If you’ve been injured on the job, you probably know to file a claim for workers’ comp. If your employer accepts liability for the injury, he’s on the hook for your medical care. Specifically, “the employer is obliged to furnish reasonable services and supplies to treat an injured employee, and has the right to choose the care.” Supposing you need some other kind of care—say, a different treatment, or a doctor closer to your home—you’re supposed to let the employer know. If the employer doesn’t agree to give it to you, you can file a petition for alternate medical care and the Iowa Workers’ Compensation Commission will resolve the dispute. But if your employer disputes liability or compensability for the injury, it’s a totally different story.
If your employer denies compensability, he has no duty to provide medical care. This means that he also doesn’t get to choose the care. But it also means that if you end up filing a petition for alternate medical care, it’s going to be dismissed. Here’s how the Iowa Supreme Court discussed this issue in the 2003 case R.R. Donnelly & Sons v. Barnett:
“We emphasize that the commissioner's ability to decide the merits of a section 85.27(4) alternate medical care claim is limited to situations where the compensability of an injury is conceded, but the reasonableness of a particular course of treatment for the compensable injury is disputed. Although R.R. Donnelly acknowledges the compensability of the injury, the dispute in this case cannot be characterized as a dispute over the reasonableness of treatment. The reason R.R. Donnelly claims the alternate care is unreasonable is because it is sought for a medical condition that is not compensable. Thus, the commissioner cannot decide the reasonableness of the alternate care claim without also necessarily deciding the ultimate disputed issue in the case: whether or not the medical condition Barnett was suffering at the time of the request was a work-related injury.”
Linda McLaughlin (not her real name) suffered a workplace injury to her lower back in May 2011. Her employer disputed liability, but was found liable in arbitration with the Commission. The decision was affirmed in November 2013. Ms. McLaughlin received another lower back injury in January 2014, also at work. Although her doctor initially noted that this injury constituted an aggravation of her previous condition, he stated in a hearing this June that it was more likely unrelated—a result of events that January, not of the 2011 injury. To complicate matters, the employer switched insurance carriers between May 2011 and January 2014.
Ms. McLaughlin filed a petition for alternate medical care for her 2014 injury, but the only defendants she named were the employer and the employer’s current insurance carrier—not the former insurance carrier. Naturally, even if the employer was going to admit liability, the named insurance carrier would want to attribute liability to the former insurance carrier. Both defendants ended up denying liability, and so the Commission could do nothing but dismiss the petition.
The next step for Ms. McLaughlin will be to obtain reasonable medical treatment and pay for it herself; she will later have the opportunity to seek reimbursement through the Commission. According to James Elliott, the Deputy Workers’ Compensation Commissioner who dismissed her petition, she intends to file another petition naming the employer and both insurance carriers as defendants. Her employer, meanwhile, will file a petition to determine which insurance carrier will be liable for medical costs.
Ms. McLaughlin’s case is a complicated one, but she might have been able to avoid the hassle she’s going through now by naming both insurance carriers on her first petition. Don’t let yourself get blindsided by problems like that—make sure you get a lawyer who thinks ahead. 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.
Source; June 20, 2014, File number 5038683.