Articles Posted in Medical Care

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In Iowa workers’ compensation cases the employer and insurance company have the right to choose the medical care providers for the injured worker.

If the worker is unhappy with the medical care they can file a Petition for Alternate Medical Care to have the care changed.  The employer’s obligation is to provide reasonable care.  The Claimant has the burden of proof to show that the authorized care is unreasonable.  Determining what care is reasonable is a question of fact.  As a general matter when the evidence shows that the employer-authorized medical care has not been effective, and that the authorized care is inferior to the requested care, the Petition for Alternate Medical Care will be granted.

On April 4, 2018 the Commissioner issued an alternate medical care decision in the case of Bushbaum v. Custom Wood Products which involves a worker’s request for alternate medical care, and also a complaint that the defendants had abandoned providing any medical care.  If the Commissioner finds that the defendants have abandoned medical care in a case, then the Commissioner will allow the worker to choose his future medical care.

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I.  MEDICAL BACKGROUND OF COMPLEX REGIONAL PAIN SYNDROME

The cause of Complex Regional Pain Syndrome (CRPS) is not well understood.  The current theories are that CRPS is caused by an injury or an abnormality of the peripheral and central nervous systems.  CRPS generally occurs as the result of a physical injury or trauma such as infections, surgery and heart attacks.

There are two main types of CRPS.  Type 1 is also known as Reflex Sympathetic Dystrophy Syndrome (RSD).  Type 1 CRPS develops after an injury or illness that does not directly damage the nerves in the affected limb.

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The Iowa Workers’ Compensation Commissioner recently issued an Appeal Decision in the case of McDonald v. Sedona Staffing and Ace American Insurance Co.  The McDonald case is factually very complex, and deals with the issue of whether an employer can cut off medical care for a worker who was injured on the job, and then injured the same body part in a later non-work accident.

The claimant was working at a manufacturing company through Sedona Staffing where he primarily was a welder.  The claimant injured his low back when he slipped and fell on the job.

The claimant was treated conservatively for several months, but ultimately underwent low back surgery by Dr. Abernathey from Cedar Rapids, Iowa.

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Under Iowa law a worker who is injured on the job is entitled to receive lifetime medical care for the work injury. The Iowa work comp system has an alternate medical care procedure to deal with many of the disputes that can develop over the medical care benefits.

Iowa workers’ comp law also allows both the insurance company and the injured worker the opportunity to obtain medical examinations to address disputes over causation and the severity of an injury.

We have added a new section to our website that explains all of these medical care issues. You can find this new section here.

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Sometimes an employer will fail to purchase Iowa workers’ compensation insurance. If you end up getting hurt on the job when your employer does not have workers’ compensation insurance there is a procedure for suing the employer in a civil action. I will write about the strategies for dealing with an uninsured employer in the future.

Today I am going to write about the situation in which an employer does have workers’ compensation insurance, but the employer has a very high deductible. This is similar to the situation in which you can get collision coverage as part of your auto insurance, and choose the amount of the deductible you want. You can get a very low deductible like $100 or a very high deductible like $5,000. Your auto insurance company does not have to chip in until you have paid the amount of your deductible. When an Iowa employer has a high deductible workers’ compensation insurance policy this means that the insurance company does not have to pay towards your work comp benefits until the employer has paid the amount of the deductible.

Recently we have run into a number of cases in which employers have deductibles in the area of $250,000 per injury. This means the employer has to pay for the first $250,000 of workers’ comp benefits for each injured worker before the insurance company is required to start paying. This is not a problem as long as the employer has the money to pay for the medical care and the weekly checks for the work injury.

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People frequently ask me whether I can help them recover more money in an Iowa work injury case than they can get on their own. In this blog post I am going to talk about the benefits of hiring an experienced Iowa workers’ compensation attorney if you have been hurt on the job.

1. FREE CONSULTATIONS. Many Iowa attorneys, including lawyers at our firm, will talk to you for free about your case. In these meetings we probably will not be able to figure out everything about your case, but usually we can give you a pretty good idea of the strengths and weaknesses of your case, and an overview of what our strategy would be to handle your case if you wanted to hire us.

2. CONTINGENT FEE. We represent our clients in workers’ compensation, personal injury and wrongful death cases on what is called a contingent fee basis. This means that we get paid a percentage of what we are able to recover for our clients. It also means that if we don’t recover for our clients, then they do not have to pay us.

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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.

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