If you’ve got a workers’ comp claim and your employer has admitted liability, then they get to choose the medical care, and the care has to be reasonable.  If you’re dissatisfied with the provided care and want something different—“alternate medical care”—you need to try to hash it out with your employer.  If you and your employer can’t agree, you can turn to the Iowa Workers’ Compensation Commissioner.  If the Commission finds that you’ve provided reasonable proof of needing the alternate care, you’ll be granted the care.

In a recent Iowa Workforce Development decision, claimant Wendy Johnson (not her real name) had surgery on her lower back.  Her doctor recommended two to three weeks of therapy, and her employer allowed the therapy.  There was some kerfuffle and Ms. Johnson ended up not attending a physical therapy appointment of which she was notified.  She didn’t try to reschedule, and neither did the physical therapy provider.  Less than two weeks later, she went back to the doctor who had recommended physical therapy to begin with, and he found that she was doing just fine, and that additional physical therapy would not be necessary.

But after that appointment, things started going downhill.  Ms. Johnson’s back has been hurting, and she wants physical therapy so she can feel better.  Her employer didn’t agree to it, so she filed a petition for alternate medical care with the Commissioner.  On June 10, Iowa Workforce Development issued its decision: the petition for alternate medical care was denied.

Why was it denied?  Because, under Iowa law, a petition for alternate medical care may be granted only upon “reasonable proofs of the necessity therefor”.  What Ms. Johnson should have provided was evidence that she needed the therapy.  But the only available doctor’s opinion specifically said that addition physical therapy was not necessary.  Ms. Johnson’s allegations of pain were not strong enough to overcome the contents of the doctor’s medical record.

Now, was the alternate care requested actually unnecessary?  We don’t know.  The doctor apparently wrote his note when Ms. Johnson was feeling fine, and may not have reflected her actual condition at the time of the hearing.  What matters under the law is whether Ms. Johnson was able to show that the alternate care was necessary—and she wasn’t.  Maybe if she had kept in better contact with her doctor, or if she had any evidence at all other than her own allegations of pain, this would have turned out differently for her. 

Please don’t let this happen to you.  I like to say to my clients, "Help me to help you."  If we can help you, call the Lombardi Law Firm to speak with attorneys Steve Lombardi and Katrina Schaefer. We can be reached at 515-222-1110 or by emailing us at [email protected] and [email protected] We look forward to your call.

Read this decision (File number 5050155, decided 06/10/2014)

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