Attention! Iowa’s Workers’ Compensation laws changed July 1, 2017. This article’s information may be out of date. Visit our Workers’ Compensation Page for more information.
The workers’ compensation insurance company is required by Iowa law to pay all reasonable and necessary medical care for a work-related injury — but too often Iowa workers’ compensation refuses to pay. There are many reasons why the insurance company may be refusing to pay for your medical care. Let’s discuss some of the most common reasons your medical care for a work injury may be refused, and what you can do about it.
The Insurance Company Didn’t Authorize Your Medical Care
Let’s start with the authorization defense. For Iowa workers’ compensation, if you are injured on the job, the employer’s workmans’ comp insurance company must to pay for the medical care—but they get to pick the doctors. In other words, the care has to be “authorized.” If you decide to seek medical care that the insurance company doesn’t authorize, there can be consequences:
- Your employer or their insurance company will likely refuse to pay for any medical treatment it has not approved. This means you could be left paying for this unauthorized treatment, even if it was medically necessary.
- Your weekly, temporary benefits could stop. An employer is not supposed to stop your weekly benefits because you refuse medical care.However, if you refuse medical care, a doctor could say that you are as good as you are going to get, medically speaking. They may place you at what is called “maximum medical improvement,” or what we call MMI. Once you are placed at MMI, your temporary workers compensation checks are stopped, even if you haven’t returned to work yet.
- If you have your private health insurance pay for medical care, you will likely be paying co-pays and other out-of-pocket expenses that your health insurance company won’t cover. Your health insurance will likely want to be paid back out of any workers’ compensation settlement that you receive.Workers’ compensation may refuse to reimburse your private health insurance because the care was not authorized—leaving you to pay it back. That can dig into any workers’ compensation settlement you receive.
There may be some valid reasons to seek medical treatment on your own—like if the work comp insurance company has refused to pay for care. You should ask an Iowa workers’ compensation attorney whether it is appropriate to seek care on your own outside of the work comp system.
Your Employer’s Insurance Company Doesn’t Think Care is Necessary
Let’s move onto the next defense insurance companies sometimes use—that the care you are asking for isn’t necessary. You may believe that there is an alternate form of medical care that could help you, but the insurance company isn’t paying for it. If that’s the case, your workers’ compensation attorney should get a written opinion from the doctor recommending the care. This opinion should state that the care is reasonable and will be beneficial.
Once that is done, you can petition the Iowa Workers’ Compensation Agency to force the insurance company to pay for the care you want. It’s called a petition for alternate medical care.
Workers’ Compensation Insurance Company Doesn’t Believe Care is Related to a Work Injury
Your employer’s insurance company may decide that the care a doctor is recommending is not related to your work injury—that it was caused by something else, like a pre-existing condition.
If your employer’s worker’s compensation insurance company says your injury is not work related, don’t take their word for it. Another doctor may have a different opinion. When workers’ compensation refuses to pay, you may need to hire an independent medical expert. This expert will offer an opinion about whether the injury you have, and the care you need for that injury, was caused by work related activities.
If the workers’ compensation insurance company is refusing to pay your bills after a work-related injury, contact one of our work comp attorneys at 1-319-774-1542. We can help you get the compensation you deserve.
