Audubon Workers Compensation Attorneys

Getting hurt on the job in Audubon can turn your life upside down almost overnight. Between missed paychecks, mounting medical bills, and confusing paperwork, injured workers often find that the workers' compensation process is far more complicated than they expected. Iowa law is designed to help workers who are hurt on the job, but insurance companies and employers do not always make the process easy. Understanding how claims can be denied, who controls your medical care, and how to avoid mistakes that hurt your case are all essential steps toward protecting your benefits.

At Walker, Billingsley & Bair, our Audubon workers' compensation attorneys have helped injured workers throughout the community understand their rights and fight back when their claims are wrongly denied. Below, we explain some of the most common reasons workers' comp claims are denied in Iowa, whether you have the right to see your own doctor after a workplace injury, and why "doctor shopping" can put your benefits at risk.

Common Reasons for a Denied Workers' Comp Claim in Audubon

It is not uncommon for an injured Audubon employee to be denied workers' compensation benefits after filing a claim. Sometimes denials happen because of an honest error or a lack of adequate evidence. In other situations, an employer or insurance company may try to deny benefits simply because they do not want to deal with the expense of paying an injured worker, and they may assume the employee will not have the fortitude to fight back.

Overstepped the Time Limits

Not reporting your injury right away can be a major problem. Audubon workers should always notify their supervisor immediately when they are hurt on the job, or as soon as they recognize they have developed a work-related illness or condition. Iowa law gives injured workers 90 days to file a workers' comp claim. Failing to do so could thwart your rights to benefits. The longer you wait to report an injury, the more likely the insurance company will use that delay to question whether your condition is real. They may argue that if the injury was serious, you would have reported it to your employer sooner.

Medical Authorization Issues

When a worker refuses to sign a medical authorization, the insurer may deny the claim. The rules surrounding medical authorization can be confusing. Your employer's insurer is entitled to review your medical records connected to your work-related accident, but you are not legally required to sign a release giving the insurer authority to independently obtain your entire medical file. Another option is to obtain your own records and provide them to the insurer yourself, which prevents the insurer from accessing personal medical records unrelated to the work accident. Insurers are not always fond of this approach, since they may worry you are only sharing records that favor your claim. It is best for Audubon workers to get an attorney's assistance in these situations.

Failing to Abide by a Doctor's Orders

If you have not fully followed your doctor's orders, you could be denied benefits because the insurer may use your non-compliance as evidence to question the legitimacy of your injury. The insurer may argue that if you were truly hurt, you would have stuck to your treatment plan. Insurers and employers may use the following excuses to deny that you are actually injured:

• You missed appointments
• You posted pictures on social media showing physical activity
• You refused a medical exam
• You were caught on surveillance doing things, such as lifting or climbing, that your injury supposedly does not allow (employers and insurers sometimes send investigators if they believe you are not being truthful about your injury)

Fortunately, there is a workers' comp appeals process that Audubon workers can use to try to obtain benefits after a wrongful denial. You can collect and present additional evidence to support your case. It is highly advisable to have a workers' compensation attorney help guide you through the appeals process so you are fully prepared.

Can You See Your Own Doctor After a Work Injury in Audubon?

If you have been hurt on the job in Audubon, you technically have a right to see your own doctor, but there are significant caveats when it comes to Iowa workers' compensation. Your employer and their insurance carrier will typically only pay for medical care that has been approved or authorized by them. In most cases, this means care administered by the physician or physicians of their choosing. Be sure to ask your company representative before seeking medical treatment from a doctor other than the "company" doctor or one chosen under your employer's workers' compensation directives. It is also worth knowing that your health insurance provider may reject a claim if it stems from a work injury, since Iowa workers' compensation benefits are technically supposed to pay for that medical care.

Receiving Medical Help After a Work Injury

According to Iowa workers' comp laws, the employer has the right to choose the medical care an injured Audubon employee receives. If you are not satisfied with the care you are receiving, or you have concerns about the treatment being recommended, you should discuss this with your employer first.

Only in certain circumstances will an employee be allowed to request alternative care, and even then, the employer or insurance carrier may deny that request. In that case, you would need to appeal the decision to the workers' compensation commissioner. If you receive an impairment rating that you believe is too low, Iowa law also gives you the right to see another doctor. This second opinion will be at the employer's expense, but it will still be a doctor of the employer's choosing.

What Should You Do If You Are Not Satisfied With Their Doctor?

If you are not satisfied with the level of medical care being offered by your employer or their insurance company, you may need to file a petition to receive alternate medical care. This is the process used to get a judge to allow you to see a doctor of your own choosing while still having it covered by workers' compensation. This process can be challenging, and Audubon workers will likely need a qualified workers' compensation attorney to assist if it comes to filing a petition for alternate medical care.

What if You Don't Want the Recommended Care?

You may be surprised to learn that you also have the right to refuse medical care. You do not have to undergo any procedure or treatment recommended for your work injury. For instance, if the company doctor recommends a hip replacement but you do not want the surgery, you maintain the right to refuse that procedure. However, refusing care could negatively affect your Iowa workers' compensation claim, so it is important to discuss the decision with an experienced workers' compensation attorney before turning down any medical treatment.

The Dangers of "Doctor Shopping" When Returning to Work

When an Audubon worker is injured on the job or develops an occupational disease, he or she may collect workers' compensation benefits, including medical benefits that pay for care and treatment. This requires seeking medical attention from a physician. However, when there are concerns about a diagnosis, disagreements about the severity of a worker's condition, or questions about treatment or when the worker can return to work, it may lead the employee to seek a second opinion. It is important for employees to understand the impact this can have on a claim, especially if seeking a second opinion turns into "doctor shopping," meaning seeking care from multiple physicians with no coordination of care.

Choosing Medical Care for a Work-Related Illness or Injury

Iowa workers' compensation laws allow employers to choose the medical care an employee receives when injured at work, except in circumstances where emergency medical care is necessary. In all other cases, it is the employer's right to choose the doctor. Sometimes an employee is not happy with that choice, but this does not mean the employee can simply seek a second opinion without first talking to the employer or carrier. If the employer or carrier refuses to allow alternate care, the employee can petition the Workers' Compensation Commissioner. There is one specific circumstance in which an employee has the right to seek a second opinion on their own, and that is when the employer-approved physician gives a permanent impairment rating lower than what the employee anticipated. In that case, a second opinion can be sought at the employer's expense, though the choice of doctor still belongs to the employer.

When Seeking a Second Opinion Turns into Doctor Shopping

There is a real risk of workers' compensation benefits being denied when an employee navigates this process incorrectly, including by not seeking care from an employer-approved physician or by seeing another physician without approval. A claim could be subject to denial when an employee requests or goes ahead with seeking care from multiple doctors. It is hard to put an exact number on what would be considered unreasonable, but if it looks like an employee is doctor shopping, it will certainly raise a red flag.

One assumption an insurer might make is that the employee is attempting to avoid returning to work. If the original doctor recommends an earlier return than the employee feels is reasonable, going from one doctor to the next may appear as though the worker is trying to find someone who will say they can stay out of work longer. Other concerns may be raised as well, such as an employee trying to make an injury appear more severe than it really is, or attempting to obtain a more serious diagnosis. Doctor shopping could be viewed as an attempt to collect benefits for a longer period than necessary, even when that is not the worker's actual intention.

Handling Disputes Over a Medical Condition the Right Way

The problem is that even when an employee's intentions are legitimate, doctor shopping can still look bad. It is not unheard of for an employer-approved physician to downplay someone's injuries, assign a permanent impairment rating lower than deserved, suggest an illness has nothing to do with the work environment, or even push an individual back to work sooner than they are ready. But the best way to handle these types of concerns is not to go shopping around for a new doctor. The right next step is to seek legal counsel. With the risk of a claim being denied or an Audubon worker not receiving the appropriate benefits, it is best to talk with an attorney whenever there are concerns about a doctor's diagnosis or the level of care being provided.