Who Chooses the Doctor for a Workers' Compensation Injury in Iowa?

One of the most frustrating aspects of the Iowa workers' compensation system for injured employees is the lack of control over their own medical care. When you suffer an injury on the job, your first instinct is often to call your trusted family physician. However, doing so can jeopardize your benefits.

Under Iowa Code § 85.27, the law is very clear: the employer is obligated to furnish reasonable medical care, but in exchange, the employer gets to choose the care provider. This is known as the 'employer's right to direct medical care.' Whether you work in Dubuque, Iowa City, or Council Bluffs, you must follow your company's instructions regarding which clinic or doctor to visit. Navigating this system is crucial to ensuring your medical bills are paid and your lost wages are approved.

Step-by-Step Process for Seeking Medical Care in Iowa

Understanding how to handle medical treatment after an injury can save you thousands of dollars. Here is how the process works and what to do if you are dissatisfied with your care.

Step 1: What to Do in an Emergency Room Situation

The rules bend slightly in a true medical emergency. If you suffer a severe trauma-such as an amputation, severe burn, or massive head injury-you or your coworkers should call 911 or rush to the nearest emergency room, regardless of whether it is an 'approved' facility. Iowa law expects employers to cover emergency care. However, once you are stabilized and discharged, all follow-up care must be directed by the employer.

Step 2: Refusing Treatment from a Company Doctor

If you suffer a standard injury like a sprained back, your employer will direct you to an occupational health clinic. You might feel the company doctor is downplaying your injury to save the employer money. Despite this, you cannot simply refuse to go and see your own doctor instead. Refusing the employer's authorized care gives the insurance company grounds to cut off your weekly workers' compensation checks and deny coverage for the medical bills you incur elsewhere.

Step 3: Filing for Alternate Medical Care

If the authorized doctor is providing inadequate care, ignoring your symptoms, or refusing to refer you to a specialist, you have legal options. You must file a formal petition with the state. This requires submitting Form 100C, Iowa, Division of Workers' Compensation, Original Notice and Petition Concerning Application for Alternate Care. You must prove that the care offered by the employer is 'unreasonable' and not adequately treating your injury.

Step 4: The Alternate Medical Care Hearing

Alternate medical care petitions are expedited. A telephone hearing is usually scheduled within 10 to 14 days with a deputy commissioner at the Iowa Division of Workers' Compensation, Des Moines. Precedents like Bell Bros. Heating v. Gwinn, 779 N.W.2d 193 (IA Supreme Court 2010) establish that the burden of proof is on the injured worker to show the authorized care is lacking. Having a skilled lawyer represent you during this hearing significantly increases your chances of being allowed to see a specialist.

Step 5: Reimbursing Unauthorized Medical Bills

If you became impatient and went to your own doctor before getting an order for alternate care, you are responsible for those bills. However, if you eventually win your case and prove that the employer abandoned your medical care or wrongly denied your claim entirely, a judge may later order the insurance company to reimburse you for those out-of-pocket expenses. This is a highly risky strategy and should only be done under the advice of a lawyer.

How Much Does it Cost in Iowa?

Getting your medical care approved shouldn't cost you directly, but disputes can lead to expenses:

• Authorized Medical Care: $0 out of pocket. The employer's insurance must pay 100% of authorized medical bills and mileage to the doctor.
• Unauthorized Medical Care: You will be responsible for 100% of the bills if you see a doctor without permission and lose your case.
• Lawyer Fees: Most attorneys handle alternate medical care disputes as part of your overall workers' compensation case on a contingency fee basis, meaning no upfront costs to you.

How Long Does the Process Take?

Initial medical care should be provided immediately upon reporting the injury. If you have to file a Petition for Alternate Medical Care, the state moves quickly. The hearing is typically held within 14 days of filing, and a decision is usually issued by the judge within a few days after the hearing concludes. If your employer completely denies your claim, litigating the issue to force them to provide care can take 6 to 12 months.

Frequently Asked Questions (FAQ)