Fourth Quarter 2020
By: Ashley R. Fischer
In a compensable Iowa work compensation claim, can a medical provider seek reimbursement from an employee?
No, in Iowa a medical provider may not seek reimbursement for medical services rendered directly from an injured employee. Any disputes regarding the reasonableness of any fee for medical services provided shall be resolved pursuant to the informal dispute resolution procedures established by the workers’ compensation commissioner.
The applicable Iowa statute, I.C.A. §85.27(3) provides broad protection for employees who owe medical providers for medical services rendered in a compensable workers compensation claim. Specifically, the statute states: “When a dispute under the [Iowa workers’ compensation statutes]… regarding reasonableness of a fee for medical services arises between a health services provider and an employer or insurance carrier, the health services provider, employer, or insurance carrier shall not seek payment from the injured employee.” (emphasis added). Further, a medical services provider is not entitled to recover in law or equity any amount in excess of the charges set by the Iowa workers’ compensation commissioner. Id.
When a dispute regarding the reasonableness of a fee for medical services arises, I.C.A. §85.27(3) states that any disputes between a health services provider, insurance carrier, or employer shall be resolved “pursuant to the informal dispute resolution procedures established by rule by the commissioner.” Id. These dispute resolution procedures are codified in Iowa Admin. Code §876-10.3(17A,85,86), and an employer or insurance carrier must initiate the proceedings within 60 days of receiving a disputed medical bill.
Since the Iowa statutes provide employees with broad protections against medical providers’ attempts to collect unpaid medical expenses, it is our recommendation to issue prompt payment for any reasonable medical services rendered in a compensable workers’ compensation claim. However, if a medical bill is exceedingly high and you wish to challenge the cost of the expense, Iowa law allows for these costs to be challenged in non-judicial proceedings. It should be further noted that even in disputed claims, Iowa law protects injured employees from debt collection actions for outstanding medical proceedings while the contested case is still pending. Thus, if an injured worker or his or her attorney attempts to argue that a medical provider is attempting to collect unpaid medical expenses from the injured worker directly, be aware that this practice is prohibited by Iowa law.