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How Do Disputes Over Claims For Workers’ Compensation Benefits Get Resolved?

December 13, 2017By Niko Pothitakis
For employers and insurance companies, workers’ compensation claims can be no different from any other type of expense. These businesses want to save money. To protect their bottom lines, they will often dispute benefit claims in hope of reducing or avoiding payment. They may hope that an injured employee whose claim has been denied will simply seek other types of treatment or drop the claim. Fortunately for Iowa workers, however, there is a process that allows workers to dispute benefit decisions to ensure that all injured employees are able to obtain the care and compensation they deserve.

Resolving a Dispute Directly With Your Employer

Many times, workers’ compensation disputes can be resolved with direct and open communication among the employee, the employer, and the insurance company. Iowa employers are required to be clear about the reasons for a decision and present evidence that supports that decision. There are penalties for denying a claim unreasonably, and employers and their insurers have a duty to provide benefits when appropriate. Often, when addressed directly about the situation, employers will recognize their responsibility to provide compensation. If this is not possible, a more formal process can be pursued.

Taking a Workers’ Compensation Dispute to the State Commission

The Iowa Division of Workers’ Compensation maintains files on all claims and can help all parties understand their rights and options. When an employee and an employer cannot resolve their disagreement, the office can suggest ways to seek a resolution. A compliance administrator can evaluate the case. While compliance administrators cannot represent the interest of either side, they can and do provide information on state law, the rights of both parties, and state procedures. They can also offer:

  • Mediation services
  • Alternate medical care
  • Health services dispute resolution

This can be a good place to find information and provide a framework for resolution short of the formal process. Many cases are resolved in this manner and avoid the stress of a formal dispute.

Pursuing a Formal Contested Case Proceeding in Iowa

When other resolution methods fail, however, injured employees can file a formal dispute with the Workers’ Compensation Commissioner. This is known as a contested case proceeding. In a contested case proceeding, the commissioner or a commissioner’s deputy will hold a hearing. At that time, both sides will offer their version of events and provide evidence to support their claims. In these situations, the burden of proof is on the injured employee to prove that he is entitled to the benefits sought.

While an attorney is not required, the office does often suggest seeking representation to ensure that an employee’s rights are fully protected. An experienced workers’ compensation attorney can help injured workers understand their rights, gather evidence, prepare for the hearing, secure expert testimony, and present a thorough case to the commissioner.

If a claim is again denied, the injured employee would not have any further recourse in the workers’ compensation system. The case would have to be further pursued through the state court system.

Take Action Now to Protect Your Iowa Workers’ Compensation Claim

It is important to report a work injury and file a claim as soon as possible. In Iowa, failure to meet the stated deadlines will result in the denial of your workers’ compensation claim. Many times, claims are denied and benefits lost simply because the injured employee waited too long to file or appeal a claim.

If you or someone you love has suffered a job-related injury or illness, the experienced workers’ compensation lawyers at Pothitakis Law Firm may be able to help. Our skilled legal team has helped many injured Iowa workers obtain the care and compensation they deserve. Contact us today for a free copy of our book, 7 Things You Must Know If You Get Hurt at Work, to learn more about your rights.