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Frequently
Asked Questions about Workers’ Compensation
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.
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.
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.
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. This includes reasonably necessary transportation expenses. Mileage
for use of a private auto is reimbursed at a rate set by the State of Iowa,
currently at 29 cents per mile.
Under certain circumstances an employee who has to leave work for medical treatment may be eligible for payment of lost wages.
While a contested case proceeding is pending, the medical care provider cannot seek payment of its charges from the employee.
Types of Disability Benefits:
·
Temporary Total Disability:
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.
·
Temporary Partial Disability:
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.
· Healing Period: During the period of recuperation from an injury which produces a permanent impairment, the employee may be entitled to HP benefits beginning on the first day of disability following the date of injury and continuing until the occurrence of one of the following events:
1)
the employee returns to work;
2)
it is medically indicated that significant improvement from the injury is
not anticipated; or
3)
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.
No
waiting period applies to HP benefits.
·
Permanent Partial Disability:
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: When a job-related injury leaves an employee incapable of returning to gainful employment, the employee may be entitled to PTD benefits. The PTD benefits are payable as long as the employee remains permanently totally disabled. (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 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)
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.
 | 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. |
| 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 loss 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. |
| 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 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: Yes. (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.
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.
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.
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).
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.
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.
A:
Maybe. You must 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 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.
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