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Getting hurt on the job is only the beginning of a long and often confusing process for Sibley workers. Between doctor releases, treatment decisions, and the paperwork required to apply for benefits, it is easy to make a mistake that costs an injured worker money they are rightfully owed. The attorneys at Walker, Billingsley & Bair have spent years helping Iowans understand exactly what happens after an on the job injury, and this guide breaks down what every Sibley worker should know about doctor releases, alternative treatment, and the mistakes to avoid when applying for benefits.

One of the best ways to protect a workers' compensation claim is to seek legal counsel. An attorney can explain eligibility for benefits and how the severity and extent of injuries may affect what a Sibley worker is entitled to receive.

What Happens When Your Doctor Releases You From Care

When a doctor releases an injured Sibley worker, it can lead to a stoppage of payments on the workers' compensation claim. The outcome depends on various factors, including whether the employee is released to regular job duties, light duty work, or if the condition has reached a point of maximum medical improvement.

Designated as Healed

In many cases, the employee's injury or illness eventually heals completely. Once the worker can return to their regular job duties, workers' compensation payments would then stop.

Released With Job Restrictions

Another scenario arises when the employee is released to return to work, but with certain restrictions. Job responsibilities might be adjusted, or the employee might work fewer hours. If treatment is ongoing, payments should continue during this period. However, if the employee fails to adhere to the prescribed work restrictions, such as declining a light duty assignment, this decision could impact eligibility for benefits.

Adapting to Changing Work Circumstances

If a Sibley worker receives a lower wage due to the injury, temporary total disability benefits could transition to temporary partial disability benefits. Unlike temporary total disability, which provides 80 percent of average spendable earnings, temporary partial disability pays two-thirds of the difference between pre-injury wages and reduced wages.

A worker should receive a temporary total disability check on a weekly basis. If a check does not arrive on time, contact the insurance adjuster to request an explanation, or have an attorney's staff reach out on your behalf. The insurance company can be subject to paying penalty benefits of up to 50 percent for checks that arrive late.

Furthermore, a physician might determine that the employee has reached maximum medical improvement. This is common in cases involving serious injuries where the condition has plateaued and additional improvement is unlikely, though ongoing treatment might still be necessary.

Benefit Availability Based on the Nature of the Injury

The availability of benefits depends on the nature of the injury. If an individual has a permanent impairment, healing period benefits could be accessible during recovery. Once a doctor concludes that significant improvement is unlikely and releases the worker, healing period benefits cease and permanent disability benefits might begin. Even if a Sibley worker is cleared to work despite a permanent disability, they might qualify for permanent partial disability benefits. If the physician deems the worker unable to return to work at all, permanent total disability benefits could be applicable.

Your Right to a Second Opinion

Under Iowa law, a Sibley worker always has the right to seek medical treatment on their own, though it usually will be at their own expense unless they are able to win a petition for alternate medical care.

Cooperate First, Then Consider Your Options. If the insurance company is offering medical care, you should attend and fully cooperate with the care and treatment they offer. If their doctors do not have any further medical care to offer and you go see a doctor who does have care that they believe will help, you may want to file a petition for alternate medical care.

Once the company doctor has evaluated a worker for a permanent impairment rating, the worker has the right to a second opinion, sometimes called an Independent Medical Examination, with a doctor of their choosing. Iowa Code Section 85.39 provides that the insurance company has to pay for a one-time IME with a doctor of the worker's choice.

Tips for an Independent Medical Examination

  • Choosing the right doctor for the IME matters a great deal, since some IME doctors work almost exclusively with insurance companies and may give an opinion that helps them, not you
  • The insurance company should pay for roundtrip mileage, time missed from work, and the fees associated with the examination and any testing the IME doctor orders
  • If the IME doctor recommends additional medical care, you can proceed with the alternative medical care process to try to force the insurance company to provide the recommended treatment

When Payments Stop Prematurely

When payments stop, it is important to understand if they stopped for the right reasons. It could be that they ended prematurely and the employer is attempting to deny benefits the employee has every right to receive, or it could be that the type of benefit changed depending on the employee's injury status. Either way, seeking legal counsel is one of the best ways to protect the claim.

Seeking Alternative Treatment for a Sibley Work Injury

Some Sibley workers who were hurt on the job may want to pursue alternative treatment for their injuries. It is possible for injured employees to use alternative treatments, but they should follow the appropriate procedures in requesting this treatment and be prepared if an employer or insurance company denies the request.

Types of Alternative Treatments

Alternative treatments can include acupuncture, massage, and chiropractic treatment. People seek out alternative treatments for many different reasons, and some use them as a lifestyle choice because they do not want to rely on certain medications, such as addictive painkillers, or other traditional treatments.

Alternative Medical Treatment and Workers' Compensation

A worker's employer or the employer's workers' compensation insurance company is required to pay for medical costs associated with the work related injury. Section 85.27 of the Iowa Code specifically mentions osteopathic and chiropractic treatment among other, more traditional treatment options. The general requirement for these companies is to provide reasonable and necessary medical treatment for the work injury.

When a Sibley worker is interested in pursuing alternative medical care, they first need to speak with their doctor about the treatment. The question of whether the treatment is approved comes down to whether it will help improve the employee's condition. Since the employer chooses the employee's doctor, some workers suspect that any denial of reasonable treatment is related to the doctor's attempt to please the employer. Workers have options if the treatment is denied, but they must request the treatment first.

90 Days Time limit under Iowa Code Section 85.23 to notify your employer of a work injury
80% Average spendable earnings paid under temporary total disability benefits
50% Potential penalty benefit an insurer may owe for late weekly checks

What if the Insurance Company Denies Alternative Treatment?

Employees who wish to seek alternate care because they are dissatisfied with their current doctor's treatment should first speak with their employer and the insurance company. Seeking alternate care without first gaining approval is unwise, since it will not be covered by workers' compensation.

If the employer or insurance company does not approve the alternate care, workers have the option to petition the Iowa Workers' Compensation Commissioner. The Commissioner will consider the petition and decide whether the worker may seek alternate care. A hearing may be scheduled, either by telephone or in person, where the parties will make their case regarding the alternate care. An injured Sibley worker may benefit from an attorney if the case becomes contested, since a lawyer can help collect proper documentation and present the case to the Commissioner. A decision is typically made within 10 days of the application in the case of a telephone hearing, or within 14 days for an in-person hearing.

Four Things a Sibley Worker Should Never Do When Applying for Benefits

If you are applying for workers' compensation in Iowa, there are four mistakes that should always be avoided.

Mistake Why It Matters
Forgetting to notify your employer Under Iowa Code Section 85.23, you only have 90 days to file a claim for workers' compensation benefits. If you do not notify your employer in time, you forfeit your right to benefits.
Exaggerating the extent of your injuries It can be tempting to exaggerate injuries out of fear of a denied claim, but doing so is one of the worst mistakes a worker can make. A medical examiner may doubt your authenticity when discussing pain or disability, which can lead to an incorrect assessment.
Accepting a medical opinion you do not agree with Your employer has the right to choose the medical provider who treats you, but if you disagree with a medical opinion or treatment plan, notify your employer. If the dispute cannot be resolved through conversation, you have the right to initiate a contested case.
Settling for less than you are entitled to As an injured worker, you are entitled to payment for the total cost of medical expenses and treatment, plus disability payments if you miss work. If you believe you are entitled to a benefit amount that has been denied, you do not have to settle, and an attorney can help you appeal your claim.

Types of Disability Benefits

  • Temporary total disability benefits
  • Temporary partial disability benefits
  • Healing period benefits
  • Permanent partial disability benefits
  • Permanent total disability benefits
  • Secondary injury fund benefits
  • Vocational rehabilitation benefits

Seeking Legal Assistance in Sibley

Seeking legal counsel from experienced Sibley Iowa car accident attorneys such as those at Walker, Billingsley & Bair can provide invaluable support in filing insurance claims or pursuing personal injury lawsuits. With a comprehensive understanding of Iowa law, their team can help gather evidence, establish liability, and secure the compensation deserved by accident victims.

Suffering from the aftermath of a car accident shouldn't impede your pursuit of justice and fair compensation. The Iowa injury lawyers at Walker, Billingsley & Bair work hard to level the field between injured Iowans and insurance companies.

That's why we provide this FREE book; The Legal Insider's Guide to Iowa Car Accidents: 7 Secrets to Not Wreck Your Case. To learn more about what our legal team will do to help you protect your Iowa injury claim, contact Walker, Billingsley & Bair to schedule a no-cost consultation. Call 641-792-3595 to order your free accident book today.

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