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News And Updates
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
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