These are the current proposed amendments in the Iowa legislature. They do not reflect the current laws in the State of Iowa under Chapters 85 or 85A.
HF86 – Changes to Iowa code section 85.27
Iowa Code section 85.27 currently states that the employer has the right to choose medical care and alternate care hearings must be via telephone or in-person only.
The proposed amendment would allow an injured employee to choose care, unless care needs to be provided at the job site in response to a life-threatening emergency, if the employee has predesignated a physician who is a primary care provider, who has previously provided medical treatment to the employee, and has retained the employee’s medical records. The employer would be required to provide written notice to all employees of their rights to predesignate a physician. The employer would be required to provide written notice to an injured employee of their right to predesignate a physician at the time the employee provides notice of the alleged work injury. If the employer fails to notify employees of their right to choose a physician, the injured employee has the right to choose any physician to provide treatment for the injury and the treatment shall be considered authorized care.
A physician who practices in another state will not be predesignated by an employee unless the physician’s office is located within sixty miles of where the employee is employed or was injured unless the workers’ compensation commissioner allows otherwise.
A physician chosen by an injured employee to provide treatment is authorized to arrange for any consultation, surgical consultation, referral, emergency care, or other specialized medical services as the physician deems necessary to treat the injury. The employer would be required to pay for all such care, unless the workers’ compensation commissioner determines otherwise.
Under the proposed changes, if the employer has reason to be dissatisfied with the care chosen by the employee, the employer should communicate the basis of such dissatisfaction to the employee, in writing if requested, following which the employee and the employer may agree to alternate care reasonably suited to treat the injury. If the employee and employer cannot agree on such alternate care, the commissioner may, upon application and reasonable proof of the necessity therefor, allow and order other care. The proposed change would allow alternate care hearings to be held via audio-video conferencing as well as telephone and in-person.
HF97 – Iowa Code section 85.27 et al.
Under the proposed amendment, the employer would have the right to predesignate the initial provider of medical care. Upon written notice of a work injury by the employee, the employer is required to provide the employee with the State’s workers’ compensation laws and the rights/responsibilities of both parties.
The employer is required to notify an injured employee of the employee’s ability to contest the employer’s choice of the predesignated treating physician or other provider of medical care.
The employer’s predesignated physician can treat the employee at the physician’s discretion with out seeking preapproval for treatment or referrals to other physicians.
The physician must provide ongoing documentation of the physician’s opinions, treatment recommendations, and plan for treatment. The physician must provide documentation that the plan for care is in care plan are in accord with the most recent edition of either the official disability guidelines and treatment guidelines in workers’ compensation published by the work loss data institute or the American college of occupational and environmental medicine practice guidelines published by the American college of occupational and environmental medicine, and if so, shall cite the appropriate guidelines.
If an employee receives treatment for an injury from a physician predesignated by the employer and prior to an evaluation of permanent disability by that predesignated-physician, the injured employee may be examined by and obtain a second opinion, treatment recommendations, or a care plan from another licensed physician of the employee’s choosing. The employee can request and the employer must pay the reasonable costs associated with this examination, including reimbursement for transportation expenses incurred by the employee for the examination. The employee would be required to notify the physician predesignated by the employer that the employee is consulting with another physician of the employee’s choosing. If an employee receives treatment for an injury from a physician designated by the employee, the employer is not responsible for the costs of obtaining a second opinion, treatment recommendations, or a care plan from an additional licensed physician of the employee’s choosing.
If an employee is dissatisfied with the treatment provided by the employer’s predesignated physician, then the employer and employee can mutually agree of alternate care. If the employer and employee cannot mutually agree, either party may contact the insurance carrier within 5 days to have a conference to review the dissatisfaction of the treatment. The insurance carrier must provide an advisory opinion to resolve the medical care dispute. (The Commissioner is not bound by the advisory opinion) If the conference with the insurance carrier does not resolve the issue, then the employee can seek an order from the Commissioner for alternate medical care.
The employee is responsible to make the application for alternate care and to provide reasonable proof for the necessity of alternate care if all of the following actions occurred:
- The employer provided written information about the
state’s workers’ compensation laws;
- The employer predesignated a treating physician listed
on the state registry of workplace injury care providers;
- The treating physician predesignated by the employer
provided written documentation of the physician’s opinions,
treatment recommendations, and care plan to the employee along with a citation to appropriate treatment guidelines.
The employer is responsible to make the application for alternate care and to provide reasonable proof for the necessity of alternate care if any of the action specified above [(a), (b), or (c)] did not occur or if the employee designated the treating physician to treat the injury.
In an emergency, the employee could choose the employee’s care at the employer’s expense, provided the employer or the employer’s agent cannot be immediately contacted to indicate who the employer has predesignated as a treating physician.
The employer would have the right to request an employee to submit, as often as is reasonable and at a reasonable time and place, to an examination by a licensed physician chosen by the employer for any purpose relevant to the employer’s duties to provide benefits to the employee. However, each time that an employee is requested to and submits to an examination requested by the employer, the employee has the right to be examined by a licensed physician chosen by the employee for any purpose relevant to the employer’s duties to provide benefits to the employee. Each time that an employer obtains an evaluation of an employee’s permanent disability by a physician chosen by the employer, if the injured employee believes that the evaluation of the extent of the employee’s permanent disability is too low, the employee may obtain a subsequent examination and evaluation of the employee’s permanent disability by a physician of the employee’s choice.
The physician chosen by the employee has the right to confer with and obtain sufficient medical history of the employee from the physician who examined the employee on behalf of the employer to make a proper evaluation of the employee’s permanent disability. The employer shall promptly pay the costs of all of the examinations obtained under this particular subsection.
The proposed amendment would also enact Iowa Code section 85.73 – State registry of workplace injury care. Under the proposed amendment, the commissioner, by administrative rule, shall establish requirements for a physician to be listed on the registry and establish a registration fee. A physician does not need to be listed on the registry in order to offer or provide treatment of work-related injuries. This does not prohibit an employer from predesignating or an employee from designating a physician to provide treatment of a work-related injury who is not listed on the registry. If the employer does not predesignate a physician, the employee may designate a physician listed in the State registry of workplace injury care created by Iowa Code section 85.73.
The proposed amendment would also enact Iowa Code section 85.74 – State registry for IME physicians. Under the proposed amendment, a physician must be listed on the registry in order to perform independent medical evaluations and issue impairment ratings of injured employees in this State. The Commissioner may prohibit an employer or employee from using an independent medical evaluation or an impairment rating of an injured employee from a physician who is not listed on the registry as evidence at a hearing to determine benefits.
The proposed amendment would enact Iowa Code sections 85.75 and 85.77 – collecting fees and establishing a fund to administer the registries under 85.73 and 85.74. The proposed amendment would also enact Iowa Code section 85.76, which states that the Commissioner can retain the services of a medical director to assist the division of workers’ compensation in advancing occupational health in Iowa and to advise the commissioner on how to successfully apply and administer the state’s workers’ compensation laws, including assessments of the use of evidence-based care in treating work-related injuries.
Last, the proposed amendment enacts Iowa Code section 85.78 to establish an advisory council will be established, made up of 6 members: 2 appointed by the Governor; 2 appointed by the Senate; and 2 appointed by the House.
SF2192 – Intoxication
Iowa Code section 85.16 currently states that if an employee tests positive for drugs or alcohol following a work-related injury, there is a rebuttable presumption that the employee was intoxicated at the time of the accident and that the intoxication was a substantial factor in causing the accident. The proposed amendment eliminates both presumptions.
SF2003 – Prosthetics
Iowa Code section 85.27 currently states that the employer must provide reasonable and necessary medical treatment including prosthetics. Currently, the employer is only required to provide one prosthetic device for each specific injury.
The proposed amendment states that the injured worker would be entitled to replacement of a prosthetic device, including subsequent replacements, by the employer if the prosthetic device is needed as a result of a compensable injury, and the replacement of the prosthetic device would otherwise be considered reasonable medical care.
Push to Return to Pre-2017 Legislative Changes
There are 2 (two) proposed amendments to go back to the laws in effect before July 1, 2017.
SF349 – Push to go back to the majority of laws immediately preceding the 2017 legislative changes.
SF451 –Push to go back to all of the laws immediately preceding the 2017 legislative changes.
Written by: Paul Powers