Order In the Matter of Certain Deadlines for Electronic Filing on the Workers' Compensation Electronic System (WCES)
The Iowa Workers' Compensation Commissioner issued an order In the Matter of Certain Deadlines for Electronic Filing on the Workers' Compensation Electronic System (WCES). To view the order, click here.
Uniform Guidelines for Preparation of Hearing Exhibits -- Effective July 22, 2019
The Iowa Division of Workers' Compensation (DWC) is implementing mandatory electronic filing (eFiling) on the Workers' Compensation Electronic System (WCES) in contested cases effective July 22, 2019.
As part of the transition to mandatory eFiling on WCES, the DWC has made changes to the Uniform Guidelines for Preparation of Hearing Exhibits (Uniform Guidelines). The new Uniform Guidelines take effect on July 22, 2019.
To view the new Uniform Guidelines, click here.
Updated Iowa Workers' Compensation Law for Injured Workers -- Questions and Answers
The Iowa Division of Workers' Compensation (DWC) issues a brochure each year with information about the state's workers' compensation system for injured workers.
The DWC has finalized the brochure for the time period beginning on July 1, 2019, and ending on June 30, 2020.
To view the updated brochure, click here.
WORKERS' COMPENSATION ELECTRONIC SYSTEM (WCES) UPDATE -- JULY 12, 2019
To view the WCES update for July 12, 2019, click here.
PETE THILL'S INTERVIEW WITH COMMISSIONER CORTESE
I had the privilege of chatting with Commissioner Joseph Cortese recently and wanted to share some insights from the head of the agency we all practice before…Enjoy! - Pete Thill
Family life…Commissioner Cortese is the proud grandfather of 12 grandchildren ages 1 to 13. His three adult children live in Chicago, West Des Moines and Omaha. When asked to disclose a couple of things practitioners may not know about him, I learned he and his wife are fans of the 2014 Netflix drama “Winter Sun” which he describes as a Turkish drama with English subtitles. When asked for his favorite podcast, he openly admits he has never listened to a podcast.
The Commissioner’s role in the agency…In the past 3 ½ years serving as the Iowa Workers’ Compensation Commissioner Joseph Cortese has found the job to be both professionally challenging and personally rewarding. When asked to address the most challenging aspect of his job as Commissioner, he quickly replied by stating “the budget.” The Division of Workers’ Compensation does not generate any revenue but still provides a high level of service to injured employees and employers/insurance companies alike with a limited staff and a limited budget appropriation. As the head of the agency, Commissioner Cortese spends approximately 50% of his time on administrative duties and 50% of his time writing appeal decisions. Aside from the challenging budgetary aspects of his position, he is most impressed with how hard each and every employee of the agency works and the level of dedication of each staff member to provide the highest level of service to everyone needing assistance from the workers’ compensation system. For such loyalty and commitment to the agency that thousands rely on every year, the Commissioner says “Well done!”
New Interest rules (Iowa Code section 535.3(1) as amended)…We spent some time talking about changes in the law last year concerning changes in calculating interest owed on past due weekly benefits. We discussed two (2) simple examples that illustrate interest calculations on benefits accruing both before and after the effective date of the new workers’ compensation legislation (7/1/17):
Example No. 1: In a September 1, 2018 arbitration decision, the deputy ordered an employer to pay the claimant 50 weeks of benefits commencing July 1, 2015 and terminating June 15, 2016. Because all of the ordered weekly benefits were due and owing (ie, accrued) prior to the effective date of the new legislation (7/1/17), all the weekly benefits are subject to the 10% interest rate. Just follow the long standing two step interest calculation approach. See pages ix and x of the IWCAC law book revised 7/1/17 for further explanation.
Example No. 2: In a September 1, 2018 arbitration decision, the deputy ordered an employer to pay the claimant 50 weeks of benefits commencing January 1, 2017 and terminating December 16, 2017. Under this scenario, the employer is obligated to pay interest at 10% for the weekly benefits accruing from January 1, 2017, through June 30, 2017. The remainder of the weekly benefits accruing from July 1, 2017, through December 16, 2017 are subject to an annual rate equal to the one-year treasury constant maturity published by the federal reserve in effect on the date of injury plus 2%. See pages ix and x of the IWCAC law book revised 7/1/17 for further explanation including a formula for use in calculating interest on owed weekly benefits accruing on and after 7/1/17. For assistance in locating the applicable interest rate on the date of injury in your particulate case, you can check out https://fred.stlouisfed.org/series/DGS1
Arbitration Petition trends…Commissioner Cortese and I discussed current trends in filing of arbitration petitions. For the fiscal year 2017 (July 1, 2016 through June 30, 2017), 5,147 arbitration petitions were filed. Interestingly, in March 2017 there was a staggering increase in the number of filings (1,241 petitions in that month alone). For fiscal year 2018 (July 1, 2017 through June 30, 2018), 3,339 arbitration petitions were filed, which is down approximately 35% from comparable filings in fiscal year 2017. Filings of alternate medical care petitions and independent medical examination petitions are not included in these totals.
Fully submitted appeals…As of August 23, 2018, Commissioner Cortese indicates there were 169 fully submitted appeals awaiting decision. An appeal is deemed “fully submitted” once the case has been fully briefed by the parties. Many cases that are appealed are resolved before they are fully submitted. It is rare for cases on appeal to be settled after they are fully submitted, but it does happen occasionally.
Appeal deputies…Commission Cortese explained that two deputy workers’ compensation commissioners, Toby Gordon and Stephanie Copley, have been selected to assist with the writing of appeal decisions, either as appeal recommendations or pursuant to delegation of authority from the Commissioner. Deputy Gordon and Deputy Copley will devote 50% of their time to hearing arbitration cases and writing arbitration decisions and 50% of their time to writing appeal decisions. These deputies should be commended for their ability and willingness to assist with the appeal work!
Docket employees…The commission presently has 3 docket employees. There is a regular docket and an appeal docket. Jennifer Brown and Julie Hinners are responsible for handling the regular docket. Brenda Johnston is responsible for handling the appeal docket. Depending on the timing of the implementation of WCES (a/k/a Worker's Compensation Electronic System), Commissioner Cortese explains that one additional docket employee may be hired at some point in the future.
Deputy hiring…Commissioner Cortese explained he was recently given the go-ahead by Financial Management of Iowa Workforce Development to hire one additional deputy this fiscal year. The plan is to conduct interviews of potential candidates for the position in December 2018. When the new Deputy is hired, the Division will finally be back up to a full crew of 12 Deputy Commissioners.
Word Processors…Commissioner Cortese explained the commission currently employs three (3) word processors who assist the deputies in proofreading and finalizing arbitration decisions and orders and rulings on motions, etc.
Do’s and Don’ts with Appeal Briefs…Overall, the level of expertise exhibited by attorneys practicing before the agency is most impressive. Most post-hearing and appeal briefs are very well written. However, the Commissioner strongly recommends that all appeal briefs be proofread twice before they are filed. A few briefs filed with the agency have the appearance of never having been proofread. He also recommends that practitioners before the agency try our best to craft clear and succinct arguments on appeal. Also, do not be reluctant to ask for the precise relief your client desires on appeal. For example, if an injured worker is the appellant requesting an increase in the level of industrial disability awarded in the arbitration decision, counsel for the claimant should request a specific industrial disability percentage, or at least a specific range, in the appeal brief and back up that request with a cogent argument. Similarly, if an employer is asking for a reduction in the award of industrial disability benefits, counsel for the employer should either request a specific percentage of industrial disability, or a specific range, that the Commissioner should consider and explain why the request is supported by the evidence. Don’t forget….the standard of review to the Commissioner is de novo and the entire arbitration record is subject to review on appeal. Finally, Commissioner Cortese believes some appeal briefs submitted to the agency are too long. He believes most appeal briefs can and should be written in 10-15 pages.
Status of WCES (new electronic filing, case management, hearing scheduling and EDI system)… A delay in the implementation of WCES has been announced. The system was originally scheduled to go live on December 3, 2018. The start-up has been delayed because the system cannot be fully tested by December 3. Many agency staff members (including Deputy James Elliott, Deputy William Grell and many others) have devoted countless hours toward getting this long-awaited system up and running. A strategy session with the vendors to develop a new timeline for project will be held at the Division offices October 8 and 9, 2018.
Late settlement sanction…Commissioner Cortese and I discussed the impact of the new 24-hour late settlement sanction that was implemented by the agency in July, 2018. Deputy Commissioners are reporting a dramatic decrease in settlements being reported less than 24 hours before the scheduled start time of the arbitration hearing. The Commissioner believes the $300.00 sanction is achieving the desired result, which is to get cases off the docket more than 24 hours before the start time of the hearing to free up valuable agency resources and reduce travel expenses of the agency whenever possible.
CourtCall status…CourtCall is a computer-based system that has been made available for the parties to conduct arbitration hearings via videoconferencing with a goal to reduce time and expense for all parties to a workers’ compensation claim. The Commissioner reports there have been 1 or 2 hearings conducted so far via CourtCall and they went very well. Even though this is a limited sample size, the Commissioner highly recommends the parties look into using the CourtCall technology for hearings in the future.
(11-2018)
NOTICE OF DELAY FOR START OF THE WORKERS’ COMPENSATION ELECTRONIC FILING, CASE MANAGEMENT, HEARING SCHEDULING AND EDI SYSTEM (WCES).
The Division of Workers’ Compensation is announcing a delay in the roll-out of WCES, the new electronic filing, case management, hearing scheduling and EDI system for workers’ compensation, WCES.
The Division had planned to Go-Live on December 3, 2018. It has been determined it is not possible to thoroughly test the system before December 3, 2018. The Division was advised to delay the Go-Live date until we can be confident WCES has been thoroughly tested.
A new Go-Live date for WCES has not been determined. Work will not stop on this project and the Division will publish a revised Go-Live date once we have agreement among the vendors and the Division.
The delay in the go-live date applies to both filing in contested claims as well as EDI. EDI filers will continue to file using EDI Release 2.0 until WCES goes live and then will switch to EDI Release 3.1. Claimants, employers and insurance carriers will continue to file paper documents in contested claims until WCES goes live. The process for scheduling hearings will also remain as it is currently until WCES goes live.
Thank you for your continued engagement and please let the Division know if you have any questions.
(09-2018)
USE OF THE LATEST DIVISION OF WORKERS’ COMPENSATION FORMS
A number of parties have not been using the most current forms from the Division’s web site. Specifically the Compromise Settlement form 14-0025 (revised August 2018) is not being used by many parties. Please use the most recent form when filing with the Division as required by Iowa Admin. Code r. 876-3.1(2018).
(09-2018)
PROPOSED RULES FOR THE DIVISION’S ELECTRONIC FILING SYSTEM ARE PUBLISHED
On August 29, 2018, the Division of Workers’ Compensation published in the Iowa Administrative Bulletin a Notice of Intended Action concerning rules for the Workers’ Compensation Electronic System (WCES). The link to the Iowa Administrative Bulletin is: https://www.legis.iowa.gov/docs/aco/bulletin/08-29-2018.pdf
Any interested person may submit written or oral comments concerning this proposed rule making. Written or oral comments in response to this rule making must be received by the Division no later than 4:30 p.m. on September 18, 2018. Comments should be directed to:
James Elliott
Division of Workers’ Compensation
1000 East Grand Avenue
Des Moines, Iowa 50319
Phone: 515.725.3829
Fax: 515.281.6501
Email: james.elliott@iwd.iowa.gov
(08-2018)
MEDICAL MILEAGE
Medical mileage is increased to $.545 effective July 1, 2018.
(07-2018)
Late Settlement Sanction
By order of the Commissioner, beginning July 1, 2018, the Iowa Division of Workers’ Compensation will impose a monetary late settlement sanction on parties in cases where settlements are reported to the Division less than 24 hours before the scheduled start time of the hearing. Settlements must be reported to both the Division and the Deputy Commissioner assigned to hear the case 24 hours or more before the hearing is scheduled to start to avoid imposition of the sanction. This sanction is modeled on the late settlement sanction which is imposed by the Iowa District Courts. The Division has recently experienced an increase in late settlements which places further strains on diminishing resources. This action is necessary to allow the Division to better serve the people of the State of Iowa. The late settlement sanction order is effective for all cases with hearing dates of July 1, 2018, or later.
Claims that have been assessed a late settlement sanction will not have the settlement approved until the sanction has been paid. The late settlement sanctions shall be paid to the Division of Workers’ Compensation and all funds received will be paid over to the Iowa General Fund.
The late settlement sanction will apply in cases filed using the Form 100. It will also apply in full and partial commutation cases filed before July 1, 2017. It is not applicable to alternate medical care, vocational benefits or compliance proceedings.
Beginning in June 2018, the late settlement sanction order will be provided to the parties in all contested cases with hearing dates of July 1, 2018, or later, and it will also be incorporated into the hearing assignment order in all new cases. The order is found below:
ORDER
Late Settlement Sanction. Effective July 1, 2018, parties are hereby ordered to report any settlement in any contested matter to the Division of Workers’ Compensation and to the Deputy Commissioner assigned to hear the case no less than 24 hours before the scheduled start time of the hearing. If a settlement is not reported, or if the settlement is reported less than 24 hours before the scheduled start time of the hearing, or if the case is settled during the hearing, or after the hearing before a decision of a deputy commissioner is issued, the parties shall be sanctioned a total amount of $300.00. The sanction shall be assessed in equal proportionate shares against the claimant and the self-insured employer or the insurance carrier(s), unless the parties reach a different arrangement among themselves as part of the settlement for payment of the sanction. See 876 IAC 4.36 and 4.40. This sanction will not apply in any case where the Second Injury Fund of Iowa is the only defendant and it will not be assessed against the Second Injury Fund in any other case. This sanction will not apply in alternate medical care proceedings. If there is a showing of good cause, this sanction may be waived at the discretion of the hearing deputy. The sanction monies shall be made payable to the Division of Workers’ Compensation and sent to the Division of Workers’ Compensation, 1000 E. Grand Ave., Des Moines, IA 50319-0209. The sanction monies will be forwarded by the Division of Workers’ Compensation to the Treasurer of the State of Iowa to be deposited into the Iowa General Fund.
(05-2018)
Summary of IAWC President, Pete Thill's March 30, 2018 Interview with Commissioner Joseph Cortese
(04-2018)
Important Electronic Data Interchange (EDI) Claims Updates:
All IWD DWC Workers’ Compensation Carriers, Claims Administrators, and Self-Insured Employers:
This correspondence is to provide you with the attached announcement with important Electronic Data Interchange (EDI) Claims Updates for the IWD DWC.
Please see the attached announcement for more information.
(04-2018)
Important Electronic Data Interchange (EDI) Claims Updates: New R3.1 EDI Claims Release 3.1 Requirement Tables and Trading Partner Profile Registration Now Available!
(03-2018)
EDI Claims Update
To All IWD DWC Workers’ Compensation Carriers, Claims Administrators, and Self-Insured Employers:
This correspondence is to provide you with the attached announcement regarding an Iowa Division of Workers' Compensation (IWD DWC) EDI Claims update. Iowa has decided to implement Claims Release 3.1 rather than 3.0 as previously announced, with the mandatory reporting period start date of December 3, 2018.
Please see the attached link for more information. Iowa Claims Release 3.1 EDI Announcement
(11-2017)
2017-2018 Iowa Workers' Compensation Law Books
While the 2017-2018 Iowa Workers' Compensation Law books are not yet available, you are now able to pre-order your books online. The order link is: http://www.iwcac.org/publications.html
Please note, paper order forms will not be used this year.
(11-2017)
Video Hearings Available
CourtCall and the Division of Workers’ Compensation are providing a system to make workers’ compensation hearings available by phone or video, from offices, homes, or other convenient locations. CourtCall allows lawyers and parties to avoid the travel time and costs associated with commuting to a hearing location. CourtCall is currently available at the Des Moines hearing venue for each Deputy Commissioner for any hearing that the parties and the Deputy Workers’ Compensation Commissioner agree to. CourtCall may also be available for road venues with advanced arrangements.
If the parties know who the Deputy Commissioner assigned to the case is the parties shall contact the Deputy Commissioner directly for permission to use CourtCall. If a Deputy Commissioner is not assigned the parties shall contact the Hearing Administrator. Once approved by the Division of Workers’ Compensation the parties shall contact CourtCall to be placed on CourtCall’s system.
CourtCall staff coordinates and facilitates the remote appearances. A remote participant may speak to the Judge in the presence of others, or they may speak privately and directly to others outside of the Judge’s hearing. Document sharing is available through CourtCall’s platform.
CourtCall is a private company and charges a fee for this service. Telephonic appearances cost $66.00 per participant, per hearing, and video appearances cost $76.00 per participant, per hearing. If a party requests to appear via CourtCall to provide testimony, the cost is $45.00 for the first 45 minutes, and $12.50 for each 15-minute increment thereafter.
Remote appearances are arranged directly through CourtCall, and not through the Division of Workers’ Compensation. The use of CourtCall is voluntary by the parties. Parties need to obtain approval from the Deputy Commissioner prior to scheduling a CourtCall appearance. CourtCall enables a participant to easily serve notice of intent to use CourtCall.
Contact CourtCall at www.CourtCall.com or (888) 882-6878 for further information or to schedule appearances in advance of hearings.
(10-2017)
2018 Change in Davenport Venue Location
Beginning in 2018, hearings in Davenport will be held at the following location:
(10-2017)
Change in Road Venue Hearing Times
Beginning July 1, 2018, road venue hearing times will be 8:00 a.m. and 1:00 p.m. with two backup options for each time slot. There will no longer be an option for a 3:00 p.m. hearing.
The Division of Workers' Compensation is instituting this change because some of the facilities which host the road venue hearings are requiring all persons to be out of the facilities by 4:30 p.m. There are genuine safety concerns for Deputy Commissioners, as well as for attorneys, parties, witnesses and court reporters exiting the facilities when hearings that start at 3:00 p.m. don't end until after dark.
Also, hearings via the CourtCall remote video web conferencing system will be available starting November 1, 2017, if all of the parties to a case agree to use the service.
(09-2017)
Hand-Delivery of Mail for Division of Workers' Compensation
Beginning October 2, 2017, all hand-delivered documents for the Division of Workers’ Compensation MUST be delivered directly to the Workforce Development location at 150 Des Moines Street between the hours of 8 am - 4:30 pm.
(09-2017)
Items of Interest
Mark D. Sloan v. Sloan Family Dentistry, P.C. - Partial Commutation Ruling
John Deere Declaratory Order Regarding Profit Sharing Bonus and Continuous Improvement Pay Plan
(07-2017)
Notice from the Division of Workers’ Compensation
There will be an increase in copy fees effective July 1, 2017.
Effective July 1, 2017, the Division of Workers’ Compensation is increasing the fee for all copies from fifteen cents (.15¢) to twenty-five cents (.25¢).
This change reflects the increased costs the Division has incurred since it last changed the fees and brings the Division of Workers’ Compensation in line with the costs charged by Iowa Workforce Development.
The revised fee schedule has been put on our web site. Click here for new fee schedule.
(06-2017)
Notice from the Division of Workers’ Compensation - March 15, 2017
Please share this information with all customers and staff who contact Workers’ Compensation to make them aware there will be some delay in responding to inquiries.
The Division of Workers’ Compensation is experiencing an extraordinary number of filings of Original Notices and Petitions which began two weeks ago. Our docket staff is diligently processing these petitions. Soon we expect to start receiving replies and pleadings in response to each of those petitions, which will also require additional processing time.
With such a significant increase in our workload, our response time to voicemails, return calls, and requests for information will not be as prompt as we would like.
Defense counsel offices:
Please contact the insurance carrier/claim administrator for the compliance number and/or the DWC file number.
Answers and pleadings containing claimant’s name and injury date will provide sufficient information for us to link to the petition and process properly.
While we expect this inconvenience will be temporary, we have no way to determine a time frame. We appreciate your patience and understanding during this time, and we thank you for your support.
(05-2017)
Guidelines for Preparation of Hearing Exhibits
Parties are encouraged to use the following guidelines before they become MANDATORY on May 1, 2017.
Uniform Guidelines for Preparation of Hearing Exhibits
Mandatory May 1, 2017 – Parties May Follow These Before May 1, 2017
Note: Exhibits submitted at hearing that do not comply with these preferences shall be returned to the party, who will be ordered to resubmit them after hearing in the proper form.
- Treatment records shall be organized by provider. Each provider’s records shall be chronological. Providers shall be organized in chronological order.
- Medical treatment records, before and after the alleged injury, are not to be offered separately by each party unless authentication of a record is in dispute. All such treatment records shall be contained in a separate joint exhibit.
- No X-rays or other imaging films are allowed absent a showing that such will be helpful to the deputy in addressing the disputed issues and such films do not require expert medical interpretation.
- Medical and vocational opinion reports may be offered separately by the parties.
- Any party submitting exhibits, including joint exhibits, shall include a table of contents.
- Claimant shall identify his or her exhibits numerically. Defendants shall do so alphabetically. The Fund shall use double alphabetical references such as AA, BB, CC, and so forth. Joint exhibits shall be identified numerically, preceded by the letters “JE” e.g. JE1-1, JE1-2, JE2-3, JE2-4, and so forth. Each page of every exhibit shall be numbered with Exhibit Letter or Number and the page number. For example, the bottom right hand corner of each page will include A-1, A-2, B-3, B-4, and so forth.
- Highlighting is permitted, but not required.
- Any handwritten evidence shall be legible or shall contain a typewritten translation initialed by the original author of the handwritten evidence.
- No duplicates should be included.
- Any video evidence should be provided in MP4 format or any other universal format. The evidence shall be submitted only on DVD format. If audio or visual evidence (e.g. video/DVD/CD) is included in the evidence presentation at hearing, the party referencing the materials shall provide the equipment necessary for its presentation.
- Page limits for exhibits will be enforced and are as follows:
- A. 50-pages per party for individual exhibits;
- B. 100 additional pages for joint exhibits.
- The requesting party’s hearing time will be used to determine the relevancy of proposed exhibits that exceed these limits. The submission of extensive medical treatment records may not be allowed when only the extent of permanent disability is in dispute. A deputy in his or her discretion may allow a party, or parties, to exceed the above-stated page limits upon a showing of good cause.
- In addition to hardcopies of exhibits introduced at hearing, exhibits shall also be scanned and provided to the deputy on a CD at the start of the hearing. If new exhibits are admitted into evidence at the time of hearing, a new CD shall be prepared by the parties which includes the entirety of the exhibits and mailed to the deputy within five days of the end of the hearing.
(02-17)
2017 Change in Iowa Falls Venue
Beginning in 2017, DWC will no longer hold hearings in Iowa Falls. Instead we will hold hearings in Fort Dodge, on the Iowa Central Community College campus, at the following location:
Iowa WORKS
3 Triton Circle
Fort Dodge, IA 50501
Discovery under the new Iowa rules of civil procedure and workers’ compensation cases
A number of attorneys have inquired as to how this agency will apply the new changes to the Iowa Rules of Civil Procedure. The following is general guidance as to how the agency is proceeding.
Rule 876 IAC 4.35 requires this agency to follow the Iowa Rules of Civil Procedure unless it is inconsistent with Iowa Code chapters 85, 85A, 85B, 86, 87 and the rules of this agency. As of January 1, 2015 a number of changes took effect concerning the Iowa Rules of Civil Procedure. A committee consisting of members of the Workers’ Compensation Advisory Board, Iowa Workers’ Compensation Lawyers and some deputy workers’ compensation commissioners reviewed the new rules. As commissioner, I was presented the report of that committee.
At present this agency is not applying the new rules that require automatic disclosure of information as required by Iowa Rule of Civil Procedure 1.500(1). The new disclosure requirements under rule 1.500(1) are triggered by a required discovery conference. As the current procedure before this agency does not have a mandatory discovery conference, this rule is not consistent with current procedure and is not required.
The time limits set forth in 876 IAC 4.19 (a), (b), (c) and (d) as well as the hearing assignment order still applies. Parties are still required to disclose practitioners reports within twenty (20) days following an answer or ten (10) days following receipt pursuant to 876 IAC 4.17.
The agency has been applying the new Iowa Rules of Civil Procedure that require an attorney to call and speak to opposing counsel before filing a discovery motion. Iowa Rules of Civil Procedure 1.504(3) and 1.517(5) require that before a motion for a protective order or other discovery motion be filed the moving party call or attempt to call and speak to opposing counsel. The movant must certify in the motion this was complied with when filing a discovery motion. If the representatives of the parties actually speak personally on the phone, a fair number of discovery disputes will be resolved without the intervention of the agency.
This guidance is meant to be informational. Rulings made by the deputy workers’ compensation commissioners, the commissioner and the courts could change the above information.
Second Compromise Settlement
The Division of Workers’ Compensation will not approve a second compromise settlement for the approval of an MSA set aside. A file stamped addendum is all that will be accepted for filing. The addendum can then be attached to the original settlement and send to CMS. If a reliable source informs the division that CMS is not accepting that as compliant, the division will revisit the issue once what CMS actually requires is apparent.
(4-13)
Frequently Asked Questions About HIPAA & Workers' Compensation
Question
State law says I may disclose records, relating to the treatment I provided to an injured worker, to a workers' compensation insurer for purposes of determining the amount of or entitlement to payment under the workers' compensation system. Am I allowed to share this information under the HIPAA Privacy Rule?
Answer
Yes. A covered entity is permitted to disclose an individual's health information as necessary to comply with and to the full extent authorized by workers' compensation law.
Question
State law says I may provide information regarding an injured workers' previous condition, which is not directly related to the claim for compensation, to an employer or insurer if I obtain the workers' written release. Am I permitted to make this disclosure under the HIPAA Privacy Rule?
Answer
Yes. A covered entity may disclose protected health information where the individual's written authorization has been obtained. A covered entity would be permitted to make the above disclosure if the individual signed such an authorization.
Question
I am a health care provider and my State law says I have to provide a workers' compensation insurer, upon request, with an injured workers' records that related to treatment or hospitalization for which compensation is being sought. Am I permitted to disclose the information?
Answer
Yes. The HIPAA Privacy Rule permits a covered entity to disclose protected health information as necessary to comply with State law.
Question
Does an individual have a right under the HIPAA Privacy Rule to restrict the protected health information his or her health care provider discloses for workers' compensation purposes?
Answer
No. Individuals do not have a right under the Privacy Rule to request that a covered entity restrict a disclosure of protected health information about them for workers' compensation purposes if the disclosure is required or authorized by a workers' compensation law.
Further information may be found at Summary of HIPPA rules.
(1-28-13)
Earned Income Tax Credit Information for Injured Iowans
Many injured workers will suffer a loss of income as a result of a disability or loss of employment. That loss of income may lead to entitlement to an Earned Income Tax Credit that can be explored when filing federal and state income taxes for wages earned in any year. Low-income taxpayers who may qualify for this credit can receive additional information at the following location:
IRS Publication
Information regarding the Iowa state credit can be found at:
Department of Revenue Webpage
or by calling 1-800-367-3388.
Please do not direct questions regarding this Tax Credit to the Iowa Division of Workers’ Compensation.
2008 AMA Guides Task Force Recommendations
Reports from committee members:
- Matthew Dake
- James Gallagher
- John Brooke
- Dr. John Kuhnlein
- Marlon Mormann
- R. Saffin Parish
- Sara Sersland
- Peter Thill
Self-Insured Employer's link
In addition to the ability to check for the employer's workers' compensation carrier that we recently added to our site, this link will take you to the Iowa Insurance Commissioner's office and the list of approved self-insured employers in Iowa.
Iowa Insurance Division Webpage.
How Your Workers' Compensation Benefits can affect your Social Security Benefits.
For Answers to questions on how your social security benefits can be affected by workers' compensation benefits.
(7-31-13)
Resolution of Medical Fee Disputes
Over the past several months the Workers’ Compensation Commission has received numerous inquires regarding the resolution of medical fee disputes. As required by Iowa Code section 85.27(3), and rules 876 IAC 10.3 and 876 IAC 4.46, insurers and providers who have a medical fee dispute must take the following steps to resolve the dispute:
- An insurer who disputes a charge must give a provider written notice of the disputed charge within 60 days of receiving a bill. Charges not in dispute must be paid to the provider before using the procedures in rule 876 IAC 10.3.
- The notice should contain: names of employee and employer; date of injury; date of disputed treatment; the amount of the charge the insurer agrees to pay; the amount of the charge in dispute; the reason the charge is believed to be excessive or unnecessary, and the documentation relied on; the address for directing correspondence; and the procedures available through the Workers’ Compensation Commission to resolve the dispute.
- If the provider does not accept the amount the insurer agrees to pay, the provider must give written notice, and ask the disputed amount go to a reviewer for review.
- The person chosen as the reviewer cannot be the Workers’ Compensation Commission. If the parties cannot agree upon a reviewer, each shall submit a name to the commissioner, and the commissioner shall decide who is to act as a reviewer.
- The reviewer, as soon as practicable, is to determine in writing the amount of the charge that is reasonable and necessary. Costs of the review are to be paid as agreed to by the parties.
- A dispute over a charge can include the reasonableness of the charges. It may also include the necessity of the charge.
- A contested case proceeding may be commenced only after these steps for dispute resolution have been followed, and good faith efforts to resolve the dispute have failed. Such a proceeding must be commenced within 30 days after written determination is made by the reviewer.
- Rule 876 IAC 10.3 does not prevent providers and insurers from developing other procedures to informally resolve their disputes, if those procedures aid in the resolution of a medical fee dispute.
If the process, detailed in rule 876 IAC 10.3, does not resolve the dispute and the parties have attempted resolution in good faith, a contest case may be initiated, pursuant to rule 876 IAC 4.46. The following applies to contested cases regarding medical fee disputes:
- Evidence is filed at the time the contested case is initiated and is limited to that provided by the reviewer, and the determination made by the reviewer.
- The commissioner may request or allow additional evidence.
- If a brief is to be filed, it needs to be filed at the time the matter is commenced.
- The opposing party has 30 days from the date of service of the petition, to file a response and optionally a brief.
(8-4-08)
Settlements
When submitting settlements for approval please following these requirements:
- Compromise Settlements under ICS 85.35(3) - please be specific in your dispute. Make it clear exactly what the dispute is. Nature and extent are not sufficient without supporting medical to clearly describe the dispute.
- Please remember that PPD benefits begin at the end of the healing or TTD period and not on a stipulated date or the date in which the doctor issues his rating.
- Please remember that accrued benefits cannot be commuted.
- PARs are not required except with Agreements for Settlement, and commutations, unless they are requested by the Workers' Compensation Compliance Administrator (WCCA).
- Do not include language in violation of rule 876 IAC 6.1(2) regarding any and all injuries and do not include language that says in other states or jurisdictions. Settlements with this language will be lined out and denied by the WCCA and the settlement will be approved.
(10-19-07)
Full and Partial Commutations
Please note that full and partial commutations will no longer be approved for accrued benefits, those benefits that were due at the end of the healing period. Stipulations by the parties as to a date on which permanent benefits commenced in lieu of those benefits commencing at the end of the healing period, will no longer be accepted. A commutation of less than 10 weeks is not considered in claimant's best interest. (5-1-07)
Present Value Discount Table is now available on the 535.3 Interest page.
First Report of Injury Compliance Hearings
Procedure for Judicial Review of the Division’s findings:
The deputy’s ruling on a penalty in a “FROI” compliance hearing is not subject to review by the workers’ compensation commissioner. Pursuant to Iowa Code section 86.26, any petition for judicial review arising from a deputy’s order assessing a penalty under Iowa Code section 86.12 shall name the Iowa Division of Workers’ Compensation and the injured worker as respondents. Proper service of the petition for judicial review shall be made on the Iowa Division of Workers’ Compensation, 1000 E. Grand Ave., Des Moines, Iowa 50319 and upon the Office of the Iowa Attorney General/Special Litigation Division, 1305 E. Walnut Street, Des Moines, Iowa 50319.
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.iowa.gov.