Iowa Workers’ Compensation Claims: Eligibility, Filing, and Appeals
In Iowa, all private employers must carry workers’ compensation insurance. As in other states, the workers’ compensation system in Iowa is a no-fault system that compensates injured workers for medical bills, lost wages, and permanent impairments resulting from their injuries. To take advantage of these benefits, injured workers must follow certain procedures required by Iowa law.
Who Is Eligible for Workers’ Comp Benefits?
Most employees are covered by workers’ compensation in Iowa. However, there are a few exceptions for employees engaged in certain types of work. For example, workers’ comp does not cover farm workers, nor does it cover domestic workers who earn less than $1,500 per year.
Workers’ compensation covers all injuries or illnesses that happen in the course of employment, including traumatic injuries and occupational illnesses. Traumatic injuries are those that result from a one-time accident at work, such as a broken bone from a slip and fall. Occupational diseases are injuries or illnesses that occur over a period of time, including injuries caused by repetitive movements at work (such as carpal tunnel syndrome) and illnesses developed from exposure to toxic substances at the workplace (such as cancer from exposure to asbestos).
What Should I Do if I’m Injured at Work?
To receive workers’ comp benefits, you must report your injury to your employer within 90 days. Your claim for benefits may be denied if you fail to give notice and your employer does not already know about your injury. Once your employer has notice of your injury, it will notify its insurance company. The insurance company will then decide whether to accept or deny your claim.
How Do I Get Medical Treatment?
In Iowa, except in the case of an emergency, your employer (or its insurance company) has the right to choose your treating doctor. If you’re unhappy with your treatment, you can ask the insurance company for a change of doctors. If the insurance company refuses, you will need to file a petition for alternate medical care with the Iowa Workers’ Compensation Commissioner.
What Benefits Can I Receive?
All reasonable and necessary medical treatment related to your work injury will be covered through workers’ comp in Iowa, including the cost of doctors’ visits, hospital bills, prescriptions, and prosthetic devices. You’ll also be reimbursed for the mileage you incur in traveling to and from medical appointments. In addition to medical benefits, you will also be eligible to receive disability benefits.
Temporary Total Disability Benefits
If your injury is only temporary and you are expected to fully heal, you can receive temporary total disability benefits. These benefits are available once you are out of work for three or more days. If you’re unable to work for more than 14 days, you will be paid retroactively for the first three days of missed work.
Temporary total disability benefits are 80% of your spendable wages (your average net earnings after payroll deductions are taken out), subject to a weekly maximum set by the Iowa Workers’ Compensation Commissioner each year. As of July 1, 2015, the weekly maximum is $1,628. You will receive these benefits until you are able to return to work or until your doctor finds that your condition has improved as much as it is going to (this is called “maximum medical improvement”).
Healing Period Benefits
If your injury is expected to cause permanent damage, you can receive healing period benefits while you are unable to work. There is no waiting period for receiving these benefits; you can receive them from your first day of missed work. Healing period benefits are the same amount as temporary total disability benefits and paid until you are able to return to work or until you reach maximum medical improvement.
Temporary Partial Disability Benefits
If you are able to work while recovering from your injury, but you’re earning less than you normally do, you can receive temporary partial disability benefits. These benefits are two-thirds of the difference in your earnings. However, they cannot be more than the amount you would receive in temporary total disability benefits. A three-day waiting period applies to temporary partial disability benefits.
Permanent Disability Benefits
If your injury has left you permanently and totally disabled, you can receive permanent total disability benefits. You will be considered to have a permanent total disability if you are no longer able to work in any capacity due to your injury. Permanent total disability benefits are paid for life, at the same rate as temporary total disability benefits.
If your injury has left you with a permanent injury, but you are still able to work in some capacity, you can receive permanent partial disability benefits. These benefits are 80% of your spendable earnings, subject to a weekly maximum of $1,498 (as of July 1, 2015). How long you will receive these benefits depends on whether the injury is listed in Iowa’s schedule of injuries.
Iowa’s schedule lists injuries to certain body parts—such as a hand, arm, leg, foot, finger, toe, eye, and ear—and designates a maximum number of weeks for which benefits are paid. For example, the schedule allows a worker to receive benefits for 150 weeks for the total loss of use of a foot. If the worker has suffered only a 50% loss of use, he or she can receive benefits for 75 weeks.
Injuries not listed on the schedule are considered industrial disabilities to the body as a whole. You will receive a disability rating based on your lost earning capacity (the difference between what you were earning before your injury and what you are able to earn after your injury), which will be multiplied by 500 weeks. For example, if you have a 50% industrial disability, you can receive benefits for 250 weeks.
What If My Claim Is Denied?
If the insurance company denies your claim, you can file a contested case proceeding with the Iowa Workers’ Compensation Commissioner. A hearing will be held before a workers’ comp judge, who will issue a written decision. If you disagree with the judge’s decision, you will have an opportunity to appeal the decision. For more information on the appeals process, see our article on appealing a denial of your Iowa workers’ comp claim.