The employer and insurance carrier or administrator have the right to choose the medical care for workers injured in Iowa. Medical care is to be provided in a form that is reasonably suited to the injury. The employee generally cannot be required to travel more than an hour, unless it is for a one-time examination, if a specialist is available within an hour of the injured worker’s home. Under certain circumstances, if the worker believes that the care he or she has received was not acceptable, the Iowa Workers’ Compensation Commissioner’s office may order additional or alternative care.
The insurance carrier may be legally liable for failing to provide medical care, or for failing to provide the appropriate kind of medical care. A decision by the Iowa Supreme Court, McIlravy v. North River Insurance and Crum & Forster Insurance, filed in October of 2002, set out the Iowa Supreme Court standard for when a workers’ compensation insurance carrier can be held responsible for refusing to provide care for a work injury. Click on the decision title to read the decision. Among other things, the ruling states that despite evidence supporting a denial of care at an earlier point, if later evidence shows that the injury was work-related, or requires care, the insurance carrier has a continuing obligation to provide that care, and may be legally liable for the refusal to provide medical care in good faith.
The insurance claims person is entitled to see the medical records for the care for the work-related injury, and for any other medical care that might have an impact on their decisions on how to treat the claim. For instance, if there was a previous injury in the same part of the body, they may try to refuse to accept the injury as work-related. The Iowa Supreme Court has severely limited the employer’s attempts to avoid responsibility because of earlier injuries or pre-existing conditions. For an Iowa Supreme Court decision concerning that issue, which came out in favor of the employee, see Smithart v. Excel. Issued December 18, 2002, the decision refused efforts by employers to have the Court say that multiple injuries could not be compensated appropriately. Click on the decision title to read the decision.
Employers and insurance carriers will tell injured workers that the workers are not entitled to medical records obtained by the employer or carrier in connection with the claim. That is just not true. Section 85.27 of the Iowa Code requires the employer and insurance carrier to release “all information to which the employee, employer, or carrier has access concerning the employee’s physical or mental condition relative to the claim and further waives any privilege for the release of the information. The information shall be made available to any party or the party’s representative upon request.” Section 85.27 of the Iowa Code.
If an employer has chosen the doctor, and the doctor issues an impairment rating, the worker is entitled to choose a doctor at employer expense to assess the condition independently. See the page on Independent Medical Examinations.
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