If you have been hurt on the job you have probably recieved care you think is substandard.  Though, perhaps you are one of the lucky ones who have been sent to a physician you like right away.  Iowa Workers Compensation Law gives the insurance company the right to control and direct care.  However, despite what the adjuster trys to tell you, their right is not absolute.  The insurance company has to provide injury workers with care reasonably suited to treat the injured worker.  This means, if you have a broken arm, then you have a right to see an orthopedist (usually), if you have a work related heart attack, you have the right to see a cardiologist and so on.

Normally, work injuries are not emergency events.  The usual case involves lifting an object, sustaining a fall or something along these lines.  Typically, the insurance carrier will send the injured worker to a “company doctor.”  These company doctors are usually occupational health providers.  You will know an occupational health doctor when you are sent to one.  I often times see occupational health doctors place patients into physical therapy before ordering an MRI or referring patients out to orthopedic specialists.  Usually, initially seeing an occupational health physician is reasonable and incompliance with the insurance carrier’s obligations under the Iowa Workers Compensation laws.

Where the fight comes in is when the occupational physician orders testing or referral that the insurance carrier ignores.  By law, if an authorized doctor orders care, that care is deemed authorized because the insurer selected physician is an agent of the insurance company.  Thus, if the occupational health doctor refers you to a specific orthopedist, then that orthopedist becomes an authorized provider.  If that orthpedist then recommends surgery or other treatment, that treatment should be provided.  The insurance carrier cannot just decide that they disagree and get a different doctor.  If the carrier refuses to provide the recommended care, then an Alternate Medical Care Petition can be filed with the Iowa Workers’ Compensation Commissioner to force care.  Most Alternate Care Petitions are successful unless the insurance carrier denies the work injury.  Feel free to contact me if you have any questions.

—Ryan Beattie