Iowa's Workers' Compensation System: Answers to Common Questions

1. What is Workers' Compensation?
   • The term "workers' compensation" refers to a system of laws outlining specific benefits to which injured employees are entitled, and the procedures for obtaining such benefits.
2. Who is covered?
   • Almost all Iowa workers are covered by workers' compensation laws. Exceptions include self-employed farmers, maritime workers, and federal employees. Employers are required to carry workers' compensation insurance or be self-insured to pay for workers' compensation claims. Workers compensation benefits compensate and provide medical care workers for injuries which arise out of and in the course of employment.
3. What to do when an employee has been injured at work:
   • Report the injury to the employer as soon as possible, though time limit is 90 days from the date of the injury.
   • Make sure all medical care providers know of the injury and that it may be work-related.
   • Statute of Limitations - Employee must file for benefits within two years of the injury or within three years of the date of the last workers' compensation benefit check paid to the employee.
4. What types of injuries are covered?
   • Incident Injuries - Those which occur suddenly, such as workplace accidents.
   • Cumulative Injuries/Gradual Injuries - Those which occur over time from work activities and include injuries from overuse or repetitive motion. These injuries may develop over a period of months or, in many cases, a number of years.
     • In cumulative injury or gradual injury cases, the date of injury is often a point of dispute. Generally, it is NOT when the employee first began experiencing pain or problems. It is more likely to be:
       • When the employee first sought medical care for the condition,
       • When a medical professional first informed the employee of the nature and seriousness of the condition, or
       • When the employee first missed work or had hours reduced because of the condition.
       • Occupational Diseases - Diseases caused by workplace factors, such as black lung disease or occupational asthma.
       • Occupational Hearing Loss - Hearing loss caused by workplace factors/noise exposure.
5. What does it mean to have an injury "arise out of and in the course of" employment?
   • The injury must have a causal connection to the employee's work activities. The employee's work activities must be a substantial factor in causing the injury, but need not be the only cause of the injury.
6. Does the employee have to prove negligence?
   • No. Only that the injury was sufficiently related to the employee's work.
7. Can an employee file a lawsuit outside of workers' compensation?
   • Probably not. Workers' compensation is an injured worker's exclusive remedy. Exceptions include separate claims based on products liability, intentional torts, injuries caused by a third-party, and gross negligence.
8. Do I have to give the Employer/Insurer my medical records or a medical release?
   • Yes, though there are limitations and you have rights related to the records.
9. What information do I have a right to get from the Employer/Insurer?
   • Medical records, personnel file, payment records, wage information, etc.
10. What if the employee already had an injury to the affected area?
    • Pre-existing conditions do not bar employees from recovering workers' compensation. The employee can recover benefits if the injury was aggravated or worsened by the employee's work activities.
11. What types of benefits are available?
    • Medical Benefits - An employee is entitled to reasonable medical care for the injury which is to be provided by the employer.
    • Monetary Benefits - Employee may be entitled to healing period benefits and permanency benefits.
12. Aside from causation, what other disputes may arise?
    • Many other issues, but the most prominent is the extent of the disability.
    • Other potential issues include potential penalties for failure to pay benefits in a timely manner, date of injury, and compensation rate.
13. What types of monetary benefits are available?
    • Healing Period:
      • Temporary Total Disability - Benefits paid to the employee who is wholly unable to work for a time during recovery from injury.
      • Temporary Partial Disability - Benefits paid to supplement the employee's income while working limited hours or in a lower wage position during a period of recovery.
    • Permanency:
      • Permanent Partial Disability - The employee is compensated for extent to which the injury has permanently impaired him or her.
      • Permanent Total Disability/Odd Lot Doctrine - The employee's injury has resulted in such a level of permanent impairment that it is unlikely the employee will be able to attain gainful employment again.
    • Death Benefits - Burial expenses paid, other benefits based on whether or not the worker has surviving dependants.
14. What is the difference between a scheduled injury and an industrial disability?
    • Scheduled injuries are those which are compensated according to the state's predetermined value chart, such as an injury to an arm or leg.

      Scheduled Body Members	Weeks
      Loss of thumb	60
      Loss of first finger	35
      Loss of second finger	30
      Loss of third finger	25
      Loss of fourth finger	20
      Loss of hand	190
      Loss of arm	250
      Loss of great toe	40
      Loss of any other toe	15
      Loss of foot	150
      Loss of leg	220
      Loss of eye	140
      Loss of hearing in one ear	50
      Loss of hearing in both ears	175
      Permanent disfigurement, face or head	150
      Body as a whole/industrial disability	500

    • Industrial disability comes into play when an injury has affected the body as a whole. Because shoulder, neck, back, and hip injuries are not on the schedule, they are assessed in workers' compensation in terms of industrial disability.
    • Industrial Disability Factors
      • Physical loss as well as the loss of earning capacity.
        • Factors include age, education, work history/experience, capability for retraining/new skills, earning before and after the injury, etc.
15. What is the Second Injury Fund?
    • The Second Injury Fund protects employers from having to pay higher rates for "second injuries." An example would be an employee who has injured an arm prior to working for a company and injures the other arm in a work accident. This results in the employee being entitled to additional benefits for lost earning capacity, even though the employer is only responsible for the loss of the one arm. The Second Injury Fund pays for the additional compensation.
16. What if there are problems with medical care?
    • The employer chooses the authorized medical providers, but the services must also be reasonable. An employee may seek alternative medical care by filing with the Workers' Compensation Commissioner for a remedy.
17. What about second opinions?
    • An employee has a right to have an independent medical examination. This examination can be done to see if greater work restrictions are needed, if a higher impairment rating is appropriate, etc.
18. What types of settlements are there?
    • Open File - Allows for future medical care while paying benefits by agreement.
    • Closed File - Closes future medical care but still pays benefits by agreement.
19. What if my case doesn't settle?
    • Hearing usually takes place within one year of the petition being filed.
    • Cases are heard by Deputy Workers' Compensation Commissioner.
20. What happens if my case is appealed?
    • Appeals of hearing decisions may be taken by either party to the Workers' Compensation Commissioner, then to District Court, then to the Iowa Supreme Court or Iowa Court of Appeals.

This outline is meant only as a basic reference and is not meant to serve as a replacement for sound legal advice. The contents of this outline are the property of Hedberg & Boulton, P.C. and are not for redistribution without consent. Copyright Hedberg & Boulton, P.C., 2008.

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