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Being hurt at work near Story City, Iowa raises immediate and pressing questions: Is my condition covered by workers' compensation? Who will pay my medical bills, and when? What happens if the insurance company sends me to a doctor I did not choose? Three of the most common and consequential situations that Iowa workers face in the workers' compensation system are covered in this article. Understanding how tarsal tunnel syndrome qualifies as a work injury, how medical bills are actually paid in Iowa workers' comp cases, and what to expect if the insurance company schedules you for an independent medical examination are all pieces of knowledge that can protect your benefits and prevent costly mistakes.
Tarsal Tunnel Syndrome as a Work Injury Near Story City
Very similar to carpal tunnel syndrome, tarsal tunnel syndrome falls into a category of disorders called musculoskeletal disorders, or MSDs, which comprise sprains, strains, tears, and other connective and soft-tissue disorders. MSDs may be related to poor ergonomics, repetitive motion, or improper work practices.
The United States Bureau of Labor Statistics reports that for the year 2012, in the state of Iowa alone, there were 3,700 cases of work-related musculoskeletal disorders. These conditions are among the most common and costly types of workplace injuries covered by Iowa workers' compensation.
What Is Tarsal Tunnel Syndrome?
The tarsal tunnel is a narrow opening on the inside of the ankle. This ligament tunnel protects arteries, veins, tendons, and nerves, one of which is the tibial nerve. For various reasons, these ligaments can become inflamed and swollen, or a bone spur or a cyst can form within the tunnel. Regardless of the specific cause, the abnormality produces compression on the tibial nerve, which can result in significant pain radiating anywhere from the ankle all the way through the foot.
Symptoms of tarsal tunnel syndrome include tingling or burning that may feel like an electric shock, shooting pains, and numbness. People who develop this condition generally report that the pain increases after long periods of standing or walking. The affected area tends to become more uncomfortable as the day progresses and can be extremely painful at night.
What Can Cause Tarsal Tunnel Syndrome in a Workplace Setting?
There are a number of medical conditions and lifestyle factors that can lead to this disorder, and several specific work-related practices are directly associated with its development near Story City. Workers with flat feet may have a heightened susceptibility. Tarsal tunnel syndrome can also be caused by a bad ankle sprain, standing for extended periods of time such as in a retail or service job, repetitive motions such as working a pedal or clutch on equipment, or excessive pivoting of the foot. Workers in occupations that require any of these activities on a regular basis face an elevated risk of developing this condition over time.
How Is Tarsal Tunnel Syndrome Diagnosed and Treated?
After a physician makes the diagnosis through a combination of a physical examination and imaging tests, the patient is normally advised to keep the ankle immobile and apply ice whenever possible to control swelling. Pain is generally managed with over-the-counter painkillers, and physical therapy is often prescribed as part of the recovery plan. Workers should avoid any activities that aggravate the pain during the healing process. In cases where these conservative measures are not sufficient to provide relief, surgery may be necessary to decompress and relieve pressure on the affected nerve.
Workers' Compensation Benefits for Tarsal Tunnel Syndrome
Workers in Iowa who develop tarsal tunnel syndrome as a result of a workplace injury or occupational exposure are entitled to workers' compensation benefits. These benefits include medical coverage that pays for treatment related to the injury, as well as disability benefits that provide wage replacement while you are unable to work or when you return to work at lower wages than you earned before the injury.
If your employer is not taking your tarsal tunnel syndrome claim seriously or is not allowing you adequate time off to heal, speaking with a qualified Story City workers' compensation attorney is strongly recommended. An attorney can help you pursue the full benefits to which you are entitled and ensure your employer and their insurance company are meeting their legal obligations.
For more on tarsal tunnel syndrome and how it qualifies as a work injury in Iowa, read Tarsal Tunnel Syndrome Caused at Work in Iowa at iowainjured.com.
How Medical Bills Are Actually Paid in Iowa Workers' Compensation Cases
One of the most confusing aspects of a workers' compensation claim near Story City is understanding how and when medical bills actually get paid. The process involves a specific set of rules that affect both injured workers and the medical providers who treat them, and misunderstanding how the system works can lead to unexpected bills, claim complications, and disputes between providers and the insurance company that injured workers find themselves caught in the middle of.
Iowa Is an Employer Choice State
Iowa is an employer choice state when it comes to workers' compensation medical care. This generally means that the employer and their insurance company have the right to choose which medical providers their injured workers receive treatment from. With that choice comes a corresponding responsibility: the employer and insurance company are also supposed to pay for the medical bills generated by the providers they designate. The most important threshold for any medical provider to clear in this system is being recognized as an authorized provider.
The biggest issue for medical providers treating workers' compensation patients is making sure they are an authorized medical provider approved by the workers' compensation insurance company. If they are not authorized, the chances are very high that the workers' compensation insurance company will not pay their bill. When that happens, the provider may need to submit the bills to the patient's personal health insurance company instead, or seek payment directly from the patient.
What Happens When a Workers' Compensation Claim Is Denied
A separate and particularly important situation arises when a workers' compensation claim has been denied. If your claim has been denied, you should have received a written letter from the insurance company stating so. The medical provider can ask for a copy of that denial letter for their records.
Iowa law provides critical protection in this situation. Iowa Code Section 85.38(2)(a) addresses the obligation of non-occupational health insurance plans when a workers' compensation claim has been denied:
"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."
In practical terms, this means that if your workers' compensation claim has been denied, your personal health insurance company is required by Iowa law to pay for your medical care. Your health insurer cannot refuse payment simply because the question of workers' compensation liability has not been resolved. Knowing this statutory protection exists and understanding how to invoke it is something an experienced Story City workers' compensation attorney can help you navigate.
What Happens When Insurance Companies Audit Medical Bills
Even for authorized medical providers, many workers' compensation insurance companies will audit medical bills and reduce the amount they are willing to pay. When this happens, providers may then attempt to bill the injured worker for the difference between what they charged and what the insurance company paid. This practice is not permitted under Iowa law.
If there is a dispute about the reasonable charge for medical care rendered in a workers' compensation case, that dispute is one between the medical provider and the insurance company. It is a matter that can be taken before the Iowa Workers' Compensation agency for resolution, and it should not be a dispute that the injured worker is caught in the middle of. If you are receiving bills that appear to charge you for amounts that your workers' compensation insurance company should have covered, an attorney can help clarify your rights and address the situation.
For a complete overview of how medical bills are handled in Iowa workers' compensation cases, read How Medical Bills Are Paid for Iowa Workers' Compensation at iowainjured.com.
What to Expect From an Independent Medical Examination in Your Story City Workers' Comp Case
If you are pursuing a workers' compensation claim near Story City and you receive notice that the insurance company is scheduling you for an independent medical examination, commonly called an IME, you are not alone in feeling anxious or confused about what that means. Most injured workers have never been through this process before. Here is what to expect at each stage, and why conducting yourself properly throughout the examination matters so much to your case.
Preparation Before You Arrive at the Examination
The examination process may begin before you even enter the doctor's office. Before your IME appointment, you may receive paperwork in the mail from either the doctor's office or your attorney. Check your mailbox carefully to ensure you receive and review any forms sent to you in advance. Some doctors' offices may have a link on their website to download, print, and bring the paperwork in already completed. These packets typically contain a medical history form for you to fill out so that the doctor has information about your injury, your prior treatment history, and any restrictions or impairment you are experiencing.
One of the primary components of an IME is the history portion, during which the doctor will ask not only about the history of your injury but also about your work history. This helps the doctor develop a clearer picture of what your job involves and how you fit into that workplace, which helps them gauge whether you are ready to return to work and evaluate any tools or equipment related to your duties. Complete honesty is the best policy throughout this part of the exam. If you do not know or cannot remember something, say so rather than guessing or making something up. Tell the doctor about all treatment you have received on your own, such as applying ice to the injured area, as well as every other doctor you have seen and what those providers recommended. Your family medical history should also be disclosed. The doctor needs a complete and accurate picture to produce a fair and well-informed opinion.
There is naturally a physical component to the IME. Your height, weight, age, and other physical characteristics may be recorded. The doctor will examine the injury itself to determine range of motion, flexion, adduction, and other movement-related measurements relevant to your condition. Depending on the type of injury being evaluated, the doctor may order X-rays or take your blood pressure. How you present during the physical portion of the exam carries significant weight in the written report the doctor will produce, and that report will be reviewed by the insurance company and potentially used to evaluate or reduce your benefits.
Another component of the IME involves analysis of your daily activities. This portion may seem less significant than the physical exam, but it matters because it allows the doctor to assess whether certain activities are helping or harming your injury and to evaluate your overall health and functional level. Even if you feel uncertain about sharing a particular daily activity because you worry the doctor might view it negatively, be honest and tell them. The doctor needs a complete picture to form the most accurate possible opinion. You should also explain specifically how your daily activities affect your level of pain and discomfort. As with any medical appointment, do not hesitate to ask the doctor questions when something is unclear. Asking thoughtful questions demonstrates engagement in your own recovery and most physicians will welcome the opportunity to clarify.
Why Conducting Yourself Properly Throughout the IME Matters
It is worth remembering that an IME doctor is rarely a truly independent evaluator. The doctor selected by the insurance company is typically one who regularly performs examinations for insurers and whose opinions tend to be favorable to the insurance company's position. This does not mean the examination is fraudulent, but it does mean you should enter the appointment with a clear understanding that the doctor is not your treating physician and is not there to advise you on your medical care. The report they write will be reviewed by the insurance company and may be used to support decisions about your benefits, including whether benefits should be continued, reduced, or terminated.
Be consistent in how you present your condition throughout the entire visit, from the moment you arrive in the parking lot to the moment you leave. Do not describe or perform your functional limitations differently during the exam than you did while waiting in the waiting room or walking to and from your vehicle. Inconsistencies between observed behavior and reported limitations will be noted and used against you.
Important: If the insurance company has scheduled you for an IME near Story City, consult with a qualified workers' compensation attorney before attending. An experienced attorney can help you understand what to expect, how to prepare, and what your rights are throughout the examination process.
For more on what to expect during an independent medical exam and how it affects your work injury claim, read 4 Important Elements of an Independent Medical Exam and How It Affects Your Work Injury Claim at iowainjured.com.
Contact a Story City Workers' Compensation Attorney Today
Whether you have developed tarsal tunnel syndrome from the physical demands of your job near Story City, are struggling to understand why your medical bills are not being paid, or have received notice of an upcoming IME and want to know how to protect your rights throughout the process, the Iowa workers' compensation system is not one that rewards going it alone. The insurance company has professionals working to minimize what they pay from the moment your injury is reported. You deserve to have an experienced professional working to protect every benefit you are entitled to receive.
Getting Legal Assistance In Story City
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 Story City 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.