November 6, 2012

Medical Care Disputes In Iowa Work Comp

Under Iowa workers' compensation law the employer has the right to select the medical care providers for an injured worker. The employer also has the obligation to make sure that the medical care is offered promptly and without undue inconvenience to the injured worker.

In Iowa work comp it is very important to make sure that the employer authorize or approve the medical care. In certain circumstances an employer can be required to pay medical care for a work injury that was not authorized or approved. However, it is a much better idea for a worker to get the medical care authorized before it is performed.

Disputes relating to medical care can fall under several broad categories. One potential problem area is where the employee refuses to cooperate with the medical care or does not full cooperate with medical care. As a general matter, an injured worker is not required to undergo invasive medical procedures such as surgery. However, if an injured worker fails to cooperate with less invasive treatment such as physical therapy or medication, the Workers' Compensation Commissioner will examine whether there was substantial compliance with the medical care or whether the worker had a reasonable excuse for not cooperating with the medical care. An unreasonable failure to comply or completely cooperate with medical care could result in a suspension or reduction of weekly benefits to the injured worker.

Sometimes the real issue in a medical care dispute is that the employer does not agree that the injury was caused by work, or the employer believes that the worker's problems caused by the work injury have resolved. The employer does not have to provide medical care through workers' compensation if the employer does not believe that the problems are related to work. If this situation arises the employee's options are to pursue medical care to be paid for through non-workers' compensation health insurance; or an employee can file a petition for workers' compensation benefits. If the Workers' Compensation Commissioner ultimately decides that the employee's problems were a work injury the employer will be ordered to either reimburse whoever paid for the medical care that was previously provided, and/or pay for the future necessary medical care.

Another frequent area of dispute is where an authorized doctor makes a referral to a specialist or orders a test or a procedure that the employer does not agree to authorize. Generally, where an authorized physician recommends some type of further care the Commissioner will ultimately require that the employer pay for the recommended case.

The most common medical dispute area is where an injured worker wants additional care, a change of doctors, or a second opinion.

In any situation where an employee is unhappy with the medical care being provided he has the option to file what is called a Petition for Alternate Medical Care. Before filing a Petition for Alternate Medical Care the injured worker is required to communicate their dissatisfaction concerning the current care to the employer. In alternate medical care proceedings the injured worker has the burden of proving that the currently authorized care is not reasonable and adequate to bring the worker to maximum recovery.

It is not enough for the employee to simply say that he is dissatisfied with the medical care being provided. Instead, the employee needs to show that the current care has not been completely effective, and that it is inferior to the alternate care that the employee desires.

In some situations the employee's complaint about the authorized care is that it requires too much travel. There is not a hard and fast rule about the distance that an employee can be required to travel for medical care. However, as a general matter if appropriate medical care is available in an injured employee's community he will not be required to travel out of town for medical care.

Alternate medical care proceedings move fairly quickly. Once the Petition for Alternate Medical Care is received by the Workers' Compensation Commissioner, a telephone hearing will be scheduled, and a decision on the application will be issued within 10 days of the filing of the Petition.