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Workers Compensation FAQs

We realize that all of the issues involved in a Worker’s Compensation claim can be overwhelming. Following are some of the more common questions answered for you.

Q: What is Workers’ Compensation?

A: The Workers’ Compensation law requires most employers to provide benefits to eligible employees who have injuries arising out of and in the course of employment. When a worker is off work on the company doctor’s orders due to a work injury, the employer is required to pay healing period (HP) or total temporary disability (TTD) benefits. HP/TTD benefits are payable until the workers is returned to work, or reaches maximum medical improvement (MMI).

If the worker is returned to work part-time or temporarily in a position with lower pay, the employer must pay partial weekly workers’ compensation benefits in addition to the part-time or reduced pay. These benefits are known as temporary partial disability benefits (TPD), and are payable until the worker reaches MMI, or is returned to full pay if that happens before MMI.

The employer must also pay medical benefits for care related to the injury. The employer has the right to tell you where you will go for your medical care for the work injury.

Once the worker has reached MMI, the treating doctor should be asked to give an impairment rating. If the worker has permanent impairment (sometimes referred to as disability), the worker is entitled to permanent partial disability benefits (PPD).

Most employers have workers’ compensation insurance, so that an insurance company pays the benefits the employer is legally responsible for. (Back to Top)

Q: What types of injuries are covered?

A: In Iowa , “injury” is defined very broadly to include any health impairment other than the normal building up and tearing down of body tissues. The health impairment must be a result of employment activities.

An employee is not entitled to benefits for a preexisting injury or disease unless it is aggravated, or worsened, by the employment. (Back to Top)

Q: How long will this suit take?

A: In Iowa , once a claim for workers’ compensation is filed with the Commissioner, it usually takes about a year to get through the hearing stage where a first determination for benefit eligibility is made. (Back to Top)

Q: What kind of recovery can I get from Workers’ Compensation?

A: If you have a work-related injury you may have the right to medical benefits and disability benefits.

Medical Benefits: The law provides for the payment of all reasonable and necessary medical care incurred to treat the injury. The employer has the right to determine where you will receive your medical care for a work injury. An injured worker is also entitled to reimbursement for reasonably necessary transportation expenses to attend medical appointments. Mileage for use of a private auto is reimbursed at a rate set by the State of Iowa .

Under certain circumstances an employee who has to leave work for medical treatment may be eligible for payment of lost wages.

Types of Disability Benefits:

Temporary Total Disability (TTD): When an injury results in more than three calendar days of disability, the employee may be entitled to TTD benefits beginning on the fourth day and continuing until the employee has returned to work or is medically capable of returning to substantially similar employment, whichever occurs first. The three-day waiting period becomes payable if the disability period exceeds fourteen calendar days.

Healing Period (HP): Usually, benefits paid while the employee is off work due to an injury are paid out as TTD benefits. HP benefits, if they are paid, are paid during the period of recuperation from an injury which produces a permanent impairment. Benefits paid while the employee is off work temporarily due to injury are paid either as TTD benefits, or as HP benefits; both are not payable at the same time. HP benefits are payable beginning on the first day of disability following the date of injury and continuing until the occurrence of one of the following events:

  • The employee returns to work
  • It is medically indicated that significant improvement from the injury is not anticipated
  • The employee is medically capable of returning to employment substantially similar to the employment in which the employee was engaged at the time of the injury.

Temporary Partial Disability (TPD): TPD benefits may be payable if the employee returns to work at a lesser paying job or reduced hours because of the injury. The TPD benefit amount is to be 66 2/3 percent of the difference between the employee’s average gross weekly earnings at the time of the injury and the employee’s actual earnings while temporarily working at the lesser paying job. The three-day waiting period (explained above) also applies to TPD.

Permanent Partial Disability (PPD): When a job-related injury results in a permanent disability, the employee may be entitled to PPD benefits based upon the degree of permanent disability. The PPD benefits are payable in addition to the HP benefits and are to begin generally when the employee returns to work or has reached maximum medical improvement.

Permanent Total Disability (PTD): When a job-related injury leaves an employee incapable of returning to gainful employment, the employee may be entitled to PTD benefits. (Back to Top)

Q: If I am injured, when do I begin collecting benefits?

A: The law is written to encourage prompt payment of workers’ compensation benefits so that the employee will not suffer any undue hardship. Before making payments, most insurance companies or self-insured employers require a written first report of injury (which is usually completed and filed by the employer) and some medical verification of the injury. The law provides for weekly payments of disability benefits, beginning on the eleventh day of disability. If the benefits are not paid when due, interest on untimely payments must be made. If benefits are unreasonably delayed or denied, the employee is entitled to penalty benefits up to 50 percent of the delayed or denied payments.

Once benefits start, the payments shall be terminated only when the employee has returned to work, or upon thirty days notice stating the reason for the termination, and informing the employee of the right to file a claim with the workers’ compensation commissioner. (Back to Top)

Q: Will I get compensation for pain and suffering?

A: There is no compensation for pain and suffering when your injury is work-related. If your injury was caused by the negligence of somebody not employed by your employer, however, you may have another claim outside of workers’ compensation for which pain and suffering may be recovered. (Back to Top)

Q: Can I go to my own doctor?

A: The employer is required to provide medical care reasonably suited to treat the employee’s injury, and has the right to choose the medical care. If the employee is dissatisfied with the care offered, the employee should discuss the problem with the employer or insurance carrier. In certain situations the employee may wish to request alternate care. If the employer, or insurance carrier, does not allow alternate care, the employee may apply to the Workers’ Compensation Commissioner for alternate medical care.

If the employer-retained physician gives a rating of permanent impairment, which the employee feels is too low, the employee does have a right to another examination by a doctor of the employee’s choice at the employer’s expense. (Back to Top)

Q: Are there any time limitations in which I need to file a workers’ compensation claim?

A: Yes. These rules are very important, and are set out below.

Reporting of Claims: An Employer’s First Report of injury must be filed with the Workers’ Compensation Commissioner when an employee alleges an injury arising out of and in the course of employment, which results in time lost from work of more than three days, permanent injury, or death. The report is to be filed with the Workers’ Compensation Commissioner within four days of notice or knowledge of the injury. The report is also to be filed with the insurer so the employee’s claim can receive proper consideration. Forms for reporting injuries may be obtained from the workers’ compensation commissioner.

Notice of Injury: The law provides that the employer must have notice or knowledge of an alleged injury within 90 days of its occurrence; if not, benefits may be denied. The 90-day period begins to run when the employee knew, or should have known, the injury arose out of and in the course of employment. The employee must notify the employer of the injury within 90 days. It is best to notify your employer in writing and to keep a copy of the notice for your own records. If a 90-day notice is not given by the worker, all rights to workers’ compensation benefits are lost, unless the employer has actual notice of the injury.

Statute of Limitations: The statute of limitations is the period within which you must bring a claim. Generally, the statute of limitations for an injury is two years from the date of the injury. If you’ve been paid weekly workers’ compensation benefits, then the statute of limitations is three years from the date of the check that was the last weekly payment. Payment of medical benefits (doctor bills, hospital bills, etc.) does not extend the two years from the date of injury that you normally have within which you must file suit. If you’ve received medical benefits, but not weekly checks for your time off work, or weekly checks from someone other than the workers’ compensation insurance company, then you only have two years from the date of injury to file. If you don’t file within the statute of limitations period, then your right to file a claim based upon your injury will be lost forever. (Back to Top)

Q: Can I cash my checks even though I don’t agree with an offered settlement amount?

A: If the insurance company mails you checks for your work injury, you can cash them without risk. The situation is different from personal injury cases, in which the check from the insurance company will often state that by signing, you are accepting the check as payment in full. You can cash your workers’ compensation benefit checks, even if benefits are paid in a lump sum. A workers’ compensation case may only be settled by completing formal settlement documents that must be approved by the Workers’ Compensation Commissioner. Of course, if you are presented with settlement documents in a workers’ compensation claim, it would be a good idea to have the documents reviewed by a workers’ compensation lawyer. ( Back to Top)

Q: What should I do with my personal health care coverage since my employer has terminated me?

A: If your employment is terminated, you should receive a notice giving you the right to extend your health care coverage for a period of time. Unless you can arrange other comparable coverage at a lower premium rate, it is usually best to extend your existing coverage. (Back to Top)

Q: Can I collect unemployment while claiming entitlement to workers compensation and/or while I am receiving workers’ compensation benefits?

A: As long as you can honestly certify that you are “ready, willing, and able” to work, you may be eligible for unemployment benefits. If you are suffering from an injury that keeps you from doing your usual work, but are able to do other less strenuous work, you should indicate that you are ready, willing, and able to work, subject to your physical limitations. If you are receiving workers’ compensation benefits, you probably will not be eligible for unemployment benefits. On the other hand, if the your employer is denying your workers’ compensation claim, or is still investigating the claim, until benefits are paid, you should be eligible for unemployment benefits. (Back to Top)

Q: Can I switch jobs and still receive workers’ compensation benefits from the employer where I was injured?

A: Yes. (Back to Top)

Q: Why can’t I sue my employer for negligence?

A: Other than in extremely rare circumstances, workers’ compensation is the only remedy you have against your employer when you are injured on the job. The exception is if your injury was caused by the gross negligence of a co-employee. These cases are very rare, because they require that the co-employee not only knew of the danger caused to you, but also that it was probable (not just possible) that an injury would result from the co-employee’s conduct.
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Q: How much does it cost to hire a lawyer to help me obtain workers’ compensation benefits if my employer and its insurance company deny my workers’ compensation claim, or pay less than I feel they should pay?

A: Most attorneys will handle your workers’ compensation claim on a contingency fee (percentage of recovery) basis. If no recovery is made, the attorney will receive nothing for his/her time (or the time of other staff members that work on your case). (Back to Top)

Q: If a lawyer handles my case for a contingent fee, will there be any other cost to me?

A: Yes. The rules of ethics governing Iowa lawyers require that the worker always be responsible for case expenses. Case expenses may include things such as long distance phone calls, photocopy expenses, the fee for filing your case, charges to obtain medical records, court reporter fees for deposition, and doctor’s fees for consultations or reports for your case. These are examples of things that qualify as “case expenses,” although it is not an exhaustive list.
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Q: What if the workers’ compensation company offers a final settlement that I’m not sure is enough for my injury; do I have to accept the settlement?

A: No. There are different types of settlements available under workers’ compensation law. If you are offered a settlement, you should contact an attorney for an opinion as to whether the settlement is fair. Most attorneys will not charge you a fee for this service. (Back to Top)

Q: The insurance adjuster on my case says that I don’t need a lawyer to help me with my workers’ compensation claim. Is that true?

A: Maybe, but this may be a sign that the insurance adjuster is taking advantage of his/her superior knowledge of the workers’ compensation laws. You must keep in mind that the insurance adjuster’s job is to settle or close your claim for the least amount of benefits possible. Due to this, the insurance adjuster’s interests are in conflict with yours. While some insurance adjusters handle claims very fairly, there are many who will take advantage of the fact that they have superior knowledge of the workers’ compensation system as compared to you. Any time you have questions as to whether the insurance company is treating you fairly, you should contact an attorney experienced in workers’ compensation matters. Most attorneys will not charge you a fee for this service. (Back to Top)

Q: Should I look for a new job?

A: Many times injured workers end up losing their jobs. Two common questions are: Should I look for other work, and if a job is offered, should I take it?

If you lose your job, you should aggressively look for other work. Keep a written record of every job contact you make, as it may become important later on. If you have physical restrictions, limit your job search to jobs you can perform. With hard work and luck, you will find a new job, and lessen the financial hardship that often comes with the delays associated with workers’ compensation claims. If you don’t find a new job, you will have proven that you are motivated, and that there are not as many jobs available to you as there were before your injury.

If a job is offered that is within the restrictions your doctor has given you, take the job! You are going to need the money. It will probably take several months for your workers’ compensation claim to be settled, maybe more. If you do not accept work when offered, you leave yourself open to the argument that you don’t really want to work. This could be very damaging to your claim. Even if the job is not your dream job, take it! You never know when the next one will be offered. (Back to Top)

Q: I’ve been released to go back to work but still hurt; do I have to return to work?

A: If the treating doctor the insurance company picked says you should go back to work, failure to do so will probably cost you your job. Even if you think you hurt too much to go back to work, report to your job when the doctor says you are ready.

If you have work restrictions, get them in writing, and take them with you. You have the right to refuse to do anything that is beyond your restrictions. Once you have reported to work, you should do your best to work within any restrictions the doctor has given you.

Even if you do not have work restrictions from the doctor, use common sense and good body mechanics in performing the duties of your job. If you have been off work for more than a few days, it may take your body time to adjust to doing your job again.

Some discomfort is expected when you return to work following an injury. If you try working and it causes your pain to get significantly worse, you should immediately report that, and ask to go to the company doctor. If your employer refuses to let you see the doctor, do your best to finish your shift. Upon returning home, you should contact a lawyer experienced in workers’ compensation matters.
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Q: Do I have to have surgery?

A: The doctor authorized by the workers’ compensation insurance company has recommended surgery. Are you required to have the surgery? Many times, even though surgery is recommended, it carries with it a risk that a worker is not interested in taking. If you do not want to expose yourself to the risks that go with surgery, there is no legal requirement that you do so.

If you do not have surgery, you will probably be found to be at “maximum medical improvement,” and released to return to work with whatever physical restrictions you may have. Doctors do not guarantee a good result when you go into surgery, so if you decide you would rather live with your condition than have surgery, it would be difficult to second-guess that decision.

Surgery is a personal decision, and cannot be dictated to you by the insurance company. You should listen carefully to what the doctor tells you about the possible risks and benefits of having surgery, assess how you feel, consider your job options, and then make the choice that is right for YOU.
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Q: Can I Change Jobs While My Workers’ Comp Case is Pending?

A: Injured workers often consider changing jobs while involved in a workers’ compensation claim. Not uncommonly, a worker is temporarily unable to return to his or her former job, but can work in a less strenuous job. In many other cases, the employee does not feel comfortable returning to the job where they were injured.

Changing jobs will generally not have any negative impact on your workers’ compensation claim against your former employer. The only “downside” is that you may help the insurance company prove that you remain employable in various capacities outside the job you were working when you were injured. This may tend to lower your final workers’ compensation award somewhat, but the money you make while working the new job will probably more than offset any reduction in the value of your workers’ compensation case.

Another consideration is motivation. Workers who are seen as being motivated to work are usually treated well within the workers’ compensation system. Maximizing your income by accepting a new job, in most cases, will far outweigh any potential downside of accepting new employment.
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Q: The insurance company says my case is closed. Can I do anything about it?

A: Probably. Insurance adjusters often send letters to injured workers saying the company is closing their case file. This really doesn’t mean a thing. Quite often, the insurance company hasn’t come close to paying a worker full benefits for a work injury when the company says it is ‘closing its file.’

In cases involving body-as-a-whole injuries (generally head, neck, back, hips, shoulders), the insurance company will usually pay the worker’s disability rating from the doctor. After the rating is paid, the insurance company commonly informs the worker their file is being closed. At this point, the worker is almost certainly owed far more in benefits than what has been paid. With most body-as-a-whole injuries, the worker is owed benefits for how the disability has reduced the worker’s ability to find jobs.

Even if you stay on the same job after you return to work following your injury, you are probably owed more than just the disability rating for your condition. Don’t be fooled if the insurance company tells you your case is closed. If you need insight on additional benefits you may be owed, contact a lawyer experienced in workers’ compensation matters. (Back to Top)

Q: Can the nurse from the insurance company go into my doctor’s appointments with me?

A: Insurance companies commonly assign a “case manager” or “rehabilitation nurse” to injured workers. These case managers (usually nurses) are representatives of the insurance companies, and their interests are typically going to be different than yours. The job of the case manager is normally to help select treating doctors, schedule medical appointments, meet with the treating doctors to discuss the workers’ healing process, and return the employee to work.

A problem sometimes arises when the case manager insists upon going into doctor’s appointments with the injured worker. As the patient, you have the right to say no! The case manager does not have the right to go into your doctor’s appointments with you. You are entitled to receive your medical treatment without having a representative of the insurance company looking over your shoulder.

If you do not want the case manager to go into your doctor’s appointments with you, tell the manager s/he no longer has your permission to attend. This should put an end to the case manager going in with you to see the doctor. If this does not put an end to the joint visits with the doctor, you should contact a lawyer. (Back to Top)

Q: Do you need a lawyer?

A: Be on your toes if the insurance adjuster says you don’t need a lawyer. Keep in mind that the insurance adjuster’s job is to settle or close your claim for the least amount of money possible. Due to this, the insurance adjuster’s interests are in conflict with yours.

While some insurance adjusters handle claims fairly, there are others who will take advantage of their superior knowledge of the workers’ compensation system as compared to yours. Insurance adjusters are professional negotiators, and have likely handled hundreds of claims before yours.

If an insurance adjuster makes a settlement offer, and tells you not to hire a lawyer because you will be charged a third of the entire recovery (including the part you have already been offered) DON’T BELIEVE IT! Most lawyers will only charge you a fee on the portion of the recovery the lawyer helps you attain. Do not let yourself be fooled or bullied by this tactic into accepting an offer that is not fair for your injury.

If you have questions as to whether the insurance company is treating you fairly, you should contact an attorney experienced in workers’ compensation. Most attorneys will not charge you a fee for this service. (Back to Top)

Q: How are Permanent Partial Disability Benefits Determined?

A: In cases involving body-as-a-whole injuries (generally head, neck, back, hips, shoulders), the insurance company will usually voluntarily pay the worker’s disability rating from the doctor. It is rare, however, for the insurance company to make voluntary disability payments beyond the disability rating.

With most body-as-a-whole injuries, the worker is owed benefits for how the physical disability has reduced the worker’s ability to find jobs (commonly referred to as ‘industrial disability’). There are many factors important to the determination of industrial disability. Some of the more important factors are the extent of the worker’s physical disability (the rating), permanent job restrictions, age, education, intelligence, and past work experience. In most cases, the permanent partial disability benefits owed due to industrial disability are much higher than the payment based only on the worker’s physical disability rating.

If you have suffered a body-as-a-whole injury and the insurance company refuses to compensate you beyond your disability rating, you should contact an attorney experienced in workers’ compensation matters. (Back to Top)

Q: Should I Look for a New Job?

A: Many times injured workers end up losing their jobs. Two common questions are: Should I look for other work, and if a job is offered, should I take it?

If you lose your job, you should aggressively look for other work. If you have physical restrictions, limit your job search to jobs you can perform. With hard work and luck, you will find a new job, and lessen the financial hardship that often comes with the delays associated with workers’ compensation claims. If you don’t find a new job, you will have proven that you are motivated, and that there are not as many jobs available to you as there were before your injury.

If a job is offered that is within the restrictions your doctor has given you, take the job! You are going to need the money. It will probably take several months for your workers’ compensation claim to be settled, maybe more. If you do not accept work when offered, you leave yourself open to the argument that you don’t really want to work. This could be very damaging to your claim. Even if the job is not your dream job, take it! You never know when the next one will be offered. (Back to Top)

Q: Should I look for a job while my workers’ compensation case is pending?

A: Many times workers cannot return to their old jobs due to their injuries, but are able to do other kinds of work. If you lose your regular job while your workers’ compensation case is going on, you should look for other work within your physical restrictions.

All job contacts should be documented. Keep copies of applications, and a written list of all follow-up phone calls or other job-search contacts made. It is best to make as many job contacts as possible.

If the injured worker aggressively looks for a new job, one of two things will happen, both of them good. 1.) The worker will find a new job; or 2.) The worker will prove that s/he has lost the ability to compete for jobs, or at least certain kinds of jobs. The worker will also have proven that s/he is motivated to find work, which will make a good impression on the judge if the case goes to trial.

If the worker finds new employment but it is less than desirable, the job search should continue, even if a job is accepted. The continuing job search will go a long way toward proving what types of jobs the worker is capable of landing. An aggressive job search by an out-of-work injured worker is a win-win situation. (Back to Top)

Q: I’m feeling depressed due to my work injury; can I get treatment?

A: It is not uncommon for workers who suffer injuries to suffer from depression. This is especially true when the injury causes the worker to lose his/her job, or to become unable to perform the physical duties s/he was formerly able to do. When a physical injury results in depression, the workers’ compensation insurance company should pay for the necessary mental health treatment.

Often, the insurance company is resistant to agreeing to pay for mental health treatment. One option available to the worker is to make his/her own appointment with a mental health professional, get a diagnosis and statement of causation from the professional, and then present the information to the insurance company. Faced with a statement of causation linking the depression to the physical work injury, the insurance company should agree to pay for the mental health treatment.

If you feel you may be depressed following a work injury and the insurance company refuses to pay for mental health treatment, you should contact an attorney experienced in workers’ compensation matters. (Back to Top)

Q: What Happens if the Employer Changes Workers’ Compensation Insurance Companies?

A: It is not unusual for an employer to change workers’ compensation insurance companies. This can lead to complications for workers with pending claims, or claims involving multiple injury dates. The general rule is that the insurance company that insured your employer at the time of your injury is responsible to pay on your claim. The fact that the employer switches insurance companies during the course of your claim should have no effect at all.

The situation can get complicated quickly if you have a prior injury with the “old” insurance company, and then receive an aggravation of the injury once the new workers’ compensation insurance company has come on board. In this situation, the two insurance companies will probably end up pointing their fingers at each other, nobody wanting to accept responsibility.

The law is set up to make sure that if your employer changes workers’ compensation insurance companies, you will not be prejudiced. Often, the medical evidence will resolve the issue of which insurance company is responsible. In cases where the insurance companies do not agree which is responsible, you may need to hire an attorney experienced in workers’ compensation matters to help you sort things out. (Back to Top)

Q: What happens if the workers’ compensation insurance company will not return my phone calls?

A: You deserve to have your workers’ compensation claim dealt with promptly. The insurance company should have an adjuster assigned to your case to promptly handle your calls and concerns. The insurance company has an obligation to promptly pay your weekly benefits, reimburse you for mileage and prescriptions, and arrange and pay for medical treatment. There is no reason for you to have to wait for days, if not weeks, for these things to happen. Similarly, the insurance company has a duty to tell you promptly after your injury if the company is going to accept your claim.

If the insurance company does not inform you promptly after your injury whether it will accept your claim, or if you have significant delays in receiving weekly benefits, mileage reimbursement, medical treatment, you should call Iowa Workforce Development, Division of Workers Compensation (DWC) in Des Moines . A DWC representative may be able to cut through the red tape for you, and get the insurance company to handle your claim promptly. If a DWC representative is unable to get the insurance company to handle your claim promptly, you should contact an attorney experienced in workers’ compensation matters. (Back to Top)

Q: I hurt my back at work, but have had back problems before. Am I entitled to workers’ compensation benefits?

A: Most people who work hard for a living have experienced back pain before. This does not mean you are not entitled to workers’ compensation benefits if you are injured.

If a work injury makes an old back condition worse, the worker is entitled to workers’ compensation benefits. As long as the doctor believes the work injury aggravated or worsened the old condition, the worker should be paid for all time off because of the injury. The insurance company should also pay all medical bills for treatment of the condition.

When a work injury causes permanent worsening of an old back condition, the worker is additionally owed benefits for permanent disability. The worker must be paid not only for the disability to his/her back, but also should be compensated for the worker’s reduced ability to find work because of the disability. This is true even if the worker is able to continue working the same job s/he has always worked.

If the insurance company fails to pay you all of the above types of benefits for a work injury that causes a worsening of an old injury, you should contact a lawyer knowledgeable in workers’ compensation law for assistance. (Back to Top)

Q: What does it mean the prompt payment of workers’ compensation benefits is required?

A: Iowa law requires the prompt investigation of workers’ compensation claims. Unless an insurance company has a good reason, a workers’ compensation claim should be accepted or rejected within roughly two weeks of the date the injury is reported. You can make this process work faster by promptly reporting all work injuries to your employer in writing.

The law provides for weekly payments of workers’ compensation benefits, beginning on the eleventh day of disability. If the benefits are not paid when due, interest on late payments must be made, regardless of the reasons for the late payments. If benefits are unreasonably delayed or denied, the employee is entitled to penalty benefits up to 50 % of the delayed or denied payments.

Once benefits start, the payments can be cut off only when the employee has returned to work, or upon thirty days’ notice stating the reason for the termination, and informing the employee of the right to file a claim with the workers’ compensation commissioner.

If the insurance company does not follow these rules, you should contact a lawyer for assistance.
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Q: What are the requirements for reporting a work injury?

A: If you suffer a job-related injury, you must report the injury. Iowa law requires that your work-related injury be reported within 90 days of the date of injury. If you fail to make this injury report within 90 days, your right to seek compensation for the injury is lost forever. The safest way to report your injury is to put it in writing, give the original to your employer, and keep a copy for yourself. The report should state the injury date, that the injury is work-related, and that you may claim workers’ compensation benefits.

Once you have properly reported your injury, you have two years from the date of injury to file your claim with the Workers’ Compensation Commissioner. If you fail to file your claim within two years, your right to seek compensation for the injury is lost forever. An exception to the two-year requirement exists if you have been paid weekly benefits for the injury. In that case, you have three years from the date on the last check you received within which to file your claim.

If you have suffered a work-related injury, it is crucial that you follow these rules. (Back to Top)

Q: What is the Second Injury Fund?

A: Injuries to a workers’ arms, hands, fingers, legs, feet, toes, and eyes are called “scheduled member” injuries. Compensation for disabling scheduled member injuries is much less than “body-as-a-whole” injuries (back, neck, head, shoulders, hips). This is because with a scheduled member injury, the insurance company is only required to pay for the actual physical disability to the “scheduled member.” This is in contrast to a body-as-a-whole injury, in which case the insurance company must pay for the physical disability to the body, plus a sum to compensate the worker for his/her reduced employability due to the disabling injury.

To lessen the unfair treatment provided to workers with scheduled member injuries, the Iowa legislature created the Second Injury Fund. If a worker suffers a disabling scheduled member injury, and had a scheduled member injury in the past that resulted in some degree of disability, the worker is eligible to receive additional compensation for the worker’s reduced employability due to the combined effect of the two disabling scheduled member injuries. It is not necessary that the earlier scheduled member injury be work-related.

If you think you might qualify for Second Injury Fund benefits, you should contact an experienced workers’ compensation lawyer, as this is a particularly complicated area of workers’ compensation law. (Back to Top)

Q: What happens if a work injury is caused by someone other than a co-worker?

A: The general rule is that when you are hurt in the course of your job, the only claim you can make for your injuries is a workers’ compensation claim. One exception to this rule is that if you are doing your job and are injured due to the negligence of a third party (somebody you don’t work with), you can make a claim for your injuries against the negligent third party and a workers’ compensation claim.

The damages you can recover in a suit against the negligent third party are different than what you can recover in a workers’ compensation claim. The main difference is that you can recover for your pain and suffering against the negligent third party. Pain and suffering cannot be recovered in a workers’ compensation claim.

If you receive workers’ compensation benefits due to an injury caused by a negligent third party, the workers’ compensation insurance company has the right to receive money back if you recover against the third party. If you are injured by a third party while on-the-job for your employer, you should talk to a lawyer experienced in both workers’ compensation and personal injury matters to determine exactly what your rights are. (Back to Top)

Q: When must workers’ comp benefits be paid?

A: The law is written to encourage prompt payment of workers’ compensation benefits so that the employee will not suffer undue hardship. Before making payments, most insurance companies or self-insured employers require a written first report of injury (which is usually completed and filed by the employer) and some medical verification of the injury.

The law provides for weekly payments of disability benefits, beginning on the eleventh day of disability. If the benefits are not paid when due, interest on untimely payments must be made. If benefits are unreasonably delayed or denied, the employee is entitled to penalty benefits up to 50% of the delayed or denied payments.

Once benefits start, the payments shall be terminated only when the employee has returned to work, or upon thirty days notice stating the reason for the termination, and informing the employee of the right to file a claim with the workers’ compensation commissioner. If an injured worker is not timely paid benefits, the worker will likely benefit from the assistance of a workers’ compensation lawyer.
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Q: I work two jobs, and was injured on one of them. Should the insurance company use my earnings from both jobs to figure my weekly compensation rate?

A: The answer to this question depends on which job the worker was performing when s/he was injured. If injured while working the full-time job, the weekly rate is computed using only the earnings from the full-time job. In this case, the insurance company should use the last 13 full weeks before the injury to figure the rate. If any of the 13 weeks before the injury are “short weeks,” (normally less than 40 hours), those weeks should not be used to figure the rate. If the 13 weeks include overtime, those hours should be used to figure the rate, but at the straight-time pay rate.

If the worker was performing a part-time job when injured, the answer is different. In this instance, the insurance company should use ALL the worker’s wages from all employment for 50 weeks before the injury, and divide that figure by 50 to come up with the “average weekly wage” that is used to determine the weekly workers’ compensation rate.

There are many different rules that determine how a worker’s weekly compensation rate is calculated. If you think you are being shorted in your weekly benefits, you should contact an attorney experienced in workers’ compensation matters. (Back to Top)

Q: How is the amount my weekly workers’ compensation check computed?

A: If you receive weekly workers’ compensation benefit checks, you will immediately notice that the amount is significantly less than your normal gross weekly paycheck. That is the bad news. The good news is that there are no taxes on workers’ compensation benefits.

Your weekly workers’ compensation benefit check will be roughly two-thirds of your normal weekly gross paycheck. The exact amount depends on your earnings history, your marital status, and whether you have dependent children. The general rule is that the insurance company should take your last thirteen full weeks of work, and average your weekly earnings for that time.

If you had one or more “short” weeks during that thirteen-week period, the insurance company normally cannot use the short weeks to figure your weekly workers’ compensation rate. If the thirteen weeks include weeks that you worked overtime, you get credit for the overtime, but at the “straight time” rate.

If you are receiving workers’ compensation benefits and do not think the insurance company is following these rules, you should contact the Division of Workers’ Compensation in Des Moines, or an attorney experienced in workers’ compensation matters. (Back to Top)

Q: I’ve been hurt at work; what should I tell the doctor?

A: You should be completely honest with the doctor about your injury and how it happened, and about prior injuries and conditions. Your work injury will be compensable even if you have had an earlier injury or condition involving the same body part, as long as the treating doctor believes that your work injury was a significant contributing factor in at least aggravating the earlier condition.

Many legitimate workers’ compensation claims are damaged when workers fail to tell their doctor about prior conditions. The worker’s credibility is extremely important, both in attempting to settle the case, and at trial for cases that cannot be settled. If the insurance lawyer can raise doubts about the worker’s credibility based on an inaccurate medical history, those doubts tend to cast doubt on all of the worker’s testimony.

When the doctor finds out about a prior condition for the first time from the insurance lawyer, it raises suspicion that the worker intentionally failed to tell the doctor about the earlier condition. When telling the doctor about your work injury and any earlier conditions, always be completely truthful. Anything less may severely damage your workers’ compensation claim. (Back to Top)

Q: What do I do if my employer will not honor my work restrictions?

A: It is not uncommon for workers to return to work with work restrictions from the doctor. What do you do if your employer refuses to follow the restrictions, or pressures you to do work outside the restrictions?

The first step is that you should always have a copy of your restrictions in your pocket while at work. If you are told to do something that would violate your work restrictions, pull out the written restrictions and show them to your employer. If that doesn’t take care of the problem, the final option is to refuse to do the work that would violate your restrictions.

If you refuse to do work outside your restrictions and are told to go home, you should tell your employer you want to work, but that you will not violate the doctor’s work restrictions. If you are still sent home, you are probably at the point you need to contact a lawyer experienced in workers’ compensation matters. The only person that can enforce the doctor’s work restrictions is you!
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Q: Is the insurance company required to pay my medical bills?

A: If the workers’ compensation insurance company has accepted (admitted) your claim, the company is required to furnish and pay for medical care for your injury. In this situation, the insurance company has the right to pick the doctor from whom you will receive care. All bills from that provider must be paid by the workers’ compensation insurance company. If you go to your own doctor after the insurance company has accepted your claim, you will have to pay for those bills out of your own pocket. If you are dissatisfied with the doctor the insurance company picks, there are very limited circumstances under which you can force the company to pay for a different doctor. If you find yourself in this situation, you should consult a lawyer.
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