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How Iowa Workers' Compensation Medical Care Works
Under Iowa workers' compensation law, employers have the right to choose the medical providers that treat their injured employees. The workers' compensation insurance carrier is responsible for paying for that treatment. The doctors and other providers selected by the employer are required to provide medical care that is reasonably suited to treat the work injury. For most injured workers, this arrangement works without serious problems.
However, disputes do arise. An injured employee may disagree with the treatment being administered, with the employer-chosen doctor's opinion about when the employee can return to work, or with the work restrictions that doctor has imposed. The employee's level of impairment is another issue that frequently becomes contentious. When disputes like these occur, the first step is always to try to resolve the matter directly by speaking with the employer and the insurance company. If the employer or insurer does not resolve the dispute, the injured employee has formal legal options available through the Iowa Workers' Compensation Commissioner (IWCC).
Petitioning for Alternate Medical Care
If you are dissatisfied with the medical care being provided by the employer's chosen medical providers, you have the right to seek alternate medical care by filing a formal petition with the Iowa Workers' Compensation Commissioner. This is done using Form 100C, the Original Notice, Petition and Answer Concerning Application for Alternate Medical Care. An attorney can assist you in completing this form correctly.
Form 100C requires the following information:
- Basic identifying information about the claimant, employer, and insurance carrier
- Information about the injury, including the date and location it occurred
- The specific reasons for dissatisfaction with the care provided
After the petition is filed, a hearing will be scheduled. The parties may request either an in-person hearing or a telephone hearing. Any request for an in-person hearing will be granted unless it would be impractical for one of the parties due to distance. If the hearing is conducted by telephone, the Workers' Compensation Commissioner will issue a decision within 10 days. For in-person hearings, the decision is issued within 14 days.
This formal process exists to protect injured workers who are not receiving the treatment their injury requires. If you believe the employer-chosen doctor is not adequately treating your injury or is steering your care in a direction that serves the employer's interests rather than your recovery, pursuing alternate medical care through this process can be an important step.
Petitioning for an Independent Medical Examination
When an injured worker suffers a permanent injury, the employer-chosen doctor will issue an impairment rating. That rating has a direct impact on the amount of permanent disability compensation the worker is entitled to receive. Some injured workers are suspicious of or otherwise disagree with this impairment assessment and want an independent evaluation from a doctor who was not selected or influenced by the employer or insurer.
In that situation, the worker may file Form 100A with the Iowa Workers' Compensation Commissioner to request an Independent Medical Examination (IME). Importantly, the employer is required to pay for this IME. An attorney can assist in preparing and filing this form.
Form 100A, the Original Notice, Petition, Answer and Order Concerning Independent Medical Examination, requires the following information:
- Basic identifying information about the claimant, employer, and insurance carrier
- Information about the new physician, including the examination date and location
- Information about the work injury, including the date and location
- The name of the physician who made the previous evaluation of permanent disability
- A copy of the previous evaluation of permanent disability, attached to the petition
What to Expect During an Independent Medical Examination
Most injured workers who are scheduled for an IME have never been through one before and do not know what to expect. Understanding the four key elements of the exam process can help you prepare and make the most of the opportunity.
The Exam May Begin Before You Enter the Office
In some cases the examination process starts before you even walk through the door. After scheduling, check your mail for paperwork sent by the doctor's office or your attorney. Some physicians' offices also provide downloadable forms on their websites that you can print and bring with you. These packets typically include a medical history form that gives the doctor background information about your injury, prior treatment, and any restrictions or impairment you have already been assigned. Completing this paperwork accurately and thoroughly before your appointment helps ensure the doctor has a full picture from the start.
Providing Your Medical History
One of the most important parts of an IME is the history you provide to the doctor. Be as accurate as possible. The doctor will ask about the history of your injury, your work history, and your job duties. This information helps the doctor understand what you do at work, how you fit into that environment, and whether you are ready to return. The doctor will also want to know what treatments you have already received, what doctors you have seen, and what those providers have recommended. Be sure to mention anything you have been doing on your own to manage the injury, such as applying ice or heat, as well as your family medical history including any conditions or diseases present in your family. Complete honesty is critical. If you do not know or cannot remember something, say so rather than guessing or making something up.
The Physical Examination
There is always a physical component to an IME. The doctor will likely record your height, weight, age, and other physical attributes, then examine the injury itself. Depending on the nature of your injury, the examination may include assessments of range of motion, flexion, adduction, and other movement-related observations. The doctor may also order X-rays or take other measurements. This physical evaluation forms the basis for the doctor's independent opinion about your injury and your current condition.
Discussing Your Day-to-Day Activities
The IME doctor will also ask about your daily activities. While this may feel like an unusual focus, it serves an important purpose. It allows the doctor to assess whether your regular activities are helping or hindering your recovery and to evaluate your overall health and functional capacity. Be open and honest about all of your activities, including anything you might feel self-conscious about. The doctor needs this information to render the most accurate and useful opinion possible. You should also describe how your daily activities affect you in terms of pain and discomfort, as this information directly informs the doctor's assessment of your functional limitations.
Do not hesitate to ask the IME doctor questions. Asking questions demonstrates engagement with your own recovery and gives the doctor an opportunity to clarify anything you are uncertain about. Approach the appointment as you would any other medical visit, stay calm, and focus on providing accurate information.
When Your Employer Does Not Follow Your Work Restrictions
Work restrictions issued by a doctor are not suggestions. They are medical directives designed to protect an injured worker from further harm. Unfortunately, it is a common problem in Iowa for employers to ignore or fail to enforce those restrictions. Sometimes the issue stems from an aggressive supervisor who wants the work done regardless of an employee's limitations. In other cases, restrictions simply do not get communicated properly between the human resources department, the treating physician, and the supervisors who interact with the employee day to day.
Keep a Copy of Your Restrictions at All Times
Whether your restrictions are temporary or permanent, the most practical first step is to keep a written copy of your restrictions with you at work at all times, either in your pocket or somewhere readily accessible. If your employer asks you to perform work that falls outside those restrictions, you can immediately show the written documentation specifying what you can and cannot do. This often resolves the situation on the spot and helps prevent the same problem from recurring. If your supervisor changes or someone new assumes authority over your work, proactively inform that person about your restrictions so they understand your limitations from the beginning.
Notify Your Employer and Your Doctor if Problems Persist
If you are working within your restrictions but still experiencing pain or difficulty, notify your employer and contact the doctor who established your restrictions. Most doctors will want to see you back for a follow-up to evaluate whether your restrictions need to be adjusted. Clear communication with both your employer and your medical provider is essential. No responsible employer wants a further injury on their hands, and most physicians genuinely want to ensure their restrictions are working as intended.
Report Any New Injuries Right Away
If you sustain a new injury while performing work within your restrictions, it is critical that you report it immediately. Waiting several days or weeks before reporting a new injury makes it significantly more difficult to prove that what occurred was a new and distinct injury rather than a continuation of your existing work injury. Prompt reporting protects your rights and ensures the new injury is properly documented from the start.
Getting Legal Assistance In Sioux Center
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 Sioux Center 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.