News and Updates

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INCREASE IN PETITION FILING FEE

Effective July 1, 2009, the original notice and petition form 100 will require a filing fee of $100 to accompany the form. The $65.00 filing fee shall be paid on any original notice and petition form received and filed by June 30, 2009. (6-3-09)

MILEAGE RATE CHANGE

Pursuant to Rule 8.1(2), effective July 1, 2009, the compensation rate for mileage reimbursement in Iowa has been amended to the rate of 55 cents per mile. (6-3-09)

BUDGET REDUCTIONS IMPACT IOWA DIVISION OF WORKERS’ COMPENSATION

Due to recent budget constraints brought forth by the national economic downturn, on May 1, 2009, the Iowa Division of Workers’ Compensation will again be temporarily reducing the staff of Deputy Workers’ Compensation Commissioners for a period of at least six months. Deputy Vicki Seeck will be transitioning to a federally funded ALJ position with the Iowa Division of Unemployment Appeals. Deputy Seeck will be working solely on cases already heard until her transition on May 1, 2009. (4-7-09)

BUDGET REDUCTIONS IMPACT IOWA DIVISION OF WORKERS’ COMPENSATION

Due to recent budget constraints brought forth by the national economic downturn, on February 20, 2009, the Iowa Division of Workers’ Compensation will temporarily be reducing the staff of Deputy Workers’ Compensation Commissioners for a period of at least six months. Deputy James Elliott will be transitioning to a federally funded ALJ position with the Iowa Division of Unemployment Appeals. Deputy Elliott will be working solely on cases already heard until his transition on February 20, 2009.

Division Forms

The Original Notice and Petition for Independent Medical Examination Form 100A has been revised to reflect changes due to the decision in Dodd v. Fleetguard, Inc., No. 8-332/07-1342, filed August 13, 2008, and is also a fillable form. Other forms are currently being revised to become fillable. Please check back often to see if the form you want is fillable.

Dubuque Venue

Beginning December 1, 2008, hearings for the Dubuque venue will he held at:

Town Clock Center for Professional Development

680 Main Street, 2nd Floor

Dubuque, IA 52001

(11-20-08)

Cedar Rapids Venue

Please note that hearings for Cedar Rapids venue are being held at:

Oakdale Hall Room M113 OH, Oakdale Research Campus at 2351 Old Hospital Road. Coralville, Iowa. http://www.uiowa.edu/~maps/areas/orc.htm (REPOSTED 3-09)

AMA Sixth Edition Task Force Final Reports (9-30-08)

1. Letter of Invitation to participate

2. 2008 Task Force Table of Contents

3. 2008 Task Force Process Report

4. Reports from: Matthew Dake, Dr. John Brooke, Dr. James Gallagher, Dr. John Kuhnlein, Marlon Mormann, R. Saffin Parrish-Sams, Sara Sersland (agreement), Peter Thill.

How your workers' compensation benefits can affect your social security benefits. (9-30-08)
For Answers to questions on how your social security benefits can be affected by various disability benefits please see the linked document.

SECOND INJURY FUND ASSESSMENT FOR 2008-2009

We received the following announcement from the Iowa Insurance Commissioner's Office :

Sufficient funds are not available to meet the liabilities of the Second Injury Fund. Therefore, an assessment will be imposed upon insurers and self-insured employers in the State of Iowa. The assessment is $4.0M. Notices were mailed from this office (Insurance Commissioner) on August 25, 2008. The assessment amount is due by September 30, 2008. (9-2-08)

RESOLUTION OF MEDICAL FEE DISPUTES

Over the past several months the Workers’ Compensation Commission has received numerous inquires regarding the resolution of medical fee disputes. As required by Iowa Code section 85.27(3), and rules 876 IAC 10.3 and 876 IAC 4.46, insurers and providers who have a medical fee dispute must take the following steps to resolve the dispute:

1.    An insurer who disputes a charge must give a provider written notice of the disputed charge within 60 days of receiving a bill. Charges not in dispute must be paid to the provider before using the procedures in rule 876 IAC 10.3.

2.    The notice should contain: names of employee and employer; date of injury; date of disputed treatment; the amount of the charge the insurer agrees to pay; the amount of the charge in dispute; the reason the charge is believed to be excessive or unnecessary, and the documentation relied on; the address for directing correspondence; and the procedures available through the Workers’ Compensation Commission to resolve the dispute.

3.    If the provider does not accept the amount the insurer agrees to pay, the provider must give written notice, and ask the disputed amount go to a reviewer for review.

4.    The person chosen as the reviewer cannot be the Workers’ Compensation Commission. If the parties cannot agree upon a reviewer, each shall submit a name to the commissioner, and the commissioner shall decide who is to act as a reviewer.

5.    The reviewer, as soon as practicable, is to determine in writing the amount of the charge that is reasonable and necessary. Costs of the review are to be paid as agreed to by the parties.

6.    A dispute over a charge can include the reasonableness of the charges. It may also include the necessity of the charge.

7.    A contested case proceeding may be commenced only after these steps for dispute resolution have been followed, and good faith efforts to resolve the dispute have failed. Such a proceeding must be commenced within 30 days after written determination is made by the reviewer.

8.    Rule 876 IAC 10.3 does not prevent providers and insurers from developing other procedures to informally resolve their disputes, if those procedures aid in the resolution of a medical fee dispute.

If the process, detailed in rule 876 IAC 10.3, does not resolve the dispute and the parties have attempted resolution in good faith, a contest case may be initiated, pursuant to rule 876 IAC 4.46. The following applies to contested cases regarding medical fee disputes:

1.   Evidence is filed at the time the contested case is initiated and is limited to that provided by the reviewer, and the determination made by the reviewer.

2.   The commissioner may request or allow additional evidence.

3.   If a brief is to be filed, it needs to be filed at the time the matter is commenced.

4.    The opposing party has 30 days from the date of service of the petition, to file a response and optionally a brief. (8-4-08)

2009 Weekly Minimum and Maximum Rates

Beginning July 1, 2009,

Maximum weekly rate for TTD, HP, PTD and death benefits is $1413.00.

Maximum weekly rate for PPD benefits is $1300.00.

The minimum weekly benefit amount for TTD or HP is equal to either the weekly benefit amount of a person whose gross weekly earnings are thirty-five percent (35%) of the statewide average weekly wage OR the spendable weekly earnings of the employee, WHICHEVER IS LESS. The minimum weekly benefit amount for PPD, PTD or death benefits is equal to the weekly benefit amount of a person whose gross weekly earnings are thirty-five percent (35%) of the statewide average weekly wage.

Statewide average weekly wage is $706.39.

35% of statewide average weekly wage is $247.00. (6/09)

AMA GUIDES – Rule 876—2.4 has been amended as follows:

876—2.4(85,86) Guides to evaluation of permanent impairment. The Guides to the Evaluation of Permanent Impairment, Fifth Edition, published by the American Medical Association are adopted as a guide for determining permanent partial disabilities under Iowa Code section 85.34(2)“a” to “s.” The extent of loss or percentage of permanent impairment may be determined by use of ~~this guide~~ the Fifth Edition of the guides and payment of weekly compensation for permanent partial scheduled injuries made accordingly. Payment so made shall be recognized by the workers’ compensation commissioner as a prima facie showing of compliance by the employer or insurance carrier with the foregoing sections of the Iowa workers’ compensation Act. Nothing in this rule shall be construed to prevent the presentations of other medical opinions ~~or guides~~ or other material evidence for the purpose of establishing that the degree of permanent disability to which the claimant would be entitled would be more or less than the entitlement indicated in the Fifth Edition of the AMA ~~guide~~ guides.

This rule is intended to implement Iowa Code ~~section~~ sections 85.34(2) and 86.8.

The amendment to Rule 2.4 is in response to the publication of the AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition, and a call for clarity on the use of the new Guides by several constituencies. While the amendment has been filed on an emergency basis for immediate publication, the rule has also been filed for the allowance of public comment in the normal rule making process. Public comments are encouraged.

Benefit payments for permanent partial disabilities in Iowa for scheduled injuries are frequently based upon the use of the AMA guides. The new sixth edition touts a new paradigm to rating impairment, when compared to ratings under previous editions of the AMA guides and other medical impairment guidelines or treatises. The impact on the level of impairment ratings (and perhaps corresponding level of permanent disability) cannot yet be determined or appreciated as there are no comparative studies on where various injuries or impairment are rated under both the fifth and sixth edition.

Until such studies can be completed by medical and legal experts who commonly are involved in the Iowa Workers’ Compensation system, the use of sixth edition ratings are expressly discouraged. (4-08)

AMA Guides

Please be advised that the AMA Guide to the Evaluation of Permanent Impairment, Sixth Edition has been published. 876 IAC Rule 2.4 makes the Guide published by the American Medical Association “a guide for determining permanent partial disabilities under Iowa Code section 85.34(s)’a’ to ‘s’”. Due to the substantial changes included in the 6th Edition of the Guides and the resulting need for additional study and training within both the medical and legal communities, the Iowa Division of Workers’ Compensation will continue to accept ratings under the 5th Edition of the Guides. (1-31-08)

SETTLEMENTS

When submitting settlements for approval please following these requirements:

1.Compromise Settlements under ICS 85.35(3) - please be specific in your dispute. Make it clear exactly what the dispute is. Nature and extent are not sufficient without supporting medical to clearly describe the dispute.

2. Please remember that PPD benefits begin at the end of the healing or TTD period and not on a stipulated date or the date in which the doctor issues his rating.

3. Please remember that accrued benefits cannot be commuted.

4. PARs are not required except with Agreements for Settlement, and commutations, unless they are requested by the Workers' Compensation Compliance Administrator (WCCA).

5. Do not include language in violation of rule 876 IAC 6.1(2) regarding any and all injuries and do not include language that says in other states or jurisdictions. Settlements with this language will be lined out and denied by the WCCA and the settlement will be approved. (10-19-07)

FULL AND PARTIAL COMMUTATIONS

Please note that full and partial commutations will no longer be approved for accrued benefits, those benefits that were due at the end of the healing period. Stipulations by the parties as to a date, on which permanent benefits commenced in lieu of those benefits commencing at the end of the healing period, will no longer be accepted. A commutation of less than 10 weeks is not considered in claimant's best interest. (5-1-07)

Present Value Discount Table is now available on the 535.3 Interest page.

First Report of Injury Compliance Hearings:

Procedure for Judicial Review of the Division’s findings:

The deputy’s ruling on a penalty in a “FROI” compliance hearing is not subject to review by the workers’ compensation commissioner. Pursuant to Iowa Code section 86.26, any petition for judicial review arising from a deputy’s order assessing a penalty under Iowa Code section 86.12 shall name the Iowa Division of Workers’ Compensation and the injured worker as respondents. Proper service of the petition for judicial review shall be made on the Iowa Division of Workers’ Compensation, 1000 E. Grand Ave., Des Moines, Iowa 50319 and upon the Office of the Iowa Attorney General/Special Litigation Division, 1305 E. Walnut Street, Des Moines, Iowa 50319.

Relief from Insurance

An employer required to provide compensation under Chapters 85, 85A and 85B may apply for relief from insurance and to become self-insured pursuant to Chapter 87.11. The employer must make application for self-insurance to the Insurance Commissioner. The application includes furnishing satisfactory proof of solvency and financial ability to pay the compensation and benefits as by law required. Requests to become self-insured shall be directed to the Insurance Commissioner at 1-877-955-1212 or though their website at www.iid.state.ia.us.

October 16, 2003

EDI Annual Reporting Requirements

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