Mileage pay? With the fluctuation of gas prices, callers want to know if the insurance company only has to pay 53.5 cents per mile for reimbursement of transportation expenses.
This mileage reimbursement rate changes every year so call our office to get the correct rate. Effective July 1, 2017, the mileage reimbursement rate for injured workers in Iowa was changed from .54 cents per mile to .535 cents per mile for travel performed on or after July 1, 2017. This change in rate is found in Commissioner's Rule 8.1(2). This is but one more example of how the injured worker must be vigilant in receiving accurate compensation as a result of an injury. Additionally, clients do not understand that most out-of-pocket expenses associated with medical care are covered by the insurance company. Further, most workers don't know that Iowa provides retraining money to injured workers. The amount is small, yet the worker is entitled to it. But, you won't get it if you don't know about it. Lastly, subtle omissions regarding hours worked before injury can cause your weekly rate of pay to be too low.
These are just a few examples of the insurance industry holding the dollars that belong to the injured worker. The only way for the injured worker to know their rights is to speak with an attorney knowledgeable about the full scope of compensation available in the Iowa Workers' Compensation system.
Using sick leave? Can an employer make the injured worker use personal sick leave days and vacation pay after a work injury?
No. Iowa law is very specific that an employer cannot require an injured worker to use accumulated sick leave days, or vacation pay instead of receiving workers' compensation payments for time missed from work. The only time that an employer can pay sick and vacation time to a worker who is otherwise entitled to weekly compensation benefits is when the worker expressly agrees to this arrangement.
In some circumstances, it is wise for the worker to supplement weekly workers' compensation checks with sick leave and vacation benefits. The reason for this is that the worker's weekly compensation check will likely be less than he/she was earning before the injury. By supplementing vacation and sick leave pay, the worker can move their weekly income level closer to the amount of money received before the injury. Again, this option to supplement is the worker's alone. An employer cannot require the worker to supplement weekly compensation benefits by reducing the employee's sick leave and vacation accounts.
Injured by another while working? Can a truck driver receive workers' compensation benefits as a result of an injury sustained in a traffic accident? Does it make any difference if the truck driver was completely at fault in causing the accident? Does it make any difference if the employer fires the truck driver because of the accident?
In the situations described above, a driver who has been injured as a result of a work-related motor vehicle accident is almost always entitled to receive workers' compensation benefits, including medical care and payment of weekly compensation benefits. It is no defense for the employer to argue the worker caused the injury. Simply put, the negligence of the worker does not serve to defeat an otherwise valid workers' compensation case. So, the worker's fault is irrelevant to the question of whether the truck driver would be entitled to benefits.
Under Iowa law, an injured worker must establish that the injury took place in the course and scope of the employment. The fact that the worker caused the accident or that the worker got fired for causing the accident does not destroy an otherwise valid work comp claim. Even if the employer was right to have fired the worker, the work comp claim survives.
In situations where serious injuries have taken place, the injured worker should not lose sight of the validity of their own workers' compensation claim, even if they were at fault in causing the injury. In this circumstance, the injured worker should consult with an attorney familiar with workers' compensation law.
Medical records? Can an injured worker get copies of their medical records?
Yes. Under Iowa law, an injured worker is always entitled to get copies of the entire medical records in possession of the employer, or the insurance company. This is a common problem that often arises because insurance companies, and some employers, claim that only they are allowed to possess the medical records. This is a false claim. Iowa law is crystal clear that medical records must be produced when requested by the injured worker.
Iowa Code section 85.27 makes any party in possession of medical records responsible to produce those records to the other party. This obligation works both ways. For example, if a worker is in possession of their medical records, that worker must also produce the medical information if requested to do so by the insurance company.
To receive full copies of your medical records, you should make a written request to the insurance company for full and complete copies of all medical records including test results, reports, letters and the bills.
Also, upon a properly prepared request by a patient, a physician should provide a copy of the records to the patient. The AMA, ethical opinion E-7.02, recognizes that a patient has a legitimate interest in accessing information in their own medical records. Some special circumstances do exist, but as long as the doctor has been providing treatment, and is in a doctor-patient relationship, there should be no problem in getting your records directly from the doctor. If you do run into a doctor who won't give you your records, contact the local medical society for guidance to resolve any problems.
Keep in mind that the workers' compensation company also has a mandatory obligation to provide full copies of all records in its possession. Thus, the injured worker should be able to get the records from either the doctor or from the workers' compensation insurance company. Again, both sources have an obligation to provide the information.
Closing your file? Insurance companies often offer to pay the doctor's impairment rating in a lump sum. As a part of this offer, the company seeks a "closed" file. Is this a good idea?
It's never a good idea to accept a lump sum settlement without consulting an attorney who is knowledgeable in the area of workers' compensation. Most times a lawyer who handles work comp cases on a regular basis will talk to you about these situations at no charge.
What you have to understand is that lump sum (cash) settlements usually are offered by the insurance company only if it can get a final settlement of your case. A final settlement will almost always close out your rights to future medical benefits. Additionally, a final settlement will always close out your rights to obtain more weekly pay including healing period or permanency benefits should your condition worsen in the future. These valuable rights should not be given up without a careful evaluation of your case.
Most attorneys who specialize in workers' compensation cases will discuss with you the advisability of settling your case on a final basis in exchange for a lump sum payment. Some of the factors the attorney will evaluate are:
- Whether you have a clear cut work injury? If you do, why would you ever close your case? In this respect, the fact that you have been paid workers' compensation does not mean that the insurance carrier cannot later dispute that you suffered a work injury.
- Is it a fair settlement amount for your injury? Remember that if you have an injury to your back, neck, shoulders, or hips the amount of money you are entitled to depends on your loss of earning capacity rather than the impairment rating provided by the doctor. Usually, the loss of earning capacity far exceeds the doctor's rating even where there has been little or no lost wages. And, if you don't work in the work comp business all the time, how would you have any idea of what the value of your claim would be?
- Whether your condition has stabilized so that it is unlikely that future medical care will be required? Certain parts of the body such as the neck, back, feet, ankles, knees, and hips are under such stresses during a person's work life that future medical care is often needed. If you close your file for cash today, how will you pay for your medical care tomorrow? See #4 below.
- Whether the Federal government will allow you to take your money and still access federal health care programs like Medicare, or Title 19. This is a growing problem in work comp cases. The government has powerful rights regarding your benefits and you can throw away good value on a work comp case if you don't carefully understand this complex area of law.
- Whether the settlement amount includes sufficient sums to cover expected future medical expenses? If the Federal government expects you to pay for the future care, do you have enough money to really do that?
- Whether future aggravations are likely to be covered by other insurance?
- Whether your future earning capacity can be determined? For example, are you still employed with stable employment?
- Your age. For example, a young person must consider a lifetime of future medical care related to that injury. An older worker must look at what other jobs they still can do in their remaining work life.
There are so many other factors that are taken into account in the evaluation of whether the lump sum settlement is appropriate and fair. These other factors depend on the particular facts of your case. There are circumstances where a lump sum settlement is appropriate but this determination should be made only after a careful evaluation of your particular case.
Injury causes loss of pay? Assume an over-the-road truck driver injures his neck while unloading his truck. The physical restrictions after his neck surgery make it impossible for him to continue in the same job. The employer has offered an in-town driving job but this results in a huge loss of pay because of a reduced rate. Should the worker accept this job? If the worker accepts this job, will the worker be able to replace any of the future lost wages?
As long as the new job fits within the physical restrictions set by your doctor and you believe that you are able to physically perform the job, you should give strong consideration to accepting the job. Reasons not to accept the job are if you are physically unable to perform it, or if you have a better job lined up.
Since you have an injury to your neck, you are entitled to be compensated on an industrial disability basis. In essence, a determination of your lost earning capacity needs to be made. This analysis is usually done initially by your attorney. The analysis would include your age, education, prior work experience, your physical condition, any restrictions from the injury, earnings before the injury, and earnings after the injury.
Other factors to consider include your motivation to continue to work and the fact that your employer was willing to accommodate your restrictions by finding you work, even though at a lower rate of pay.
If you have a job available to you that better fits your physical restrictions, and/or pays you a greater wage than what is being offered by your current employer, there is no reason not to explore those opportunities as well. Accepting employment with a different employer will not end your workers' compensation claim against your current employer.
Last, actual wage replacement does not take place in a workers' compensation case. The system reduces your weekly pay by at least 33% in an effort to force you back to work as soon as possible. But, if you have a severe injury where returning to your job is not possible, your desire to resume working makes no difference. This is but one more way that work comp works against the injured worker.
Fair value for Industrial Disability? A client called and asked if the rating of 5% body impairment from the company doctor was the only factor involved in determining the "Industrial Disability" caused by a back injury. The client had been told this by the work comp insurance company.
No, is the answer in almost all cases. Start by asking yourself if you have a good understanding of what Industrial Disability is? If not, call to get up to speed on this very important concept.
No single factor governs the determination of Industrial Disability. Insurance companies and medical doctors are not responsible for determining the extent of Industrial Disability. Rather, Industrial Disability is determined by the Iowa Work Comp Commissioner, or by a negotiated agreement involving the worker. The process of determining Industrial Disability requires an examination of multiple factors.
Some of the common factors to consider in evaluating Industrial Disability include the injured worker's age, education, work history, physical restrictions coming from the injury, the location of the injury (ie: back, neck, head, shoulder), and the severity of the injury. The conduct of both the employer and the worker concerning returning to work can also influence the final amount of Industrial Disability. The outcome in many cases will also be affected by the loss of actual earnings when the injured worker returns to employment after the injury.
The role of the Federal government must also be fully understood before getting into settlement discussions. Without fully understanding this growing problem, the injured worker can really mess up future health care and buy themselves a boatload of legal problems. And, it is certain that the insurance company will not protect you at all once you have given them a settlement. "Be careful" is the best advice here.
Many of the most important factors of Industrial Disability are unique to the individual worker and cannot be summarized here in a few sentences. Workers with questions concerning these factors and how the factors apply to a given case should consult with an attorney of their choice for specific advice.
Weekly pay after healing? Under what circumstances does a worker continue to receive weekly checks after healing from the injury? Does it make any difference if the worker returns to the old job or goes to work for a new employer?
In situations involving serious injuries, a worker will likely continue to receive weekly compensation even after they have returned to work, or after they have secured new employment. The fact that a worker has healed to the point that they return to employment does not automatically terminate the insurance company's obligation to pay weekly benefits.
An example of this arises with a back injury that required surgery. If the back injury is work related, the injured worker will almost always receive a body function impairment rating from the doctor. Once the body function impairment rating is established, reasonable insurance companies will automatically pay the weekly equivalent of that rating.
The best insurance companies recognize that body function impairment will result from surgery, and will automatically pay benefits even before the doctor's rating is established. These payments are made even though you are working full-time. This same practice is true for shoulder injuries, neck injuries, and hip injuries.
The question of whether or not you are entitled to further compensation can be a complicated one. The best advice for an injured worker is to become fully informed as to their rights. You can become informed of your rights by consulting with an attorney of your choice. Usually, there is no charge for this consultation.