Get Your Questions Answered Today By Iowa Workers' Compensation Attorney Nicholas Pothitakis
After an on-the-job injury, you probably have a number of questions about who was at fault, whether you are owed compensation, and whether you need an attorney to assist you with your claim. Below, we've answered some of the most common questions that we hear at our law firm.
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How much work do I have to miss to receive temporary total disability benefits?
Workers all over Iowa experience a wide variety of injuries and illnesses every year. Some recover very quickly and miss little or no work, while others face severe injuries and extended periods away from the job. More commonly, an employee finds himself somewhere in the middle. He suffers an injury, misses some amount of work, and then returns to the job. Typically, these workers are eligible for temporary total disability (TTD) benefits.
Temporary Total Disability Benefits in Iowa
Temporary total disability benefits are appropriate for Iowa workers who suffer an injury on the job that prevents them from working in any capacity. It is necessary for a doctor to determine if the employee is capable of performing any job functions. Typically, employees receiving TTD are expected to recover and return to work after some period of time. These benefits comprise two main components: payment of medical bills and wage replacement compensation. Medical coverage encompasses all reasonable and necessary care related to the work injury. Wage replacement is meant to prevent unnecessary hardship created when an employee is forced to miss work and subsequently lose income.
Medical Treatment Benefits Are Available Immediately
Medical care benefits are available for treatment of any work-related injury, whether the injury forces an employee to miss time at work or not. Medical care benefits can include a number of charges, including doctor visits, medications, hospital stays, surgery, rehabilitations, travel to appointments, and more. Medical only claims are common, and an employer (or its insurance company) would pay all bills related to the work injury. It is important to note that in Iowa employers have the right to choose the provider of the medical care. Injured employees should report their injury as soon as possible, and the employer should offer direction as to how to find the appropriate provider.
Wage Replacement Benefits and the Waiting Period
Wage replacement benefits exist to help injured employees and their families avoid the financial hardship that may accompany missed work. It is necessary, however, to miss a certain amount of work before wage replacement benefits are available. In Iowa, an injured worker must miss at least three days of work to be eligible for wage replacement. Typically, payment begins on the fourth day of missed work and continues until the injured worker returns to the job or is medically cleared by a doctor to return to work. If the employee misses more than 14 days due to the injury, workers’ compensation will pay back the initial three days of missed work. Workers will not be paid for those three days if they are able to return to work before 14 total days are missed.
Payment Timing and Rates for Injured Iowa Workers
While workers are entitled to compensation beginning on the fourth day of missed work, the actual receipt of payment can be expected the following week. State law provides weekly payments beginning on the 11th day of disability. The law encourages prompt payment, and employers or insurance companies who are late with payments unnecessarily are subject to penalties.
The rate of payment in Iowa is among the most generous in the U.S. Typically, injured employees are eligible to receive up to 80 percent of their total weekly spendable earnings. The amount is subject to set minimums and maximums, which are determined each year by the state commission. The current weekly maximum is $1,572.
If you or someone you love has suffered an injury at work in Iowa, you may be eligible to receive workers’ compensation benefits. At Pothitakis Law Firm, our experienced legal team has represented many injured workers and helped them receive the maximum amount of compensation available. Browse some of their experiences on our case results page, and call our office to find out how we may be able to help with your claim.
Do I have to use workers’ compensation after an Iowa work injury?
If you have been involved in an accident or experienced an injury at work, you may wonder if you are obligated to use the Iowa workers’ compensation system. To find your personal answer to that question, you need to ask yourself a few more. Was it a minor injury that didn’t require days away from work or a loss of pay? If the answer is yes, then you probably don’t need to worry about doing anything at all. Did you suffer a serious injury that resulted in an extended time off work and a reduction in income? Do you have lasting physical limitations or permanent scars? Do you want compensation for these injuries? If your answer to any of those questions is yes, then you do need help, and that help is most likely to come from the workers’ compensation system, though there are few exceptions. Here, we take a look at employee options after a work injury in Iowa.
When an Iowa Workers’ Compensation Claim Is Compulsory
In general, if you sustain an injury at work, you are subject to the jurisdiction of the Iowa Workers' Compensation Commissioner. This means that if you are hurt performing duties related to your job, you are required to pursue care and compensation through the workers’ compensation system. Employers are required by law to carry workers’ compensation insurance, which pays for the medical treatment and lost wages of the employee related to the work injury. This is separate from any health insurance your employer might offer, and typically a private health insurer will refuse to pay for a workers’ compensation eligible claim. If you are entitled to workers’ compensation benefits, you cannot typically pursue a claim outside the system.
Exceptions to Workers’ Compensation Rules
There are cases, however, in which it is possible to use other means rather than the state workers’ compensation program to obtain care and compensation. In some cases, it is possible to bring a legal suit against responsible parties. While the workers’ compensation system is intended to prevent lawsuits against an employer, there are certain exceptions and other third-party situations. These can include cases in which injuries were caused by:
- Manufacturer of a defective product – Manufacturers have a duty to provide safe products to the marketplace. If you are injured by a product or substance in the course of your work, it can be possible to pursue a legal case directly against the maker of the dangerous product.
- Private individual – At times, a private individual may cause your injuries. Injuries sustained on the road are common examples of this. Those responsible parties may be forced to pay the victim who suffers the consequences of their poor behavior.
- Employer who displayed intentional, egregious behavior – Employers are not entirely insulated from injury lawsuits. While rare, employers can be held accountable if they intentionally act in a way that causes an employee harm, knowingly violate state or federal safety codes, or fail to carry workers’ compensation insurance.
Disqualifications From Iowa Workers’ Compensation
In addition, there are times when a workers’ compensation claim is not possible, even if the injury was sustained at work. In Iowa, there are a few common reasons why a work injury claim would be disallowed. You may not be eligible to file a claim if:
- You are not an employee of the company. Workers’ compensation covers only those who are considered employees of a business. Independent contractors, exchange laborers, and others may not be eligible for benefits.
- Your injury is not covered. While there is a wide range of injuries covered in Iowa, workers’ compensation does not offer benefits after every injury. Some pre-existing conditions, injuries sustained outside of work, or injuries sustained under certain circumstances (such as under the influence of drugs or alcohol) may disqualify an employee.
- You are a civil servant eligible for other benefits. Firemen and police men who are entitled to benefits under the pension fund may not be able to utilize the workers’ compensation system.
While every situation is unique, workers’ compensation is typically an employee’s only and most reliable source of care and income after a work-related injury. If you have suffered an injury on the job—even if you are not sure if you are entitled to benefits—contact the Pothitakis Law Firm to learn more about how an attorney may be able to help. Our experienced legal team has helped many Iowa workers obtain the care and compensation they deserved after a wide variety of accidents and injuries. Take a moment to fill out the contact form on this page today, and you will hear back from a member of our team who can answer your questions.
When can I expect to receive my Iowa workers’ compensation payments?
Suffering a work injury can leave Iowa employees and their families in a difficult situation. When the injury forces an employee to miss work, the lost income can cause significant stress during an already frustrating time. As injured workers and their families focus on healing from the injury, they should not have to deal with this added financial pressure. The Iowa workers’ compensation system, like others across the country, offers payment for medical care and wage loss to prevent unnecessary hardship and aid in the employee’s return to work. Here, we take a look at the timelines related to these payments. Find out more about your benefits, what you can expect after a work injury, and what to do if your compensation is not being appropriately managed.
Payment Start Dates Depend on the Nature of the Work Injury
Each state sets its own specific rules about workers’ compensation benefits and payment. In Iowa, payment commences at different times depending on the type of injury and the amount of work missed (and expected to miss). The state has set the following start dates for each type of benefit:
- Temporary partial disability – On the fourth day of disability after the injury. If more than 14 calendar days of work are missed due to the injury, the initial three days will be paid.
- Temporary total disability – On the fourth day of disability after the injury. If more than 14 calendar days of work are missed due to the injury, the initial three days will be paid.
- Permanent partial disability – On the first after the termination of the Healing Period benefits.
- Permanent total disability – On the date of the injury.
- Healing period – On the first day of disability after the injury.
- Death benefits – On the date of the employee’s death.
If Your Workers’ Comp Payments Are Late or Don’t Arrive at All
The state understands the hardship that injured workers and their families can experience during this time. As a result, the state workers’ compensation commission supports prompt payment of benefits. The law requires weekly payments be offered starting on the 11th day of the disability. It is typically necessary to provide verification of the injury from an employer and medical provider before payments begin, but those parties often provide these documents.
If benefits are not paid to an injured worker when they are due, the employer or its insurance company may have to pay interest to the worker. Additionally, if payments are inappropriately withheld or habitually late, the employer or its insurance company could face further fines and penalties, all of which would be paid directly to the injured worker.
If you think your employer is not paying the benefits you deserve, or if your payments are late, it is important to take action as soon as possible. In many cases, the issue can be resolved by addressing the employer or insurance company directly. At times, though, it can be necessary to take the matter up with the state commission. In either event, an experienced workers’ compensation lawyer can help injured workers understand their rights and present their case effectively and thoroughly, ensuring prompt payment of the maximum compensation they deserve.
Termination of Iowa Workers’ Compensation Benefits
Once workers’ compensation payments have begun, they will continue to be paid to an injured worker until certain conditions exist, including:
- The employee has returned to work.
- The employee is medically capable of returning to work.
- The employee is not expected to make significant medical improvement from the injury.
Benefits can be terminated immediately upon a return to work. However, the employer or insurer must give 30 days’ notice of termination of benefits, including a specific reason for the termination, if the benefits will end based on a medical opinion.
If you or someone you love has suffered an injury at work, you may be eligible for workers’ compensation benefits. If you have already filed a claim, and you are concerned about the timeliness of your payments, the experienced attorneys at Pothitakis Law Firm can help. Call our office today or take a moment to fill out the contact form on this page to learn more about your rights and options as an Iowa worker.
Do I need an attorney to file an Iowa workers’ compensation claim?
After an injury or illness on the job, many Iowa workers are eligible for workers’ compensation benefits. These benefits provide medical care and wage replacement compensation for injured workers and their families to help them avoid unnecessary hardship during the recovery and disability periods. While most workers do qualify for this program, it is still necessary to apply and be approved by the state commission to obtain the benefits. Many injured workers wonder if they need to hire an attorney to help navigate this process. While an attorney is not required by law, many injured workers choose to secure representation. An experienced workers’ compensation lawyer can provide unique and effective tools to help ensure maximum compensation and protection after a work injury.
How an Attorney Can Help With Your Workers’ Compensation Claim
After a work injury, it is natural to have many concerns and worries. Many injured workers fear they cannot afford an attorney or that an attorney may not add value to the claim. This is not the case, however. An experienced Iowa workers’ compensation attorney can provide individualized and effective services that can help an injured secure the maximum amount of compensation possible. A workers’ compensation attorney offers:
- Knowledge of the law and the Iowa workers’ compensation system. Too often, injured or ill workers are denied benefits or are not given full compensation simply because they do not know the full scope of the system. An injured worker may be unaware of all the benefits available in different situations and miss out on vital compensation because of it.
- Forms and filing assistance. Unfortunately, many injured workers have been denied compensation only because they failed to provide the appropriate paperwork at the appropriate time. An experienced legal team can help workers understand the state statutes of limitations, fill out forms, and ensure that deadlines are met to obtain compensation.
- Experience with negotiation. Employers and insurance companies are out to protect their own interests. They will try to save as much money as possible by offering quick—but low—settlements or disputing even valid claims. An experienced attorney knows these tactics and can be a voice for the injured worker.
When You Need an Attorney for Your Iowa Work Injury Claim
For some smaller, straightforward claims, it can be possible to resolve your workers’ compensation claim without legal aid. In many cases, however, the situation is more complicated, and even the Iowa workers’ compensation commission states it is advisable to seek legal counsel. These circumstances include cases that involve:
- Denial of benefits. If you filed a claim that was denied, it can be possible to appeal that decision. The process is more complicated than the initial application, however, and it is often necessary to state your case at a hearing.
- Permanent disability. When your work injury leaves you with a permanent disability, securing work and income in the future can be more difficult. Iowa workers’ compensation does offer specific benefits for these types of injuries, but they are dependent on an independent medical exam and a wide range of other factors.
- Industrial disabilities. Injuries that involve the neck, back, shoulder, or hip are known as industrial disabilities. These injuries are also compensated based on the extent to which the injury affects your ability to work and the results of a medical exam.
- Employer retaliation. Employers are strictly forbidden from retaliating against an employee from filing a workers’ compensation claim. Retaliation can come in many forms, including demotions, pay reduction, verbal attacks, change of duty, and much more.
- Employers without workers’ compensation insurance. Iowa law requires most employers to carry workers’ compensation insurance to cover the costs associated with employee injuries and illness. If you suspect that your employer has not met this mandate, it is important to contact an attorney who can help you learn more about the next steps and how to obtain benefits.
- Third party claims. In some cases, it is possible to bring a legal suit against a third party. These are separate legal claims, and they do require the knowledge and skill of an experienced attorney.
- Workers who receive other government benefits. If you receive Social Security or other government benefits, there can be income and tax consequences to your workers’ compensation claim. It is important to understand how each will affect another before deciding how to move forward with a claim.
Even if your case does not involve one these issues specifically, if you are worried about your claim or unsure of your rights, it is best to contact an experienced attorney. At Pothitakis Law Firm, our legal team offers free, no-obligation consultations to help injured workers better understand their situation and their rights to compensation.
The Cost of Not Hiring a Workers’ Compensation Attorney
In addition to the benefits of hiring an attorney, it is important to consider the costs of not hiring an attorney. The decision of the workers’ compensation commission in the end is final. Though it is not a legal case, the decision is legally binding and cannot be undone. For many injured workers and their families, workers’ compensation benefits provide care and wage replacement vital to their current and future stability. With stakes that high, it is best not to leave anything to chance.
If you or someone you love has suffered an injury at work, call our office, or take a moment to fill out the contact form on this page. You will speak with a member of our team who can answer your questions and get you started protecting your rights.
Who pays for an injured worker’s medical care and wage replacement after an injury?
Workers’ compensation benefits in Iowa can provide injured employees with medical care and wage replacement compensation. These benefits are available regardless of fault to help ensure that the employee can receive proper medical treatment for as full and expedient a recovery as possible. Additionally, wage replacement benefits help relieve some of the financial pressure the worker and his family may experience when he is forced to miss work. Some employees may wonder, however, where these benefits come from. Who pays these benefits to an injured worker?
Types of Benefits Available Under Iowa Workers’ Compensation
Like other state workers’ compensation systems around the country, the Iowa workers’ compensation system offers injured workers a variety of benefits to address many different types of injuries and circumstances. These include:
- Temporary total disability – Injuries result in more than three days of forced missed work.
- Temporary partial disability – During recovery from an injury, an employee can return to work at a lesser paying position.
- Permanent partial disability – Worker experiences a permanent impairment but can still work in some capacity.
- Permanent total disability – Permanent injuries prevent an employee from ever returning to work.
- Healing period – The time in which a worker is recovering and unable to return to work.
- Death – Benefits provided for surviving family members of workers who die as a result of work-related injury or illness.
Each type of benefit offers medical care and wage replacement, with the wage benefits typically providing up to 80 percent of the employee’s spendable weekly wage.
Privately Insured and Self-Insured Iowa Employers
Employee injuries can be expensive, and state law prevents employers from forcing employees to pay for any part of the company’s workers’ compensation costs. Therefore, employers are required to either purchase workers’ compensation insurance from a private insurance company or self-insure.
If the employer elects to purchase insurance coverage from a private company, that company would be responsible for paying the costs related to an employee’s illness or injury. Self-insured companies must follow specific rules to qualify. Approved self-insured employers would cover injury-related costs themselves, and injured employees would work directly with their employer to arrange the benefits. Iowa law requires self-insured employers and insurance companies to pay all “reasonable and necessary medical expenses,” as well as the wage replacement benefits as set by the state commission.
Obtaining Compensation After an Iowa Work Injury
Regardless of which route your employer takes, if you are injured at work, they have a duty to provide medical and wage replacement benefits. Despite this responsibility, it is common for employers and their insurance companies to attempt to minimize their financial loss. They often will look for any excuse to reduce or eliminate the benefits. It is vital that injured workers take all the necessary steps to protect their rights after an injury or illness. An experienced workers’ compensation attorney can help injured employees fully understand their rights, prepare and file all necessary documents, negotiate with providers, and state your case if necessary to ensure that workers are able to obtain the maximum amount of compensation they deserve.
When an Iowa Employer Fails to Provide Workers’ Comp Benefits
With limited exceptions, Iowa employers are required by law to provide these workers’ compensation benefits. Failing to provide rightful benefits either on their own or through a private insurance company is illegal. Employers could be held liable for the benefits or open themselves up for monetary damages in a lawsuit.
Additionally, if an employer knowingly fails to secure private insurance or take the necessary steps to self-insure at all, they could face significant penalties from the state of Iowa. They may be charged with a felony, and business operations could be halted.
If an employee is concerned that an employer is unfairly denying his benefits or that his employer has not obtained the proper workers’ compensation coverage, it is important to take action.
At Pothitakis Law Firm, experienced attorney Niko Pothitakis and his team work hard to help injured workers obtain the care and compensation they deserve. Call our office or take a moment to fill out the contact form on this page to learn more about the services we provide and find out how we may be able to help.
How is the weekly workers’ compensation benefit calculated in Iowa?
When an employee is injured on the job and forced to miss work, it can cause a number of hardships for the worker and his family. In addition to the physical pain and health prognosis, workers are most often concerned about how the injury will affect them and their families financially. In Iowa, workers’ compensation benefits include wage replacement to help ease that burden. Wage replacement benefits are payable on a weekly basis to injured workers and their families, and they can help prevent additional and unnecessary stress during an already difficult time.
Wage Replacement Benefits Under the Workers’ Compensation System
Wage replacement compensation is meant to assist with income loss due to missed work and any extra expenses associated with the injury outside of medical care. While ideally the injured worker would receive an amount equal to his paycheck, this is not typically the case. Wage replacement is determined by a formula and does not match the typical income of the worker before the injury. So, what can an injured worker expect to receive from these benefits?
Workers’ compensation benefits fall under the jurisdiction of each state in the U.S. Every state determines its own specific guidelines and rules that operate the system. The process for obtaining benefits and the amount of compensation offered can vary greatly from state to state. This is true for wage replacement, as well. Fortunately for Iowa workers, our state does allow the highest rate of compensation in the country. The average maximum weekly benefit in Iowa last year was $1,543, nearly twice the national average for state maximums.
Determining Your Weekly Wage Benefit in Iowa
It is important to note, however, that not every Iowa worker will receive a weekly benefit in that amount. It is the maximum amount an injured worker can receive based on the state formula and his typical wage.
Employees are entitled to a percentage of their spendable weekly earnings depending on each unique circumstance. Spendable weekly earnings are defined as the amount that remains after required taxes and withholding are taken. These amounts are based largely on the type of disability benefits required by the injured employee, and the rates follow:
- Temporary total disability – 80 percent of weekly spendable earnings
- Temporary partial disability – 66 2/3 percent of the difference between the injured worker’s average gross weekly earnings at the time of injury and his current earnings at a lesser paying job due to the injury
- Permanent partial disability – 80 percent of weekly spendable earnings
- Permanent total disability – 80 percent of weekly spendable earnings
- Healing period – 80 percent of weekly spendable earnings
- Death benefits – 80 percent of weekly spendable earnings
Each type of disability compensation is subject to the weekly maximum, ranging from 184 percent to 200 percent of the statewide weekly average wage.
Calculating Your Weekly Wage Replacement Benefit After an Iowa Work Injury
There are mathematical formulas used to address a wide variety of employment situations. To determine an injured worker’s specific wage replacement benefit, the state calculates the rate based on a number of factors, including:
- Employment status (full time or part time)
- Rate of compensation
- Frequency of pay (bi-weekly, monthly, etc.)
- Type of employment (certain jobs are subject to a flat rate of compensation)
- Type of disability benefit (permanent partial, temporary total)
These formulas can be found in the state ratebook on the Iowa Workers’ Compensation Commission website.
Additional Compensation for Iowa Work Injuries
In addition to weekly wage replacement, it is possible to receive other compensation, depending on the nature of the injury. Workers who experience the loss of a limb, for example, may be eligible for compensation for a scheduled loss. It is also possible to obtain compensation for the cost of travel to medical appointments related to the injury, burial expenses after the death of a worker, and more.
An experienced Iowa workers’ compensation attorney can help injured workers and their families examine their unique situation to determine what compensation may be attainable. If you or someone you love has suffered a work injury in Iowa, call Pothitakis Law Firm to learn more about your rights and legal options. Our experienced workers’ compensation attorneys can help you ensure you obtain the medical care and compensation you deserve.
What can I do if my doctor releases me but I do not feel I am healed enough to return to work?
After a work injury, the ultimate goal for every employee is to heal as fully and quickly as possible. Injured workers want to get back to their regular lives—both personally and professionally. Often, with the help of a medical provider, it is possible to achieve this goal. After a period of care and recovery, employees can successfully resume their lives as before the accident or injury upon clearance of a doctor. There are times, however, when an injured employee does not feel healed or well enough to return to work despite their medical release. So, what can injured Iowa workers do? Are there any options available to dispute a medical release?
Iowa Injured Workers Can Seek a Second Opinion for Treatment of Injuries
The first and sometimes most simple solution is to return to the physician to discuss your ongoing symptoms. In many situations, the doctor can reevaluate your situation and offer further treatment.
If that option fails, injured workers do have further recourse. The Iowa Workers’ Compensation Act states that employers or their insurance companies have the right to choose the medical care providers for injured workers. However, if the worker does not feel the doctor offers effective and appropriate treatment, it is possible to obtain a second opinion. To do so, it is necessary to file a special application, and an experienced workers’ compensation lawyer can be valuable in successfully navigating this process.
If the Injury Persists, Employees Should Continue to Seek Medical Care
Regardless of where an employee is in the process, it is important to continue to seek medical care if pain or other symptoms persist. Failure to obtain treatment is one of the biggest factors in unsuccessful workers’ compensation cases. If an employee does not pursue care, it can be taken as a sign that an injury does not exist or is not severe enough to warrant a claim.
Injured workers and their doctors should determine together when an employee is ready to return to work. Pressures from employer and insurance companies cannot and should not force a worker back to the job before he is fully ready. It is important to use all available options to receive appropriate care and treatment before giving up or resolving your claim.
If you or someone you love has suffered a work injury, you do not have to return to work before you are physically and emotionally ready. Call the experienced workers’ compensation attorneys at Pothitakis Law to learn more about your rights and options and find out how we may be able to help.
Can I obtain compensation for travel to medical appointments?
A work injury can cause a significant strain on employees and their families—both emotionally and financially. In addition to addressing physical pain, caretaking needs, and the disruption to daily life, many families find themselves under considerable financial stress. Missed work and lost wages, compounded by arriving medical bills, contribute to increasing worries about money. Even with weekly lost wage reimbursement from workers’ compensation, injured workers and their families often feel they must take care with their income and pay particular attention to their expenses. One often overlooked expense is the cost of traveling to and from appointments for care related to the work injury. The Iowa workers’ compensation system does acknowledge this hardship, and it is possible to obtain compensation for this expense.
Mileage Reimbursement for Work Injury Medical Care Travel
Iowa law requires the workers’ compensation program to cover all “reasonable and necessary” expenses related to a work injury. This includes mileage reimbursement when traveling by personal car. Currently, injured workers can obtain .535 cents per mile. While it may seem like a small amount, it can add up quickly with frequent appointments and distance.
Payment for Other Travel-Related Expenses After an Iowa Work Injury
If you do not own your own car, and you travel to appointments, it is also possible to obtain compensation to cover those and other costs. Injured workers can be compensated for:
- Public transportation fare
- Taxi fare (if incidental to the use of public transportation)
- Parking fees
- Cost of meals and lodging (if incidental to the use of the medical treatment)
- Ambulance service or other appropriate transportation
Document All Expenses Related to Treatment of a Work Injury
Iowa insurance companies are required to pay these expenses, but it is common for them to attempt to ignore this duty. As a result, it is important to keep track of all the expenses related to the treatment of a work injury, including:
- A mileage log book of dates, times, destinations, and mileage
- Gas station receipts
- Parking receipts
- Public transportation receipts or records
- Meal receipts
In some cases, it is necessary to provide proof of expenses, and it is best to have as many records as possible. These expenses can quickly add up and can contribute to a difficult financial picture.
Even if you did not know about the mileage reimbursement possibility or if you have not kept detailed records, it may still be possible to obtain compensation. Call the experienced workers’ compensation attorneys at Pothitakis Law Firm to learn more about your options, or take a moment to fill out the contact form on this page to discuss your case with a dedicated member of our legal team.
Should I seek medical care using my health insurance after a work injury?
One of the most important steps to take after a work injury is to seek medical care. Failing to obtain appropriate, timely treatment can negatively affect your health and your life for years to come. Additionally, it can be very difficult to successfully pursue a workers’ compensation claim for an injury that was never treated by a doctor.
There are a number of reasons why a worker would not seek care, including worries about medical bills, pressure from an employer, or a misunderstanding of the severity of the injury. These issues can be addressed, however, and Iowa workers should seek treatment for any work-related injury as soon as possible. So, how exactly should they go about finding care? And what should you do if your employer tells you to use your health insurance to obtain that care?
Iowa Employers Rights and Responsibilities After an Employee Injury
In the state of Iowa, employers have a number of rights and responsibilities after an employee is injured at work. Employers are required to provide care for a worker who is injured on the job under their employment regardless of fault. Most employers must carry workers’ compensation insurance and use that insurance to provide medical care and wage replacement benefits for injured workers. However, employers are allowed to direct the care. They may choose the provider, and they do not have to pay if an employee chooses to seek treatment outside the approved providers. Typically, an employer will provide an injured employee with a list of certified doctors, and the employee may select from that group.
Health Insurance Claims and Work-Related Injuries
Private health insurance companies have their own responsibilities to those they insure. They, too, must provide care for injuries. However, because of the existence of the workers’ compensation system, health insurance does not have to cover injuries that occur as a result of employment conditions. They also do not offer wage replacement benefits. Providers and insurance company representatives will inquire as to how the injury occurred. If an individual uses his health insurance for the treatment of a work-related injury, the health insurance company has a right to (and likely will) deny the claim. Additionally, lying about the cause of the injury to protect an employer or avoid the workers’ compensation system could constitute insurance fraud, which is a criminal offense.
How Does an Injured Worker Know Which Insurance to Use?
Determining whether an injured worker should pursue care under workers’ compensation or his health insurance depends largely on whether the work injury claim will be allowed or denied. The general guidelines for seeking treatment through workers’ compensation include:
- The worker is an employee of the company.
- The injury is job-related.
- The employer is required to carry workers’ compensation insurance or be self-insured. (Only a small number of employers are exempt from this mandate in Iowa).
Typically, if all these criteria are met, a workers’ compensation claim should move forward through the employer rather than health insurance. Though, every situation is unique, and any number of other factors could influence your circumstances.
An Experienced Iowa Workers’ Compensation Attorney Can Help
There are many rules that govern the workers’ compensation system for both employers and employees. If you have suffered an injury at work and you are unsure of how to proceed, an experienced workers’ compensation attorney can help. This is especially true if your employer is pressuring you to use your own health insurance or if you feel they will retaliate (or have already) if you file a workers’ compensation claim. These types of actions could be in violation of your rights and state law. Injured workers in Iowa have rights to care and compensation, and at Pothitakis Law Firm, our legal team works hard to ensure those rights are protected. We can help you:
- Understand your rights as an employee
- Prepare documents
- File a workers’ compensation claim
- Negotiate with insurance companies
- State your case at a hearing if necessary
If you or someone you love has suffered an injury at work, call our office nearest you to learn more about what we do and schedule a free, no-obligation consultation.
What can I do if my workers’ compensation claim is denied?
Thousands of workers’ compensation claims are filed in Iowa every year, with many injured employees able to obtain benefits fairly easily. However, there are also often claims that are denied or compensated unfairly. As a result, injured workers and their families may face a difficult time—physical pain, financial hardship, and undue stress. Fortunately, Iowa employees do have options through the workers’ compensation system to appeal a decision they feel is not right.
Common Reasons Your Iowa Workers’ Compensation Claim May Be Denied
There are a number of reasons why workers’ compensation claims may be denied in Iowa. From simple timing to more complicated medical issues, the chances of a successful appeal depend on the unique circumstances of each case. Some of the more common denials are based on:
- Missed deadlines
- Injury sustained outside work
- Injury not severe enough to warrant benefits
- Drug or alcohol use indicated
- Injured worker not considered an employee of employer
- Injury is related to a pre-existing condition
It is possible to dispute these and other reasons that employers and insurers offer when denying or reducing payments. Even if you are not sure if your claim can be appealed, don’t hesitate to reach out to an experienced attorney. A skilled legal team can help you understand your situation more fully and determine the best course of action going forward.
Appealing an Iowa Workers’ Compensation Claim Decision
There are ways to dispute a denial of benefits in Iowa. Many times, simply going back to the employer or insurance company can resolve the issue. The Iowa workers’ compensation commission encourages “free and open communication” between employee and employer. State data indicates that most workers’ compensation claims can be resolved in this manner; only about a quarter of cases escalated to official claims.
Unfortunately, there are times when the dispute cannot be resolved, and the employee must pursue more official means. In Iowa, a worker can file a contested-case proceeding. The state advises injured employees to seek legal counsel if it is necessary to pursue this option, as the decision of the commission is binding and the members of the commission are prohibited from offering any advice. Contested case hearings can be lengthy; the most recent report from the Iowa Workplace Development office stated that the average case took 571 days to resolve, and the commission heard about 600 cases in 2015.
Contested Case Proceeding to Appeal Your Workers’ Compensation Claim
In a contested-case proceeding, the injured worker appeals the decision of the employer to the state commission. A hearing is held in which both the injured worker and the employer or its insurance company are given an opportunity to state a case, offer evidence, question witnesses, and supply expert testimony. The burden of proof in these cases is typically on the injured worker—he must show that the initial decision was incorrect and that his injuries do, in fact, warrant workers’ compensation benefits. Decisions can be challenged through the system, following the chain of:
- Deputy workers’ compensation commissioner
- Workers’ compensation commissioner
- Local courts
- Iowa Supreme Court
Obtaining Proper Payment for Your Iowa Work Injury
In some cases, benefits are awarded, but they may not adequately cover your injury. It is again possible to appeal that decision to the state commission, similar to the denial of benefits entirely. Additionally, benefits decisions can heavily rely on the opinion of a doctor and his determination of your impairment rating. This rating is meant to reflect the degree of your disability, and compensation is awarded accordingly. If you feel the doctor selected by your employer is not appropriately addressing your injury, it is possible to request a second opinion.
If you have suffered an injury at work and you were denied workers’ compensation benefits, or if your benefits are not adequate to cover your injury, the experienced attorneys at Pothitakis Law Firm may be able to help. Call our office today to learn more about your rights and how to obtain the maximum compensation.