number of factors including the type of injury you have (scheduled vs. unscheduled), the severity of your injury, your impairment rating, etc. A scheduled member injury means injuries to your hand, arm, finger, leg, foot, toes, hearing loss or eye. Whereas an unscheduled injury (also known as a body as a whole injury) means injuries to your shoulder, neck, back, brain, hip, tinnitus, CRPS (complex regional pain syndrome), mental health conditions such as depression and anxiety caused by a physical injury, and other conditions and disorders of the body. Keep in mind that there are exceptions to these general rules in determining if your work injury is scheduled or unscheduled, such as:
- If you have 3 scheduled member injuries that occur at the same time.
- If you sustained a scheduled member injury and previously sustained a scheduled member injury to a different body part (known as a Second Injury Fund case).
- If you sustained injuries to 2 scheduled member injuries and are permanently and totally disabled.
The difference between these various types of work injuries and the compensation that you should receive for them is explained in much more detail in our Iowa workers compensation book that we offer for free to Iowa injured workers and their families.
Rate: This is the amount of your weekly TTD or PPD check. Your rate can be calculated in a number of different ways, but if you are paid by the hour then generally you look for 13 representative weeks of your wages prior to your work injury. If you had a short week because of illness, a vacation, or some other reason, then usually that week will be skipped in calculating your rate. You are allowed to count the gross number of hours each week multiplied times your normal hourly rate including shift differentials. For example, if you worked a total of 585 hours in the 13 representative weeks before your work injury and your hourly rate is $15 per hour your AWW (average weekly wage) would be $675. (585 X 15 / 13 = $675). Note: If you receive an annual bonus or production bonuses those are also included in your AWW. For example, if your annual bonus is $1,500, then $28.85 would be added to your AWW ($1,500 / 52 = $28.85 + $675 = $703.85). Your weekly rate is then determined by looking at a chart using your AWW, marital status and total number of exemptions you claim including yourself. The chart changes each year and is available for various dates of injury at www.IowaWorkInjuryRate.com. For example, if you were hurt on June 1, 2016, are married with a total of 4 dependents and have an AWW of $703.85 then your rate is $478.96. (Note: you round up or down your AWW so $703.85 becomes $704 on the chart).IME: This stands for independent medical examination. Sometimes during the process of your claim, the insurance company will ask you to see another doctor for an IME. Keep in mind that usually there is not much that is independent about the examination. Sometimes they will send you to the doctor they always use to just get an opinion regardless of the actual facts are in your case. I know this sounds terrible, and it is, but there are doctors who will basically tell the insurance company what they want to hear regardless of how you were injured. Some doctors almost always say it is all due to a "pre-existing condition" and is "not work related". If the insurance company obtains an opinion like this then they will likely deny your claim even if they previously admitted it and paid you benefits. Despite how awful this experience sounds, often you will be required to go see their IME doctor or they will suspend your weekly benefits if you don’t. If you have questions about whether or not they can do this in your case feel free to give us a call and ask for a work injury consultation that we offer to you at no cost or obligation.
85.39 IME: Once the doctors the insurance company sent you to have given you an impairment rating, then you have the right to a second opinion with a doctor of your choice that the insurance company is required to pay for part of. Keep in mind that you do not want to just go see any doctor for this very important evaluation. Choosing an experienced and qualified IME doctor is a very important decision in your case and you should consider talking to a workers 'compensation attorney with a good reputation about this before just going to someone you think may be good.MMI: This means maximum medical improvement and is when the doctors say that they think you are as good as you are going to get. In other words, that you have healed as much as they think that you will. Some doctors place patients at MMI weeks after surgeries while others will wait 1 year or more after a surgery. Keep in mind that just because their doctor says you are at MMI, does not mean your case is over or that there is no additional medical care that can help you. This is part of the reason it is so important to choose the right doctor for you own IME examination.
Impairment Rating: Once their doctors have placed you at MMI, they are supposed to evaluate you for an impairment rating based upon the AMA Guides, 5th Edition. The AMA Guides is a book written by doctors from throughout the country that determined numbers for different types of injuries. For example, if you sustained a herniated disc in your back that required laminectomy surgery then it is likely that your impairment rating will be around 10% whole person. Depending upon what type of work injury that you have (scheduled v. unscheduled) the impairment rating can be the only factor in determining your compensation or one of many factors. To learn more about this topic, request our workers' compensation book that includes the Iowa Injured Workers Bill of Rights available to you at no cost.FCE: This stands for functional capacity evaluation or what is sometimes referred to as a functional capacity examination. An FCE is physical testing that is done by a physical therapist that is used to determine your permanent work restrictions. The testing involves doing a number of different exercises including lifting weights to determine what work you can safely do. The testing usually lasts several hours and sometimes is done over a 2-day period. This is a very important part of any workers' compensation case because the doctors will use the FCE results to determine your work restrictions. For example, if your test is found to be "invalid" then chances are that your doctor will release you with no restrictions. We have an entire report available to assist injured workers before they have an FCE. If you have questions or concerns about an upcoming FCE test (and are not represented by an attorney) then feel free to give us a call at (641) 792-3595 so we can help make sure your FCE test goes well.
Settlement: Every week we receive many calls from injured workers who want to make sure they receive a fair "settlement". The word settlement can have many meanings in an Iowa workers compensation case because there are several different types of settlements and because some of your compensation should be paid without you settling your case. Generally, the insurance company should pay your impairment rating given to you by their doctors without you "settling" your case. Sometimes, they will try to get you to sign settlement paperwork before paying your impairment rating which is not right. Other times they will say they will pay you the entire impairment rating, plus a few thousand dollars if you will settle your case. Before you even consider a settlement offer you should learn more about your rights under Iowa law and talk to an experienced and qualified work comp lawyer before you make a costly mistake and sign away thousands of dollars. We offer injured workers a no cost work injury consultation and evaluation where we will answer your questions and tell you if we think what they are offering you is fair or not. Call now (641) 792-3595 and ask to speak with one of our workers compensation lawyers.
Your Rights as an Injured Worker
Medical Care: You have the right to medical care and treatment for your entire lifetime for medical conditions that are caused by your work. This sounds great, but in reality is not as great as it sounds because if the insurance company finds a doctor to say that your condition is not work related then they will likely stop paying for your medical care.Payment of Mileage Expenses: You are to be reimbursed for all mileage going to and from doctors’ appointments, physical therapy visits, etc. The amount you are to be paid per mile changes every July 1, but here are some recent amounts:
- $.56 per mile- July 1, 2014 to June 30, 2015
- $.575 per mile- July 1, 2015 to June 30, 2016
- $.54 per mile- July 1, 2016 to June 30, 2017
Second Opinion: Once the workers compensation doctors have placed you at MMI and provided you with an impairment rating, you have the right to see a doctor of your own choice and the insurance company is required to pay for part of the examination. As discussed earlier in this guide, it is important that you select an experienced and qualified doctor for your second opinion as it is very important in your case.
To learn your other rights, request a copy of our Iowa workers compensation book that is available to you at no cost. Request your copy of our book now and we will include a DVD which includes 21 Things You Need to Know About Iowa Your Work Injury.
Your Responsibilities as an Injured Worker
Report Your Injury: While the law gives you up to 90 days from the date of when you knew or should have known your condition was work related, it is a good idea to report your work injury right away. Some companies have policies that you are supposed to report the work injury within 24 hours and you should follow these policies. However, even if your employer has such a policy in place and you don't report it until 48 hours later, you have still complied with Iowa law.
Communicate with Your Medical Providers: The workers compensation doctors and their nurses are supposed to accurately and completely record your symptoms, how you were injured, etc. It is very important that you accurately and consistently tell your doctors how you were injured along with all of the symptoms you are having because of your work injury. For example, if you report an injury to your knee, but then develop back pain because your knee injury causes you to walk differently (called an altered gait) then you need to tell your doctors, physical therapists, etc. about your back problems. If you fail to tell them about your back and/or your back complaints do not make it into your medical records, then it can be difficult for you to be fairly compensated for your both your knee and back injuries.
Be Ready and Willing To Work: If the workers compensation doctor says that you can return to work with restrictions, then you need to provide a copy of the restrictions to your employer and tell them you are ready to work within the restrictions. If they offer you work, then you need to try to do it. We recommend that you keep a copy of your restrictions in your pocket in case someone asks you to do something outside of your restrictions. If you have problems doing the work within your restrictions then you should promptly notify your supervisor and also call the doctor's office about this. You may need a follow-up appointment with the doctor to discuss different restrictions. If your employer does not have work for you, then the insurance company should be notified so that you will receive a weekly TTD check.As an injured worker there are other responsibilities that you have which we explain in more detail in our Iowa work injury book that is available to you at no cost. Just request the book and we will send it to you right away so you can read it in the comfort of your own home. As a bonus, we will include our workers compensation DVD which tells you 21 Things You Need to Know About Iowa Work Injuries. For immediate attention or to schedule your no cost work injury case review, contact us online or CALL (641) 792-3595 and ask to speak with one of our workers' compensation attorneys.