Workers' Compensation and Social Security Disability

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FAQ

What if the company won't approve a test or procedure the doctor wants?




Iowa law requires that the company be able to choose the treating doctor. That does not give them the right to direct care, by refusing tests or surgery recommended by the doctor they chose. It is not unusual for employers or insurance carriers to try to veto the treatment recommendations of the doctor that they chose, such as telling the doctor that an MRI or surgery is not necessary. The State workers' compensation agency has made clear that the doctor and patient are to decide on the course or treatment, not the employer or insurance carrier.
 
An application can be filed with the state agency, and they will almost always order the test or surgery to be authorized and paid by the employer and insurance carrier, if it is recommended by the treating doctor.


What if I don't like the doctor they send me to?


Iowa law allows the employer to choose the doctor for your care, if you are injured on the job. However, the state workers' compensation agency retains the right to order a change, if you have a legitimate reason to be dissatisfied with the doctor's care. They will not order a new doctor if you don't approve of the company choosing your doctor. However, there are some reasons that they will consider:


  • You have to travel more than an hour to see their chosen doctor, and there is a doctor of the same specialty that you could see closer to home. 
  • Your company doctor did surgery once, and you were not happy with the outcome. Now, that doctor wants to operate again.
  • The company doctor was rude to you, to the point that you can no longer consider him or her your doctor. 
  • You have been going to a Nurse Practitioner or primary care physician for a serious condition, and nothing has improved in several months. 
  •  Iowa law provides that, if you want to change doctors, the Iowa state agency has to respond very quickly to your request, holding a hearing and issuing an order in very rapid succession.

 
The same procedure can be used if the company doctor recommends a test or procedure, and the employer or insurance carrier tries to block it. That is covered in a separate FAQ. 


What about non-attorney representatives?


Some non-attorney representatives will agree to represent people before the Social Security Administration. Sometimes they will refer to themselves as "legal representative," and will want you to think that they are attorneys. If you are talking to someone about handling something as important as a disability appeal, you should make sure that the person is an attorney. Ask if he or she is admitted to practice law in the State of Iowa. Ask if the person is able to take cases on appeal to the United States District Court, if that is necessary. 


Also, ask if they have insurance to cover any errors they make in representing you, if they have undergone any examinations to establish their ability to handle appeals or other legal matters, and if they are subject to any discipline by any professional group, such as attorneys are subject to discipline by their state bar association and the court system. If any of the answers are "no," contact a real attorney, one who has experience in social security Disability and SSI appeals. One source of attorneys who practice extensively in disability appeals is the National Organization of Social Security Claimants' Representatives, or NOSSCR .  H. Edwin Detlie has been a member of NOSSCR for close to 20 years, and has been a presenter at state, regional and national conferences of attorneys and non-attorneys on Social Security Disability. He is to speak at NOSSCR's fall national conference in 2007, and at a regional conference in 2008. He also serves as a consultant to LEXIS, the world's largest legal publisher, on Social Security law and technology issues. 


When should I contact an attorney?

While some attorneys handle claims and appeals earlier on in the process, H. Edwin Detlie handles claims only at the hearing level, unless a doctor 

has provided a clear statement setting out specific restrictions which make work impossible, or if a vocational expert sets out the reasons that the claimant is not able to work. In those cases, Mr. Detlie may agree to handle the claim at an earlier stage. 


My employer says that this is a pre-existing condition

The employer or insurance carrier may try to tell you that the condition is not their responsibility, since they think that the problem is a condition that you already had, and this injury just made it worse. Under Iowa law, if you have a condition that is made worse by a work injury, the employer is responsible to provide care for that injury and the resulting condition. 


I was injured at work; what do I do first?


The first thing to do is to report the work injury to a responsible member of management. The report does not have to be in writing. If you are a member of a union, report the injury to the union as well. Second, if medical care is necessary, make clear that you need to see a doctor. If they refuse, you need to make a note of who you contacted, and then talk to an attorney. There are remedies that you can pursue, and often a contact from an attorney will get the employer to do the right thing.