Benefits

In most circumstances, the employer has the right to choose the medical care. In an emergency, an injured worker may choose medical care if the employer or employer's representative is unreachable.

The medical care provided must treat an employee's work injury in a reasonable way.

MEDICAL SERVICES AND SUPPLIES

All reasonable services and supplies to treat the injury are payable. These may include:

• Crutches
• Artificial members
• Appliances and permanent prosthetic devices

The employer must repair or replace any of the above items that become damaged or made unusable on the job. The damage should be through means other than ordinary wear and tear.

Appliances could include any of the following:

• Hearing aid
• Corrective lens
• Orthodontic device
• Denture
• Orthopedic brace
• Other artificial device used to provide function or for therapeutic purposes

If an Employee is Unhappy with Employer-Chosen Care

An employee should discuss care chosen by their employer (or its insurance carrier) if they become dissatisfied with it. An employee can request alternate care from the employer (or its insurance carrier). The employee may file a petition with WCD for alternate care if their request is not approved.

Employer-Covered Travel Expenses Relating to Care

It is the employer's responsibility to pay for medical care to treat a work injury. This includes reasonable and necessary travel expenses for care. These may include:

• Mileage incidental to the use of a private auto.
• Meals and lodging if incidental to the examination/treatment.
• Cost of public transportation.
• Taxi fares or other forms of local transportation if incidental to the use of public transportation.
• Ambulance service or other means of transportation.

Employers should use the business standard mileage rate set by the IRS. This rate is set on July 1 each year. It determines the mileage rate for use of a private car to travel to and from a car for a work injury.

Reimbursement for Lost Wages

An employee may be eligible to receive payment of lost wages if they must leave work to receive care for an injury. This is only available in certain circumstances.

Payment for Medical Care While a Contested Case is Pending

A medical care provider cannot seek payment treatment charges while a contested case is pending.

Release of Medical Information to an Employer (or its Insurance Carrier)

When someone files or defends a workers' comp claim, they agree to share all medical information related to the claim. They give up any right to keep this information private. This information must be provided to anyone involved in the claim upon request. So, an employee has to share their medical information with their employer or insurance company for a workers' comp claim.

Release of Medical Information to an Employee

When someone files or defends a workers' comp claim, they agree to share all medical information related to the claim. They give up any right to keep this information private. This information must be provided to anyone involved in the claim upon request. So, an employer (or its insurance carrier) has to share their medical information to the employee for a workers' comp claim.

When an injured worker is off work for more than three calendar days due to a work injury, the worker may qualify for Temporary Total Disability (TTD) benefits. The injured worker may also qualify for healing period (HP) benefits. The difference between TTD and HP is that a worker may receive HP benefits when the injury causes permanent impairment.

TTD benefits start beginning the fourth day the injured worker is off due to the work injury. If an injured worker misses more than 14 days, the worker may receive payment for the first three days of work missed.

TTD benefits continue until whichever happens first:

• The injured worker returns to work; or
• The injured worker has recovered enough medically to return to similar work.

The employer, the employer's insurance carrier, or a third-party administrator pays TTD benefits.

Temporary Partial Disability (TPD) benefits may be payable if the employee returns to work after a work injury and must work 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.  

There is a three-day waiting period before TPD benefits start. TPD benefits begin on the fourth day after you return to work at a lesser paying job because of the work injury.

The employer, the employer's insurance carrier, or a third-party administrator pays TPD benefits.

If an on-the-job injury causes a worker to miss work due to a permanent impairment, the worker may qualify for Healing Period (HP) benefits.

The injured worker may also qualify for TTD. The difference between TTD and HP is that a worker may receive HP benefits when the injury causes permanent impairment.

There's no waiting period for HP benefits. They begin on the first calendar day after the date of injury.

HP benefits continue until the first of the following occurs:

• The injured worker returns to work;
• The injured worker recovered as much as anticipated from the injury; or
• The injured worker has recovered enough medically to return to similar work.

The employer, the employer's insurance carrier, or a third-party administrator pays HP benefits.

An injured worker may qualify for permanent partial disability (PPD) benefits when the work injury results in:

• A permanent impairment to the worker's body;
• A permanent physical restriction; or
• An inability to earn wages similar to those earned before the work injury.

PPD benefits are payable in addition to any TPD or HP benefits the worker may have received.

An injured worker may receive PPD benefits as well as TPD or HP benefits.

PPD benefits start when:

• A medical provider has indicated that the injured worker has recovered as much as possible from the injury.
• The extent of loss or percentage of permanent impairment can be determined by use of the American Medical Association (AMA) guides to the evaluation of permanent impairment.

End of PPD Benefits

The amount of PPD benefits to which an injured worker may qualify for depends on many factors:

• The body party injured;
• The amount of functional impairment caused by the work injury;
• Whether the worker was able to return to work with the same employer;
• The amount of the worker's wages after the injury; and
• Whether the injury affected the worker's earning capacity under Iowa law.

The employer, the employer's insurance carrier, or a third-party administrator pays PPD benefits.

Scheduled Member Disabilities

 The level of functional impairment of a scheduled member determines whether an injured worker qualifies for PPD benefits. To determine the injured worker's entitlement to PPD benefits for a scheduled member, use the percentage of permanent impairment and the most weeks allowed under the statutory schedule.

Iowa law creates a schedule of certain body parts along with the number of weeks of benefits a worker would receive for the full loss of each member. 

The schedule for all injuries on or after July 1, 2017, is below.

NOTE: For shoulder injuries that occurred on or after July 1, 2017, WCD calculates the injury as a scheduled member. For shoulder injuries that occurred on or before June 30, 2017, WCD calculates it as a disability to the body as a whole.

Industrial Disability (Body as a Whole Disability)

An industrial disability happens when an injury results in a permanent disability to the body as a whole. Consider the following factors of the injured worker to determine an industrial disability:

• Medical condition before the injury, immediately after the injury, and at present
• The site of the injury, its severity and the length of healing period
• The work experience before the injury, after the injury and potential for rehabilitation
• Intellectual, emotional and physical qualification
• Earnings before and after the injury
• Age
• Education
• Motivation
• Functional impairment as a result of the injury
• Inability because of the injury to engage in employment for which the employee is fitted
• Any loss of earnings caused by a job transfer for reasons related to the injury

There are no guidelines on how much weight to give any of the factors. WCD determines the number of weeks payable once it has determined the degree of industrial disability. To do this, multiply the percentage rating by the total value of the body as a whole (500 weeks).

If the employer offers work at the same or greater wage, an injured worker is only entitled to the functional rating until terminated from employment. The employee can request a reopening and determination of industrial disability.

When a work injury leaves a worker incapable of returning to gainful employment, the worker may qualify for Permanent Total Disability (PTD) benefits.

The PTD benefits are payable for as long as the injured worker remains permanently, totally disabled.

The employer, the employer's insurance carrier, or a third-party administrator pays PTD benefits.

A worker may qualify for Second Injury Fund (SIF) benefits if they become permanently injured in a hand, arm, foot, leg or eye after already having an permanent injury in another hand, arm, foot, leg or eye.

These benefits cover the difference between the industrial disability and the combined disability of both injured body parts.

SIF benefits start after the employer (or its insurance carrier) pays all scheduled member permanent partial disability (PPD) benefits due on account of the second injury. 

The Attorney General of Iowa represents SIF in cases before DWC. The State of Iowa Treasurer's Office pays SIF benefits.

Injured workers who may qualify for SIF should contact an attorney or the State of Iowa Treasurer’s Office.

• Second Injury Fund form
• No Second Injury Fund form

Injured workers who take part in the vocational rehabilitation program may qualify for additional workers' comp benefits. WCD refers to these benefits as vocational rehabilitation (VR) benefits.

The employer, the employer's insurance carrier, or a third-party administrator pays VR benefits.

Eligibility

To be eligible for the VR benefits, an employee must:

1. Have sustained a PPD or PTD that is compensable under Iowa workers' compensation law; and
2. Be unable to return to gainful employment because of such disability.

An injured worker may receive a $100 weekly payment on top of any other benefit payments while participating in a vocational rehabilitation program recognized by IVRS.

Length of Benefits

An injured employee may receive up to 13 weeks of the vocational rehabilitation program benefit.

The Workers' Compensation Commissioner may extend an injured worker's VR benefit for another 13 weeks. To grant the extension, circumstances must show that continuing the rehabilitation training will help.

A worker who sustains a shoulder injury and is permanently disabled may qualify for the vocational educational and training (VET) benefit.

Qualifying for VET Benefits

To be eligible for VET benefits, injured workers must meet all of the following criteria:

• Sustain a shoulder injury arising out of and in the course of employment.
• Experience permanent partial disability in the shoulder eligible for compensation under Iowa workers' compensation law.
• Be unable to return to gainful employment due to the work-related shoulder disability.
• Receive an evaluation from Iowa Workforce Development (IWD) that indicates the worker would benefit from vocational education and training.
• Enroll in a qualifying community college program within six months of IWD referral.

Fields Covered by VET Benefits

The VET benefit covers community college training programs that result in an AA degree or certificate in the following fields:

• Iowa High School Equivalency (HiSET)
• Agriculture
• Family and Consumer Sciences
• Health Occupations
• Business
• Industrial Technology
• Marketing

Determining Eligibility Process

The eligibility process involves:

• Application to IWD for evaluation, including career planning, assessments, and accommodation identification.
• Referral by IWD to a community college if deemed beneficial for vocational education and training.
• Enrollment in the referred program within six months.

Coverage and Payment

Injured workers receive financial support of up to $15,000 for tuition, fees, and required supplies. The community college bills the worker's employer, employer's insurance carrier or third-party administrator.

Reporting Requirements and Continued Eligibility

Periodic status reports may be requested to document attendance and grades. Failure to meet attendance or maintain passing grades can result in termination of benefits.

For a death caused by a work injury, the deceased worker’s employer (or its insurance carrier) must pay reasonable burial expenses. The expenses are not to exceed 12 times the statewide average weekly wage in effect at the time of death.

A surviving spouse and the dependents of a worker who dies due to a work injury may receive the death benefits. Other people may qualify for death benefits if they were actually dependent upon the deceased worker.

Surviving Spouse Benefits

A surviving spouse may receive death benefits for life or until remarriage.

The surviving spouse may qualify for a two-year lump sum settlement if they remarry and the deceased worker

Dependent Children Benefits

Dependent children receive death benefits until age 18 or age 25 if they are still dependent.

The employer, the employer's insurance carrier, or a third-party administrator pays death benefits.