Under Iowa law the Defendants in workers’ compensation cases are required to provide reasonable medical care for work-related injuries. An injured worker who is unhappy with the medical care they are receiving can bring what is called an application for alternate medical care to attempt to get his medical care changed. An application for alternate medical care is not automatically approved, and it is not enough that the injured worker is dissatisfied with the care that he has been receiving. The Iowa rules require that the injured worker must show that the care was not offered promptly, was not reasonably suited to treat the injury, or that the care was unduly inconvenient.
Additionally, the Iowa Workers’ Compensation Commissioner can order alternate medical care when the employer-authorized care has not helped, and the injured worker can show that the authorized care is inferior or less extensive than the care requested by the injured worker.
Another important rule in Iowa workers’ compensation is that the employer’s right to select the provider of medical treatment for an injured worker does not include the right to choose how the injured worker should be diagnosed, evaluated, treated or other matters of professional medical judgment. In other words, work comp defendants are not entitled to interfere with the medical judgment of their own treating doctors.
The recent September 5, 2018 alternate medical care decision of Asher v. Dollar Tree Stores and Arch Insurance Company is a good example of how medical care disputes are analyzed and handled by the Iowa Workers’ Compensation Commissioner. In the Asher case the claimant suffered a back injury while she was unloading a truck.
The defendants originally authorized treatment with Dr. Schmitz. However, after Dr. Schmitz mentioned the possibility of surgery, the defendants sent the claimant to see Dr. William Boulden. Dr. Boulden questioned whether Dr. Schmitz had reviewed the claimant’s past medical records or was aware of any of the claimant’s prior complaints of back pain. Dr. Boulden also gave the opinion that he did not think that work had caused the claimant’s herniated disk, but acknowledged that the work injury did aggravate the claimant’s symptoms. Finally, Dr. Boulden gave the opinion that surgery would not succeed and would not improve the claimant’s symptoms. Instead, Dr. Boulden recommended conservative care in the form of injections and physical therapy.
The claimant did receive epidural steroid injections, but only experienced short-term relief. The claimant returned to Dr. Schmitz who noted that based on the limited success of the injections, that the next option would likely be surgery.
Dr. Schmitz wrote a letter to the lawyer for the injured worker and confirmed his recommendation for surgery. Dr. Schmitz also stated that he believed that the claimant’s back problems were related to the work injury as she did not have any symptoms prior to the work injury.
The defendants refused to authorize the surgery recommended by Dr. Schmitz. The claimant’s lawyer filed a petition for alternate medical care which came on for hearing. The defendants argued that they should not have to follow Dr. Schmitz’s surgery recommendations because Dr. Schmitz had not reviewed the injured worker’s past medical records and was not aware of the fact that the worker had back complaints prior to her work injury.
The Deputy Workers’ Compensation Commissioner that heard the medical care dispute pointed out that Dr. Schmitz was selected by the defendants and remained their authorized treating physician. The Deputy Commissioner also pointed out that Dr. Schmitz had not reviewed the claimant’s past records because the defendants had not sent those records to Dr. Schmitz.
Accordingly, the Deputy Commissioner ruled that the defendants were interfering with the medical judgment of their selected treating physician, Dr. Schmitz. The Deputy Commissioner further found that the care offered by the defendants was inferior and less extensive than the surgery requested by the injured worker. Therefore, the Deputy Commissioner ordered the defendants to authorize and pay for the low back surgery recommended by Dr. Schmitz.
Please be sure to contact our office if you have any questions about a medical care dispute in a workers’ compensation case or any other questions about Iowa workers’ compensation law.