Hampton Workers Compensation Attorneys

A workplace injury can upend your life in ways you never expected. You may be unable to work, struggling with pain, and suddenly buried in paperwork from insurance companies and medical providers. Knowing your rights under Iowa's workers' compensation laws is the first step toward protecting yourself and your family. Whether you are dealing with a permanent disability rating, a back condition your employer is disputing, or a stack of unpaid medical bills, a qualified Iowa workers' compensation attorney can help you make sense of it all.

Permanent Partial Disability in Iowa: Scheduled vs. Unscheduled Injuries

If you suffered a permanent but not complete disability as a result of your job, you may qualify for permanent partial disability (PPD) benefits under Iowa's workers' compensation law. The amount and duration of those benefits depend heavily on which part of your body was injured. When your healing period benefits end, you will begin receiving one of two types of PPD benefits: scheduled or unscheduled.

Scheduled Member Disabilities

The Iowa Division of Workers' Compensation uses Appendix A, a list of scheduled body members, to determine how many weeks of PPD benefits an injured worker is entitled to receive. If your injured body part appears on this list, the number of eligible benefit weeks is set according to the schedule. If you lose complete function of a listed body part, you receive the full number of weeks. If you lose only partial function, for example 50 percent of the use of your arm, you receive benefits for half the allotted time.

Unscheduled Disabilities

Not every workplace injury fits neatly onto the schedule. Injuries to the hips, shoulders, back, and neck fall under what are called unscheduled disabilities. Unlike scheduled injuries, which are tied to a specific body part and a set number of weeks, unscheduled losses encompass a broader range of injuries that may affect multiple body parts or the body as a whole. Think of back injuries, head trauma, or even psychological conditions that stem from workplace incidents.

For unscheduled injuries, the Workers' Compensation board calculates your benefits based on the degree to which your disability affects your earning capacity. The board will consider a variety of factors when making this determination, including:

• How the injury affected your earnings
• Your medical history
• The duration of your healing period
• Your work experience prior to the injury
• Your potential for rehabilitation
• Your qualifications, including intellectual, educational, emotional, physical, age, and motivation
• The degree of functional impairment your injury has caused
• Earnings you have lost as a result of changing jobs to accommodate your injury
• Your inability to perform work that you are otherwise suited to do

Because there is no fixed protocol for how each of these factors is weighted, the insurer has a degree of discretion in assigning your disability rating. If you believe the rating you received is far lower than it should be, it is important to contact a workers' compensation attorney for help.

Challenging Your Disability Rating

If your workers' compensation claim has been denied or a doctor has assigned a disability rating that seems far too low given your condition, you have the right to fight it. An attorney can guide you through the negotiations and appeals process, and it is possible to work out a fair agreement with your employer or insurer without going to court. If an agreement cannot be reached through discussion and negotiation, the workers' compensation commissioner will oversee any disputes, and your attorney can help bring the issue to a formal hearing.

It is important to fight for your rights to benefits. Your workers' compensation payments will likely be a financial lifeline while you are unable to work at full capacity, and accepting a rating that does not reflect the true extent of your injury can cost you thousands of dollars over time.

Pars Defect and Workers' Compensation: Proving Your Back Injury Is Work-Related

Back pain and spinal discomfort can be caused by many different types of injuries. Some, like a herniated disc, are well known. Others are less familiar to injured workers, such as a condition called pars defect or pars fracture. If you can establish that this condition was caused by your work duties or was worsened as a result of your job, you may be entitled to workers' compensation benefits.

What Is a Pars Defect?

When strain is placed on the part of the spinal column called the pars interarticularis in the lumbar spine, it can lead to a stress fracture. The fracture may occur on one or both sides of the lumbar vertebra. When it happens on both sides, it can cause one vertebra to slip over another, a condition known as spondylolisthesis.

Most of the time this injury occurs in the lower back. Common symptoms include pain and stiffness, but it can also cause a pins-and-needles sensation in a leg, along with weakness or numbness. Symptoms generally improve with rest and worsen with activity. The injury can be aggravated if the worker hyperextends the back.

How Is a Pars Defect Treated?

Along with a physical examination, a CT scan can usually detect a stress fracture of this type. Initial treatment is generally conservative. Doctors typically begin with rest, wearing a back brace, and physical therapy to strengthen the back and stomach muscles.

If surgery becomes necessary, there are typically two procedures performed. The first is a laminectomy, in which the fractured portion of the vertebra is removed. This is done more often when nerves are compressed. The second is a posterior lumbar fusion, in which two or more bones are fused together, typically performed when a spinal segment has become unstable. With both types of surgery, rehabilitation may follow, and a full recovery can sometimes take several months.

Proving the Injury Is Job-Related

Attributing a back injury to work can be challenging. Back injuries are such common ailments that employers will sometimes reject the claim, arguing that the condition stems from everyday activities rather than work duties. However, if it can be shown that your job tasks placed repetitive strain on that part of the back, it becomes easier to establish the connection.

To file a workers' compensation claim, the worker must demonstrate that the injury arose out of and within the scope of employment. Medical records combined with thorough documentation of your job duties can go a long way in establishing that link. If the claim is approved, benefits will cover medical costs including doctor visits, surgery, physical therapy, and other necessary treatment. If the injury has left you disabled, partial wage replacement may also be available, with the amount depending on the severity of the disability.

If your employer or their insurance carrier is refusing to cover a work-related back injury, it will likely require the help of legal counsel. An attorney can explain the applicable laws and assist you in gathering all of the information and documentation needed to show that the injury was caused by your job.

Receiving Medical Bills During Your Hampton Workers' Compensation Case

Unfortunately, unpaid medical bills are very common in Iowa workers' compensation cases. The rules are different depending on whether your claim has been accepted or denied, and it is important to understand what applies to your specific situation so that you can protect yourself.

When Your Claim Has Been Accepted

If your claim has been accepted, your employer and their workers' compensation insurance company will likely be directing your medical care and sending you to their chosen medical providers. Even so, injured workers frequently receive unpaid bills. Under Iowa law, when an employer directs your medical care, they are required to pay for it. However, workers' compensation insurance companies will sometimes pay a reduced amount, leaving the injured worker responsible for a balance. This is not how the system is supposed to work.

If you receive a medical bill during an accepted claim, here is what you should do:

1. Do not ignore the bill. Send a copy to the workers' compensation insurance adjuster right away and follow up with a phone call a few days later.
2. Contact the medical provider directly and let them know this is a work injury. Under Iowa Code section 85.27(4), the employer is required to hold the injured worker harmless for any care the employer chose to authorize. The dispute over payment is between the insurance company and the medical provider, not you.
3. If bills continue to arrive and the situation is not being resolved, it is time to consult a qualified Iowa workers' compensation attorney.

When Your Claim Has Been Denied

There are also laws that provide some protection for injured workers when a work comp claim has been denied. Unfortunately, insurance companies, bill collectors, and employers sometimes ignore these laws, either because they are unaware of them or because they are taking advantage of workers who do not have legal representation. It is also important to have a copy of your denial letter, as you may need it to get your bills paid. If a denial letter was never sent to you, call the insurance company or their attorney to request one.

There are several common scenarios that come up in denied workers' compensation cases in Iowa.

Refusal to Submit the Claim to Health Insurance

Some medical providers, often chiropractors, will tell injured workers they are not allowed to submit bills to health insurance when the injury happened at work. This is rarely true. In most cases, the medical provider simply prefers to receive the full amount of their charges rather than the reduced rate that health insurance companies typically pay. If your medical provider is refusing to submit your bills to your health insurer, it may be time to speak with an attorney about whether it makes sense to change providers or to get additional assistance so that your bills are properly handled.

Denial for Payment by Your Health Insurance Company

It is common for a health insurance company to try to avoid paying medical bills when the injury occurred at work or in another type of personal injury accident. However, under Iowa Code section 85.38(2)(a), health insurance plans are required to pay for work-related medical care when the workers' compensation claim has been denied. The statute is clear on this point:

"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."

If your claim has been denied, review your Explanation of Benefits (EOB) documents from your health insurer carefully to confirm whether your bills are actually being paid or not. The same protection under Iowa Code section 85.38(2)(b) applies to short-term disability and other disability benefits that may be available to you.

Subrogation by Your Health Insurance Company

If your health insurance does pay for your work-related medical bills, you will likely receive a subrogation notice, which may come from a company like Rawlings Company or another subrogation collection firm. However, if your health insurance plan is provided through the same employer where you were injured, they likely do not have a valid subrogation claim against your recovery. Iowa Code section 85.38(2) provides a credit arrangement for employer-sponsored health plans such that requiring you to pay subrogation back to your own employer's plan would result in a double recovery for the workers' compensation insurance company, leaving you with fewer benefits overall.

If your health insurance plan is not provided through your employer, then the subrogation interest is likely valid under Iowa's general subrogation laws. It is worth noting that if your employer is large and self-insured for health insurance, they may be covered by ERISA, which can create complications because of conflicts between Iowa and federal law. This is an area where legal guidance is especially important.

Why Hampton Workers' Compensation Victims Should Not Wait

Iowa's workers' compensation system is complex, and the rules change depending on the nature of your injury, whether your claim has been accepted or denied, and which part of your body is affected. Insurance companies and employers know these rules very well and, in many cases, will use that knowledge to their advantage if you are not represented. Injured workers who try to navigate this process alone are at a significant disadvantage from the start.

Whether you are trying to understand your permanent partial disability rating, fighting to have a back injury recognized as work-related, or simply trying to get your medical bills paid the way the law requires, the right legal help can make all the difference. An experienced Iowa workers' compensation attorney will explain your rights, gather the documentation needed to support your claim, deal with the insurance company on your behalf, and fight for the full benefits you are owed.