This page answers some of the frequently asked questions concerning workers’ compensation. For more detailed information, reference should be made to Iowa Code chapters 85 through 87, 17A and chapter 876 of the Iowa Administrative Code. References to Iowa Code sections appear in parentheses.
The Workers’ Compensation law requires most employers to provide benefits to eligible employees who have injuries arising out of and in the course of employment. [85.61(7)]
In Iowa, "injury" is defined very broadly to include any health impairment other than the normal building up and tearing down of body tissues. The health impairment must be a result of employment activities.
Diseases and hearing losses are also considered to be injuries if they are a result of the employment activities or exposures. (85A, 85B)
An employee is not entitled to benefits for a preexisting injury or disease unless it is aggravated, or worsened, by the employment.
Most employees who are injured in Iowa, working under contract of hire made in Iowa, or whose employment is principally localized in Iowa, are eligible for benefits if they have a job-related injury. (85.71)
There are few classifications of employees who are exempt from the law, and therefore not eligible for benefits, please consult with a compliance administrator with the Division of Workers' Compensation.
Proprietors (independent contractors) limited liability company members and partners are not considered employees but may elect to be covered by purchasing a valid workers’ compensation insurance policy specifically including the proprietor or partner. [85.1A, 85.61(13)]
The employer provides medical care reasonably suited to treat the employee’s injury, and has the right to choose the medical care. If the employee is dissatisfied with the care offered, the employee should discuss the problem with the employer or insurance carrier. In certain situations the employee may wish to request alternate care. If the employer, or insurance carrier, does not allow alternate care, the employee (through appropriate proceedings) may apply to the workers' compensation commissioner for alternate medical care. (85.27)
If the employer-retained physician gives a rating of permanent impairment, which the employee feels is too low, the employee does have a right to another examination by a doctor of the employee’s choice at the employer’s expense. (85.39)
The majority of disputes in workers’ compensation claims can be resolved by open communication between the employee, employer and insurance carrier. The employee should be able to learn the reasons for any action taken, as well as the nature of the evidence supporting the action.
If the dispute is not resolved, a contested-case proceeding may be initiated before the workers' compensation commissioner. Though not required, it is usually advisable to consider the need for legal representation when filing a contested-case proceeding.
However, before contacting an attorney or filing a contested-case proceeding, the employee is encouraged to contact a compliance administrator in the workers' compensation commissioner’s office to discuss other options.
The workers' compensation commissioner is the head of the Division of Workers' Compensation which is part of the Iowa Workforce Development. Workers' Compensation has the responsibility of administering, regulating, and enforcing the workers’ compensation laws. Though the workers' compensation commissioner’s office cannot represent the interests of any party, the agency provides information regarding the provisions of the Workers’ Compensation Law, the rights of the parties, and the procedures the parties can follow to resolve their disputes.
Employers subject to the law are required to provide insurance through a private insurance company or qualify as a self-insurer. (85.3, 87.1, 87.11)
If the employer provides coverage by purchasing an insurance policy, the employer pays the insurance premium charges. The insurance company (or adjusting company) pays the workers’ compensation benefits to the injured employee.
If the employer is self-insured, the employer (or adjusting company) pays the workers’ compensation benefits to the injured employee.
Any employer who fails to provide insurance coverage for eligible employees, as the law provides, may be liable to an employee for either workers’ compensation benefits or for damages in a civil action. (87.21)
An employer shall not engage in business without first obtaining insurance covering compensation benefits or obtaining relief from insurance or furnishing a bond. A person who willfully and knowingly does so is guilty of a class "D" felony. (87.14A)
Relief from Insurance
An employer required to provide compensation under Chapters 85, 85A and 85B may apply for relief from insurance and to become self-insured pursuant to Chapter 87.11. The employer must make application for self-insurance to the Insurance Commissioner. The application includes furnishing satisfactory proof of solvency and financial ability to pay the compensation and benefits as by law required. Requests to become self-insured shall be directed to the Insurance Commissioner at 1-877-955-1212 or though their website at www.iid.state.ia.us.
The law provides for the payment of all reasonable and necessary medical care incurred to treat the injury. This includes reasonably necessary transportation expenses. Mileage for use of a private auto is reimbursed at a rate set by the state of Iowa, currently at 56 cents per mile. (85.27)
Under certain circumstances an employee who has to leave work for medical treatment may be eligible for payment of lost wages. (85.27)
While a contested case proceeding or a dispute on reasonableness of a fee is pending, the medical care provider cannot seek payment of its charges from the employee. (85.27)
Total weekly compensation for any employee is not to exceed 80% of the employee’s weekly spendable earnings. The law defines "spendable earnings" as that amount remaining after payroll taxes are deducted from gross weekly earnings.
The weekly amount of the disability benefit is determined by the employee’s average gross weekly earnings, the number of exemptions, and the marital status.
The weekly compensation benefit amount is based upon a seven-day calendar week. The maximum weekly disability benefit rate for PPD is $1419.00. The maximum weekly disability benefit rate of TTD, HP, PTD, and death benefits is $1543.00. These rates are effective July 1, 2013 to June 30, 2014.
Temporary Total Disability (TTD) [85.32, 85.33(1)]
When an injury results in more than three calendar days of disability, the employee may be entitled to TTD benefits beginning on the fourth day and continuing until the employee has returned to work or is medically capable of returning to substantially similar employment, whichever occurs first. The three-day waiting period becomes payable if the disability period exceeds fourteen calendar days.
Temporary Partial Disability (TPD) [85.32(2-5)]
TPD benefits may be payable if the employee returns to work at a lesser paying job, because of the injury. The TPD benefit amount is to be 66 2/3% of the difference between the employee’s average gross weekly earnings at the time of the injury and the employee’s actual earnings while temporarily working at the lesser paying job. The three-day waiting period (explained above) also applies to TPD.
Healing Period (HP) [85.34(1)]
During the period of recuperation from an injury which produces a permanent impairment, the employee may be entitled to HP benefits beginning on the first day of disability following the date of injury and continuing until the occurrence of one of the following events:
The employee returns to work; it is medically indicated that significant improvement from the injury is not anticipated; or the employee is medically capable of returning to employment substantially similar to the employment in which the employee was engaged at the time of the injury.
No waiting period applies to HP benefits.
Permanent Partial Disability (PPD) [85.34(2)]
When a job-related injury results in a permanent disability, the employee may be entitled to PPD benefits based upon the degree of permanent disability. The PPD benefits are payable in addition to the HP benefits and are to begin at the termination of the healing period. There are two types of PPD benefits:
Scheduled Member Disabilities – An employee’s entitlement to PPD benefits when a scheduled member is involved is based on functional impairment. Appendix A sets out a list of the scheduled body members (i.e., arm, leg, etc.) along with the value (in number of weeks) for each member.
Unscheduled (Body As A Whole) Disabilities – When an injury results in a permanent disability to a part of the person that is not a scheduled member, it is referred to as an industrial disability that is compensated according to the percent that the disability reduced the person's earning capacity. These typically include back, neck, shoulder, and hip injuries. Factors to be considered in determining industrial disability are: any change in the employee's earnings caused by the injury; employee’s medical condition prior to injury, immediately after the injury and presently; the status of the injury; its severity and the length of healing period; the work experience of the employee prior to the injury, after the injury and potential for rehabilitation; the employees qualifications intellectually, emotionally, and physically; age; education; motivation; functional impairment as a result of the injury; loss of earnings caused by a job transfer for reasons related to the injury; and inability because of the injury to engage in employment for which the employee is fitted.
There are no specific guidelines that indicate how each of the factors is to be considered. (See Appendix A)
Permanent Total Disability (PTD) [85.34(3)]
When a job-related injury leaves an employee incapable of returning to gainful employment, the employee may be entitled to PTD benefits. The PTD benefits are payable as long as the employee remains permanently totally disabled.
Second Injury Fund Benefits (85.63-85.69)
If an employee has a permanent partial disability to one major body member (hand, arm, foot, leg, or eye) and sustains a permanent partial disability as a result of a job related injury to a second major body member, the employee may be entitled to benefits from the "Second Injury Fund." The benefits are limited to the value of that permanent disability which exceeds the value of the two affected members separately. The benefits are not payable until after the employer, or insurance carrier, has completed payment of benefits for the second permanent partial disability.
An employee who believes that they are entitled to benefits from this fund should contact the state of Iowa’s treasurer’s office to obtain a claim form. 515-281-3885.
Vocational Rehabilitation Benefits (85.70)
The Iowa Division of Vocational Rehabilitation Services (DVRS) assists eligible individuals with disabilities to prepare for, obtain and maintain employment. An employee may be entitled to a payment of $100.00 ($20.00 for injuries occurring prior to September 7, 2004) per week (up to 13 weeks) if the employee is actively participating in a vocational rehabilitation program. An additional 13 weeks may be paid if approved by the workers' compensation commissioner.
Division of Vocational Rehabilitation Services
510 E. 12th St.
Des Moines, IA 50319
In Des Moines area call 515-281-4211
Death Benefits (85.28, 85.31, 85.42, 85.43, 85.44)
Death benefits are payable to the dependents of the employee. Benefits are first payable to the surviving spouse for life or until remarriage. Dependent children are entitled to the benefits until they reach age 18, or age 25 if they are actually dependent. Others may qualify, if there is a showing of actual dependency. Upon remarriage, if there are no dependent children, the surviving spouse is entitled to a two-year lump sum settlement. Burial expenses not to exceed twelve times the statewide average weekly wage in effect at the time of death are paid in addition to the weekly death benefits.
When are benefits to be paid?
The law is written to encourage prompt payment of workers’ compensation benefits so that the employee will not suffer any undue hardship. Before making payments, most insurance companies or self-insured employers require a written report of injury (which is usually completed and filed by the employer) and some medical verification of the injury. The law provides for weekly payments of disability benefits, beginning on the eleventh day of disability. In certain cases, if the benefits are not paid when due, or are unreasonably delayed or denied, the employee may be entitled to interest or penalty benefits.
Once benefits start, the payments shall be terminated only when the employee has returned to work, or upon thirty days notice stating the reason for the termination and advising the employee of the right to file a claim with the workers' compensation commissioner. (85.30, 86.13)
Full Commutation (85.45, 85.47)
A full commutation is a lump sum payment of all remaining future benefits. When approved, a full commutation ends all of the employee’s future rights to any additional benefits, including medical benefits. In order for a commutation to be approved by the workers' compensation commissioner, it must be shown that the employee has a specific need and that the lump sum is in the employee’s best interest.
Partial Commutation (85.45, 85.47, 85.48)
A partial commutation is a lump sum payment of a portion of the remaining future benefits. When approved, a partial commutation establishes the employee’s entitlement to disability benefits, but it does not end the employee’s future rights.
Agreement for Settlement (86.13)
The parties may enter into an agreement as to the amount and extent of compensation payment due and file it with the workers' compensation commissioner. The approval of the agreement for settlement does not end the employee’s future rights or medical benefits.
Compromise Settlement (85.35)
When there is a dispute as to whether or not the employee is entitled to benefits, a compromise settlement may be filed with the workers' compensation commissioner. Approval of a compromise settlement ends the employee’s future rights to any benefits for the settled injury. Medical benefits under Iowa Code section 85.27 shall remain under the jurisdiction of the commissioner for the purposes of adjudicating the employee's entitlement to benefits as agreed upon in the settlement.
Notice of injury (85.23)
The law provides that the employer must have notice or knowledge of an alleged injury within 90 days of its occurrence, if not, benefits may be denied. The 90-day period begins to run when the employee knew, or should have known the injury arose out of and in the course of employment.
Reporting of claims (86.11)
An Employer’s First Report of injury must be filed with the workers' compensation commissioner when an employee alleges an injury arising out of and in the course of employment, which results in time loss from work of more than three days, permanent injury or death. The report is to be filed with the workers' compensation commissioner within four days of notice or knowledge of such alleged injury.
Two-year Statute of Limitation (85.26)
If within two years from the occurrence of the injury the employee does not receive Iowa weekly workers’ compensation benefits or file an application for arbitration, benefits may be denied.
Three-year Statute of Limitation (85.26)
If Iowa weekly workers’ compensation benefits have been paid, the employee has three years from the last payment of weekly benefits to receive additional benefits or file an action before the workers' compensation commissioner. If not filed within the three-year period, the benefits may be denied. This statute of limitation does not apply to medical expenses reasonably necessary to treat the injury.
How is medical information obtained?
Any party making or defending a claim for benefits agrees to release all information concerning the employee’s physical or mental condition relative to the claim and waives any privilege for the release of such information. The information shall be made available to any party or the party’s representative upon request. (85.27)
Scheduled Body Members
Loss of thumb
Loss of first finger
Loss of second finger
Loss of third finger
Loss of fourth finger
Loss of hand
Loss of arm
Loss of great toe
Loss of any other toe
Loss of foot
Loss of leg
Loss of eye
Loss of hearing in one ear
Loss of hearing in both ears
Permanent disfigurement, face or head
Body as a whole/industrial disability
Appendix A contains the number of weeks of benefits payable for 100% loss, or loss of use, of the body member. If the PPD rating is less than 100%, the percentage rating is multiplied by the number of weeks shown. For example a 20% loss or loss of use, of a thumb would be computed as 20% of 60 weeks or 12 weeks of PPD benefits.
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