FactsforWorkers.com A Legal Information Resource for Workers provided by Hedberg & Boulton, P.C. Iowa Workers Compensation Law Fast Facts An Overview on Work-Related Injuries for Iowa Workers What is Workers Compensation? o A system of laws outlining the benefits for injured employees and the procedures for obtaining such benefits. o Compensates work-related injuries. What does arising out of and in the course of employment mean? o Arising out of employment: The injury arises out of or otherwise relates to the work he or she performed. o In the course of employment means the worker was engaged in work activities at the time of the injury or its development o Basically, the injury must have a connection to the employee s work activities. For incident injuries, the most important factor is whether the employee was working when the injury occurred and whether it was the result of a risk of employment. For cumulative injuries, the employee s work activities must be a substantial contributing factor to the injury not the exclusive cause of the problem. o GENERALLY NOT COVERED: Injuries sustained going to and coming from work and idiopathic injuries that are entirely personal to the worker, though there are exceptions. Who is covered? o Almost all Iowa workers are covered by workers compensation laws. o Independent Contractors v. Employees: Question of fact. Labels not really important. They key issue is the employer s control of the work, hours, etc. o Employers are required to carry workers compensation insurance or verify self-insured qualifications. o IT IS A CLASS D FELONY TO FAIL TO PROVIDE WORKERS COMPENSATION INSURANCE. o Exceptions include self-employed farmers, maritime workers, and federal employees. Employers are required to carry workers compensation insurance. Workers' compensation benefits compensate workers for injuries arising out of and in the course of employment. What types of injuries are covered? o Incident injuries Those which occur suddenly, such as broken bones. o Cumulative injuries Those which occur over time, such as carpal tunnel syndrome. o Occupational diseases Diseases caused by workplace factors, such as black lung. o Occupational Hearing Loss Hearing loss caused by workplace factors. Notice and First Report of Injury:
o Employees have 90 days to provide notice of the injury to the employer unless the employer has actual notice of the injury already, which is often the case. o Employer must file a First Report of Injury with the state, regardless of whether or not the employer ultimately accepts liability. o Statute of Limitations Employee must file for benefits within two years of the injury or within three years of the last payment of monetary workers compensation benefits. o Discovery Rule/Manifestation: If a worker is unaware of the nature and seriousness of the injury until later, the first time the worker appreciated that the injury was severe or work-related can extend both the statute of limitations and notice periods. If you think your work injury may have a notice or statute of limitations issue, consult an attorney to see if these exceptions may apply in your case. Does the employee have to prove negligence? o No. Rate Calculation Issues o Most Cases: Representative Earnings from 13 weeks prior to injury Non-Representative Weeks Excluded: Extremely low weeks should not be counted against you if they are not reflective of your normal earnings. o Part-time workers injured performing part-time job: all earnings from all jobs from the past 12 months divided by 50. Penalties o Benefits must be paid each week they are due. If an employer/carrier denies benefits, the burden is on the employer/carrier to show that a reasonable cause or excuse for the delay or denial AND that the reason was communicated to the employee at the time the decision to deny/delay benefits was made. o Ongoing duty to investigate and assess claim means the initial denial must be reevaluated when new evidence becomes available. Can and employee file a lawsuit outside of workers compensation? o It depends. Workers compensation is an injured worker s exclusive remedy, though additional recoveries can be made if a worker is injured by a defective product or piece of equipment, the negligence of another person such as in a work-related car collision, or if the employer and insurance carrier denied workers compensation benefits in bad faith. What if the employee already had an injury to the affected area? o Pre-existing conditions or a pre-disposition to injury do not bar employees from recovering workers compensation. The employee can recover benefits if the injury was aggravated by the employee s work activities. Specifically, the Iowa Supreme Court has held that pre-disposition to injury is not important, as injuries are compensable if they manifest within the first minute of work. What types of benefits are available? o Medical Benefits An employee is entitled to reasonable medical care for the injury which is to be provided by the employer.
o Monetary Benefits Employee may be entitled to healing period benefits and permanency benefits. What about medical care? o The employer gets to choose the authorized medical provider and the employee will not be able to recover for unauthorized medical services, except in an emergency. o Medical care must be reasonable. o If the medical care is unreasonable and a reasonable alternative exists, an employee should request the employer or insurance company to authorize another doctor. o If refused, the employee may apply to the Workers Compensation Commissioner for alternative care. o If the injury is denied, the employer does not control care. As long as the case is pending, debt collection against the claimant for medical fees is illegal. What types of monetary benefits are available? o Healing period: temporary total disability - employee is wholly unable to work for a time during recovery from injury. temporary partial disability benefits to supplement income while employee works limited hours or in a lower wage position as he or she is recovering. o Permanency Available if an employee has a permanent disability as a result of the workrelated injury Permanent Partial Disability employee is compensated for extent to which the injury has permanently impaired him or her. Permanent Total Disability/Odd Lot Doctrine employee s injury has resulted in such a level of permanent impairment that it is unlikely the employee will be able to attain gainful employment again. o Death (Burial expense and survivor benefits for spouse/dependents). What is the difference between a scheduled injury and an industrial disability? o Scheduled injuries are those which are compensated according to the state s predetermined value chart. These are essentially injuries to an arm or leg. o Industrial disability comes into play when an injury has affected the body as a whole. Because a shoulder injury is not on the schedule, it is assessed in workers compensation in terms of industrial disability. Injury Schedule Scheduled Body Members Weeks Loss of thumb 60 Loss of first finger 35 Loss of second finger 30 Loss of third finger 25 Loss of fourth finger 20 Loss of hand 190 Loss of arm 250 Loss of great toe 40 Loss of any other toe 15 Loss of foot 150
Loss of leg 220 Loss of eye 140 Loss of hearing in one ear 50 Loss of hearing in both ears 175 Permanent disfigurement, face or head 150 Body as a whole/industrial disability 500 Industrial Disability Factors Physical loss/percentage of Functional Disability/Work Restrictions Loss of earning capacity Age Education Work history/experience Capability for retraining/new skills What is the Second Injury Fund? o The Second Injury Fund is designed to shield employers from having to pay higher rates for second injuries. An example would be an employee who has lost an eye prior to working for a company and loses the second eye in a work accident. This results in the employee being entitled to significantly higher benefits, even though the employer is only responsible for the loss of the one eye. The Second Injury Fund is then responsible for the employee s higher rate of compensation. Independent Medical Examinations o An employee has a right to have an independent medical examination. This examination can be done to see if greater work restrictions are needed, if a higher impairment rating is appropriate, etc. The employer is liable for the cost of the exam and report provided that an employee believes a rating from an employer-retained physician is too low. What types of settlements are there? o Closed File- Compromise/Special Case Settlement Closes any rights to medical care or future payments. A lump sum is paid to resolve the case in a full and final settlement. Social Security and Medicare issues can complicate these settlements, so it is important to make sure adequate information is contained in the settlement documents to ensure the injured worker is not harmed by this type of settlement. o Open Agreement for Settlement The parties agree to the extent of disability, payment of medical care, and the worker s right to care in the future. o Contingent Settlements A settlement agreement is reached but an outside event, such as approval of an amount of money set aside to protect Medicare interests, must be completed before the case is resolved. o Hybrid Closes the right to future payments of benefits but leaves the right to medical care open. o Settlements not approved by the Commissioner do not count, and contracts to avoid workers compensation liability are unenforceable.
What if a case doesn t settle? o Hearings with Deputy Commissioner are generally held within a year of Petition date. o Appeal to Commissioner is de novo, meaning that the Commissioner views the case anew and is free to change the Deputy Commissioner s decision. o Cases can be further appealed to District Court, Iowa Court of Appeals, and Supreme Court. 1. For More Information, visit our full website at www.hedberglaw.com or call (515) 288-4148 for a free initial consultation. Our office is able to schedule evening appointments and appointments on Saturday mornings for the convenience of working people and their families. Our office is regularly open Monday through Friday from 8am to 5pm. Hedberg & Boulton, P.C. 100 Court Avenue, Suite 425 Des Moines, IA 50309 Telephone: (515) 288-4148 Fax: (515) 288-4149 These outlines are only a basic reference and are not meant to serve as a replacement for sound legal advice. The contents of this outline are the property of Hedberg & Boulton, P.C. and are not for redistribution without consent.