Frequently Asked Questions About Iowa’s Workers’ Compensation Laws
Iowa’s state laws establish the liability of employers for injuries sustained by workers while on the job or an illness due to their employment. Here, our workers’ comp attorneys at Hedberg & Boulton, P.C., in Des Moines answer their clients’ frequently asked questions about the Iowa workers’ comp laws. The firm offers free consultation appointments to answer any specific questions you may have.
What is workers’ compensation?
Workers’ compensation is a system of laws outlining injured employee benefits and the procedures for obtaining such benefits. Workers’ compensation compensates employees for their work-related injuries.
What does “arising out of and in the course of employment” mean?
“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.
Who is covered under workers' comp?
Almost all Iowa workers are covered by workers’ compensation laws, even professional employees.
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.
Whether someone is an independent contractors or an employee is a question of fact. Labels are not really important. The key issue is whether or not the employer controls the employees work and their hours.
It is a Class D felony to fail to provide workers’ compensation insurance. Exceptions include self-employed farmers, maritime workers and federal employees.
What types of injuries are covered?
The types of injuries that are covered under workers’ compensation include:
- Incident injuries are those which occur suddenly, such as broken bones.
- Cumulative injuries are those which occur over time, such as carpal tunnel syndrome.
- Occupational diseases are diseases caused by workplace factors, such as black lung disease.
- Occupational hearing loss is hearing loss caused by workplace factors.
A workers’ compensation lawyer can help you understand if your workplace accident, injury or illness would be covered under workers’ compensation.
What kind of notice does an employee have to give to their employer about a work-related injury?
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.
An employer must file a First Report of Injury with the state, regardless of whether or not the employer ultimately accepts liability.
Employees must file for benefits within two years of the injury or within three years of the last payment of monetary workers’ compensation benefits.
The rule of discovery or manifestation states that 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.
Does the employee have to prove negligence?
No. An employee does not have to prove that their employer was negligent.
How is workers' comp calculated?
In most cases, representative earnings are calculated from 13 weeks prior to injury. Nonrepresentative weeks are excluded. Extremely low earning weeks should not count against you if they are not reflective of your normal earnings.
For part-time workers who are injured performing a part-time job, all earnings from all jobs from the past 12 months are added together and divided by 50.
When do workers' comp benefits have to be paid?
Benefits must be paid each week that 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.
There is an ongoing duty to investigate and assess claims, which means that the initial denial must be reevaluated when new evidence becomes available.
Can an employee file a lawsuit outside of workers’ compensation?
It depends. Workers’ compensation is an injured worker’s exclusive remedy. However, 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. An experienced personal injury attorney can help you assess any possible other claims.
What if the employee already had an injury to the affected area?
Preexisting 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.
What types of benefits are available?
A workers’ compensation claim provides medical benefits. An employee is entitled to reasonable medical care for the injury, which is to be provided by the employer.
Workers’ compensation claims can also provide monetary benefits. Employees may be entitled to healing period benefits and permanency benefits.
Is medical care covered under workers' compensation laws?
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 the employee’s request is 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.
What types of monetary benefits are available through workers' comp?
During the employee’s healing period, an employee may be entitled to Temporary Total Disability. This occurs if an employee is wholly unable to work for a period of time during their recovery from injury.
An employee may also be entitled to Temporary Partial Disability. These are benefits meant to supplement income while an employee works limited hours or in a lower wage position as he or she is recovering.
If the employee suffered a permanent injury, and has a permanent disability as a result of the work-related injury, they might qualify for:
- 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.
In the event an employee was killed by the workplace accident, the employees family may be entitled to burial expenses and survivor benefits for their spouse or dependents.
What is the difference between a scheduled injury and an industrial disability?
Scheduled injuries are compensated according to the state’s pre-determined 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.
How many weeks of workers' comp do I get for my injury? What is the injury schedule?
|Scheduled Body Members
|Loss of thumb
|Loss of first finger
|Loss of second finger
|Loss of third finger
|Loss of fourth finger
|Loss of hand
|Loss of arm
|Loss of the shoulder
|Loss of great toe
|Loss of any other toe
|Loss of foot
|Loss of leg
|Loss of eye
|Loss of hearing in one ear
|Loss of hearing in both ears
|Permanent disfigurement, face or head
|Shoulder (Additional Benefits May Apply)
|Body as a whole/industrial disability
What are the different factors for industrial disabilities?
Factors include, physical loss, the percentage of functional disability and an employee’s work restrictions.
A loss of earning capacity considers the following factors:
- Work history/experience
- Capability for retraining/new skills
- Motivation/Willingness to make reasonable attempts in returning to work
What is the Second Injury Fund?
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.
Can I get an independent medical examination?
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.
What types of settlements are there?
There are several different types of possible settlement options. these include:
- Closed file settlements: This type of 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.
- Open agreements for settlement: The parties agree to the extent of the worker’s 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 settlements: Hybrid settlements close 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.
What if my case doesn’t settle?
Hearings with the Deputy Commissioner are generally held within a year of the petition date. An appeal to the 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.