First Quarter 2018
By: Stephen P. Murray
Question: In an otherwise compensable claim, when does an employer have to pay for pre-surgical testing/treatment and pay TTD benefits while such testing/treatment occurs?
Short Answer: In Iowa, employers are only required to pay for pre-surgical testing/treating when it is “reasonably necessary” as a result of a work-related accident. Employers are required to pay TTD benefits to an employee only when the employee is off-work due to a work-related accident.
Discussion: Iowa Code 85.27(1) mandates that employers furnish to employees reasonable “surgical, medical, dental, osteopathic, chiropractic, podiatric, physical rehabilitation, nursing, ambulance and hospital services and supplies” when an injury arises out of and in the course of employment. In Iowa, employees have attempted to have their non-work related injuries bundled in with their work-related injuries, in an effort to have them both covered by their workers’ compensation insurance. In situations like these, courts in Iowa allow an apportionment of expenses.
In Shilling v. Eby Const. Co., II Iowa Industrial Comm’r Report 350 (Appeal 1981), all physicians examining the claimant noted his obesity contributed to his back problem, so it was found that the claimant needed to reduce his weight. The commissioner wrote, “[t]his agency strongly urges claimant, in a cooperative effort with his physician, to exhaust all conventional means of weight-loss before any drastic measures are undertaken to effect the weight reduction. Only as a last resort should surgical intervention be utilized as a means of alleviating claimant’s obesity. However, should surgery become necessary in order to force claimant to reduce so that his injury-related back problem can be resolved, such a remedy will be considered reasonable and necessary medical treatment in the course of remedying claimant’s back problems.”
As was noted in Shilling, preexisting personal health problems, such as obesity, are not generally something that employers are mandated to cover in a workers’ compensation claim, however in some circumstances, if treatment for a preexisting personal health problem is required prior to treatment for a work-related injury, the Court can mandate that treatment be covered.
The general rule in Iowa is that employers must pay for pre-surgery testing, but employers are not mandated to pay for surgical treatment in a situation where the need for surgery preexisted the compensable injury.
Practice Tip: The courts in Iowa tend to sway on the side of the employee in most situations; however, it is important to note that the courts are still bound by the legislature. Case law and statutory law are clear that employers are only mandated to cover compensable, work-related injuries and medically reasonable treatment connected thereto. In rare circumstances, if a personal health risk or condition prevents a work-related injury from being properly treated, the court has the authority to order the employer to cover that treatment for that health risk/condition. Generally this requires the employee to first exhaust options for treatment prior to mandating coverage by the employer. In Iowa, since the employer has the first choice at choosing the medical provider, it is important to make sure a trustworthy, well-distinguished physician is chosen that will only recommend necessary treatment for the work-related injury at hand.
Since the Iowa law requires the employer to pay TTD while the employee is off work, even during pre-surgical testing/treatment, requesting the selected physician facilitate returning the injured employee to work in a limited capacity will help avoid the otherwise required TTD benefits until an employee is released to full duty.