Frequently Asked Questions About Iowa’s Workers’ Compensation Laws

“Arising out of employment” means that the injury arises out of or otherwise relates to the work he or she performed. “In the course of employment”  means that the worker was engaged in work activities at the time of the injury or its development.

Basically, the injury must have a connection to the employee’s work activities. For incident injuries, the most important factor is whether the employee was working when the injury occurred and whether it was the result of an employment risk. For cumulative injuries, the employee’s work activities must be a substantial contributing factor to the injury—not the exclusive cause.

Injuries sustained going to and coming from work and “idiopathic” injuries entirely personal to the worker, are generally not covered, though there are exceptions.

• Almost all Iowa workers are covered by workers’ compensation laws, even professional employees.
• Independent Contractors v. Employees: Question of fact. Labels not really important. They key issue is the employer’s control of the work, hours, etc.
• Employers are required to carry workers’ compensation insurance or verify self-insured qualifications. Workers compensation benefits compensate workers for injuries arising out of and in the course of employment.
• It is a Class D felony to fail to provide workers’ compensation insurance.
• Exceptions include self-employed farmers, maritime workers and federal employees.

• Incident injuries – Those which occur suddenly, such as broken bones.
• Cumulative injuries – Those which occur over time, such as carpal tunnel syndrome.
• Occupational diseases – Diseases caused by workplace factors, such as black lung.
• Occupational Hearing Loss – Hearing loss caused by workplace factors.

• Employees have 90 days to provide notice of the injury to the employer unless the employer has actual notice of the injury already, which is often the case.
• Employer must file a First Report of Injury with the state, regardless of whether or not the employer ultimately accepts liability.
• Statute of Limitations – Employee must file for benefits within two years of the injury or within three years of the last payment of monetary workers’ compensation benefits.
• Discovery Rule/Manifestation: If a worker is unaware of the nature and seriousness of the injury until later, the first time the worker appreciated the injury as severe or work-related can extend both the statute of limitations and notice periods. If you think your work injury may have a notice or statute of limitations issue, consult an attorney to see if these exceptions may apply in your case.

No.

• Most Cases: Representative Earnings from 13 weeks prior to injury.
• Non-Representative Weeks Excluded: Extremely low weeks should not count against you if they are not reflective of your normal earnings.
• Part-time workers injured performing part-time job: All earnings from all jobs from the past 12 months divided by 50.

• Benefits must be paid each week they are due. If an employer/carrier denies benefits, the burden is on the employer/carrier to show a reasonable cause or excuse for the delay or denial and that the reason was communicated to the employee at the time the decision to deny/delay benefits was made.
• Ongoing duty to investigate and assess claim means the initial denial must be re-evaluated when new evidence becomes available.

It depends. Workers’ compensation is an injured worker’s exclusive remedy, though additional recoveries can be made if a worker is injured by a defective product or piece of equipment, the negligence of another person such as in a work-related car collision, or if the employer and insurance carrier denied workers’ compensation benefits in bad faith.

Pre-existing conditions or a pre-disposition to injury do not bar employees from recovering workers’ compensation. The employee can recover benefits if the injury was aggravated by the employee’s work activities. Specifically, the Iowa Supreme Court has held that pre-disposition to injury is not important, as injuries are compensable if they manifest within the first minute of work.

• 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.

• The employer chooses the authorized medical provider and the employee will not be able to recover for unauthorized medical services, except in an emergency.
• Medical care must be reasonable.
• If the medical care is unreasonable and a reasonable alternative exists, an employee should request the employer or insurance company to authorize another doctor.
• If refused, the employee may apply to the Workers’ Compensation Commissioner for alternative care.
• If the injury is denied, the employer does not control care. As long as the case is pending, debt collection against the claimant for medical fees is illegal.

Healing period:

• Temporary Total Disability – Employee is wholly unable to work for a time during recovery from injury.
• Temporary Partial Disability – Benefits to supplement income while employee works limited hours or in a lower wage position as he or she is recovering.

Permanency:
Available if an employee has a permanent disability as a result of the work-related injury.

• Permanent Partial Disability – Employee is compensated for extent to which the injury has permanently impaired him or her.
• Permanent Total Disability/Odd Lot Doctrine – Employee’s injury has resulted in such a level of permanent impairment it is unlikely the employee will be able to attain gainful employment again.

Death:
Burial expense and survivor benefits for spouse/dependents.

• Scheduled injuries are compensated according to the state’s predetermined value chart. These are essentially injuries to an arm or leg.
• Industrial disability comes into play when an injury has affected the body as a whole. Because a shoulder injury is not on the schedule, it is assessed in workers compensation in terms of industrial disability.

Physical loss/Percentage of Functional Disability/Work Restrictions

Loss of earning capacity factors:

• Age
• Education
• Work history/experience
• Capability for retraining/new skills
• Motivation/Willingness to Make Reasonable Attempts in Returning to Work

The Second Injury Fund is designed to shield employers from paying higher rates for “second injuries.” An example is an employee who has lost an eye prior to working for a company and loses the second eye in a work accident. This results in the employee being entitled to significantly higher benefits, even though the employer is only responsible for the loss of one eye. The Second Injury Fund is then responsible for the employee’s higher rate of compensation.

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. The employer is liable for the cost of the exam and report provided an employee believes a rating from an employer-retained physician is too low.

Closed File – Compromise/Special Case Settlement

• Closes any rights to medical care or future payments. A lump sum is paid to resolve the case in a full and final settlement.
• Social Security and Medicare issues can complicate these settlements. Include adequate information in the settlement documents to ensure the injured worker is not harmed by this settlement type.

Open – Agreement for Settlement

• The parties agree to the extent of disability, payment of medical care, and the worker’s right to care in the future.

Contingent Settlements

• A settlement agreement is reached, but an outside event, such as approval of an amount of money set aside to protect Medicare interests, must be completed before the case is resolved.

Hybrid – Closes the right to future payments of benefits, but leaves the right to medical care open.

Settlements not approved by the Commissioner do not count, and contracts to avoid workers’ compensation liability are unenforceable.

Hearings with the Deputy Commissioner are generally held within a year of the Petition date.

Appeal to Commissioner is de novo, meaning the Commissioner views the case anew and is free to change the Deputy Commissioner’s decision.

Cases can be further appealed to District Court, Iowa Court of Appeals, and Supreme Court.