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Being hurt at work in Monticello, Iowa sets off a chain of events that many injured workers are completely unprepared for. Between understanding which medical benefits you are entitled to, figuring out what to do if your payments are suddenly stopped, and knowing how to respond when your employer ignores your doctor-ordered restrictions, the workers' compensation system can quickly feel like it is working against you. The attorneys at Walker, Billingsley & Bair have spent decades helping injured Iowans navigate exactly these challenges. This article breaks down what you need to know about your rights at every stage of the process.

Medical Benefits Under Iowa Workers' Compensation: What Monticello Workers Are Entitled To

Workers' compensation protects those who have been injured in a workplace accident or while conducting work-related activities. Iowa's workers' compensation law offers a range of benefits for those who sustain workplace injuries, and one of the most important is lifetime medical benefits. If you have been involved in a workplace accident or an accident that occurred on company property or time, you are entitled to have your medical treatment covered by your employer or their workers' compensation insurer.

Who Qualifies for Workers' Compensation Medical Benefits?

Under Iowa workers' compensation law statute 85.27, most workers injured in a workplace accident are entitled to medical treatment paid for by the employer or the employer's workers' compensation insurer. There are some exceptions, however. Workers who may not be eligible for workers' compensation include:

  • Employees who earned less than $1,500 from their employers during the year prior to the accident
  • Agricultural employees whose employers had a payroll of less than $2,500 cash in the year prior to the accident
  • Anyone who is related to the employer

If you are unsure whether you qualify for workers' compensation medical benefits or disability benefits under Iowa law, it is worth speaking with an attorney to review your specific eligibility rather than assuming you are not covered.

What Medical Expenses Does Workers' Compensation Cover?

Workers' compensation in Iowa covers a broad range of medical expenses related to your workplace injury. These include:

  • The cost of transportation for medical purposes, such as trips to the hospital or doctor's office
  • Lost wage payments for doctors' visits that occur during working hours
  • The cost of medical procedures, medications, and related treatment

What Does "Lifetime" Medical Benefits Actually Mean?

Disability benefits under workers' compensation are available for a defined period of time. Permanent total disability (PTD) benefits are available for life, though other types of disability benefits end after reaching a certain point. Regardless of the type of disability benefits a worker receives, medical benefits are paid for as long as they are necessary to treat the work injury, up to a lifetime. This is a meaningful protection for Monticello workers who sustain serious injuries with ongoing treatment needs, and it is one reason why understanding the full scope of your entitlements is so important.

Workers should always follow all doctor's orders related to their work injuries. Failing to comply with recommended treatment can create problems both medically and for your workers' compensation claim.

Your Right to Choose Medical Care and Request Alternative Treatment

Because the employer is responsible for paying for medical care under workers' compensation laws, the employer has the right to choose which medical provider the employee receives care from. However, if you are unhappy with the type of care selected by your employer or with the quality of care you are receiving, you have the right to request a different provider. If the employer or insurance company denies that request, you may file a request for alternative care with the Iowa Workers' Compensation Commissioner.

It is critical to go through the proper channels before seeking alternate care on your own. If you obtain treatment from an unapproved provider without following the correct process, workers' compensation may not cover the cost of that treatment.

Additionally, if you believe that the level of disability determined by the employer's physician is inaccurate, you have the right to an independent examination by a doctor of your choosing. In that case, the employer remains responsible for covering the cost of that independent medical examination.

For a full overview of what medical benefits cover in Iowa work injury cases, read Lifetime Medical Benefits Under Workers' Compensation at iowainjured.com.

What Happens When Workers' Comp Payments Stop in Iowa?

One of the most stressful situations an injured Monticello worker can face is opening the mail and discovering that their workers' compensation checks have stopped arriving. The Iowa workers' compensation system can be quite complicated, and the insurance company typically has a team of lawyers working to find ways to stop paying benefits as quickly as possible. Knowing your options when payments are cut off is essential.

Step One: Determine If You Have Been Paid Everything You Are Owed

The first thing to do when payments stop is to determine whether you have actually received all of the benefits you are entitled to. If you were off work for a set period and have made a full recovery, then the payments you received for that time may reflect what you were owed. However, if you were paid while you were off work but have a permanent injury, you are very likely owed additional benefits beyond what has been paid. Do not assume that just because the insurance company stopped paying, your case is closed.

Step Two: Assess Your Employment Status and Disability Benefit Type

If your payments have stopped, consider whether you are still working. If you are not working, you may want to consider filing for unemployment benefits. Keep in mind that you cannot receive TTD (temporary total disability) payments and unemployment benefits at the same time. You can, however, receive PPD (permanent partial disability) benefits and unemployment simultaneously. If you file for unemployment and are denied, that is a signal to speak with a workers' compensation attorney who may also be able to assist with your unemployment claim.

If you are still working and have permanent injuries, speaking with an experienced Iowa workers' compensation attorney is important. There may be additional benefits you are entitled to that have not yet been paid or even offered.

Common Reasons Why Workers' Comp Payments Stop

There are several specific reasons why your workers' compensation payments in Monticello may have been stopped:

  • You have returned to work and your TTD payments have ended as a result
  • You are waiting on a functional impairment rating from your workers' comp doctor. Beginning July 1, 2017, the insurance company is allowed to delay payments for your impairment rating until you have both reached MMI (maximum medical improvement) and are able to be given a rating. Some workers' comp doctors indicate they cannot give a rating until at least one year after MMI is reached
  • Your claim is being denied. You may have been sent for an IME (independent medical examination, which is rarely truly independent when hired by the insurance company) that concludes your condition is not work-related. Insurance companies have also been known to send only your medical records to a physician in another state who will render an opinion without ever examining you, stating that your injuries are pre-existing rather than work-related
  • Your TTD and impairment rating have both been paid in full. Even so, you have the right under Iowa Code 85.39 to your own independent medical examination at the cost of the insurance company. However, this is a more complicated area of law following a July 1, 2017 statutory change, and it is advisable to discuss this with an attorney before proceeding
  • The insurance company has sent an Auxier notice. Iowa Code section 86.13 provides that payments can only be terminated when the employee has returned to work, or upon thirty days' notice stating the reason for termination and advising the employee of the right to file a claim with the Workers' Compensation Commissioner. Some insurance companies follow this law, and others do not

Other specific reasons payments may have stopped include failing to attend an IME examination scheduled by the insurance company after July 1, 2017 (which results in forfeiture of weekly benefits until the appointment is attended), refusing to return to light-duty work that is available with your employer, being terminated for what the insurance company characterizes as cause or misconduct, or reaching MMI while the adjuster plans only to continue payments for another 30 days.

Important: Do not rush into a settlement with the insurance company without learning the true value of your case. Insurance companies almost always want a closed file, meaning no future medical care and no additional workers' compensation benefits, even if you are later terminated because of your injuries. Under Iowa law, if you have received a check for TTD or PPD, your statute of limitations is generally extended to three years from the date of the last payment, though exceptions apply. Do not wait until the last minute to speak with an attorney.

To learn more about what to do when your benefits are cut off, read What Happens When Workers' Comp Payments Stop? at iowainjured.com.

What to Do When Your Employer Will Not Follow Your Work Restrictions

It is unfortunately a common problem that injured workers in Monticello and across Iowa face: a doctor has placed them on work restrictions, and their employer either does not know about those restrictions or simply refuses to honor them. This can happen because of an aggressive supervisor who wants the work done regardless of an employee's medical situation, or because of a breakdown in communication between human resources, medical staff, and supervisors on the floor. Whatever the reason, being asked to work outside your restrictions puts both your health and your workers' compensation claim at risk.

Keep a Written Copy of Your Restrictions With You at All Times

Anytime you have restrictions in place, whether they are temporary or permanent, it is strongly recommended that you keep a written copy of those restrictions in your pocket or somewhere accessible at work. If your employer asks you to perform tasks outside of what your doctor has authorized, you can immediately show the written documentation that outlines what you should and should not be doing. This simple step will often stop the problem right then and prevent it from occurring again in the future. It is also important to make sure any new supervisor or person placed in authority over you is made aware of your restrictions from the start. Proactively informing them allows them to plan around your limitations and reduces the chance of a conflict arising.

What to Do If You Are Still Having Problems Within Your Restrictions

If your employer is technically honoring your restrictions but you are still experiencing problems or pain while performing your restricted duties, there are two important steps to take. First, notify your employer about the difficulties you are having. Second, contact the doctor who issued your restrictions and explain the problems you are experiencing. Your doctor will most likely want to see you back for a follow-up appointment to determine whether your restrictions need to be adjusted or tightened. The goal for everyone involved should be to prevent a new work injury from occurring, and clear communication is the best tool for achieving that.

What If You Sustain a New Injury While Working Within Your Restrictions?

If you sustain a new injury while performing your job within your medically authorized restrictions, it is critical that you report the new injury to your employer right away. Do not wait days or weeks before reporting it. Delayed reporting makes it significantly more difficult to prove that you sustained a new and separate injury rather than a continuation of your prior work injury. Prompt reporting protects your rights and makes the connection between the incident and your injury far easier to establish.

For detailed guidance on protecting yourself when your employer is not following your work restrictions, visit What if Your Employer Does Not Follow Your Work Restrictions? at iowainjured.com.

Why Monticello Workers' Compensation Cases Require an Experienced Attorney

As you can see from the complexity of the issues covered above, the Iowa workers' compensation system is not designed to be easy to navigate on your own. The insurance company has a team of lawyers working to minimize what you receive, delay payments, challenge your medical findings, and close your case as quickly as possible. Having an experienced Monticello workers' compensation attorney on your side levels the playing field and ensures you are not making costly mistakes that could affect your benefits for years to come.

Workers hurt on the job are beginning to understand that the insurance company is not there to help them. Learning about Iowa's workers' compensation laws before you make important decisions in your case is not just helpful, it is essential.

Iowa Workers' Compensation Attorney Corey J. L. Walker practices primarily in work injury law and has over 28 years of legal experience helping injured Iowa workers protect their rights. He offers a free book titled Iowa Workers' Compensation: An Insider's Guide to Work Injuries, which covers seven deadly mistakes to avoid if you are hurt at work. The book is offered at no cost and with no obligation because too many hardworking Iowans have made mistakes that cost them thousands of dollars simply because they did not have the right information at the right time.

Getting Legal Assistance In Monticello

Navigating the complexities of Iowa workers' compensation laws can be daunting, especially during the recovery process from a workplace injury. Seeking guidance from a seasoned Monticello Workers' Comp attorney is invaluable in ensuring your rights are protected and maximizing your chances of a favorable outcome.

Legal professionals play a pivotal role in gathering evidence, preparing documentation, and advocating for your interests throughout the claims process. Don't risk missing out on the compensation you deserve – enlist the support of a qualified attorney to navigate the complexities with confidence.

The Iowa Workers' Compensation attorney team at Walker, Billingsley & Bair know the importance of protecting your work injury claim from the get-go. That's why we provide this FREE book; Iowa Workers' Compensation - An Insider's Guide to Work Injuries: 7 Deadly Mistakes To Avoid If You Are Hurt At Work. To learn more about what our legal team will do to help you protect your Iowa work injury claim, contact Walker, Billingsley & Bair to schedule a no-cost consultation - 641-792-3595.

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