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Senate File 365 - IntroducedA Bill ForAn Act 1relating to the choice of doctor to treat injured
2employees under workers’ compensation laws and including
3effective date and applicability provisions.
4BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. Section 85.27, subsection 4, Code 2023, is
2amended to read as follows:
34. a. (1) For purposes of this section, the employer is
4obliged to furnish reasonable services and supplies to treat an
5injured employee, and has the right to choose the care unless
6the employee has predesignated a physician as provided in
7paragraph “b”. If the employer chooses the care, the employer
8shall hold the employee harmless for the cost of care until the
9employer notifies the employee that the employer is no longer
10authorizing all or any part of the care and the reason for
11the change in authorization. An employer is not liable for
12the cost of care that the employer arranges in response to a
13sudden emergency if the employee’s condition, for which care
14was arranged, is not related to the employment. The treatment
15must be offered promptly and be reasonably suited to treat the
16injury without undue inconvenience to the employee.
17(2) If the employee has reason to be dissatisfied with the
18care offered, the employee should communicate the basis of
19such dissatisfaction to the employer, in writing if requested,
20following which the employer and the employee may agree to
21alternate care reasonably suited to treat the injury. If the
22employer and employee cannot agree on such alternate care, the
23commissioner may, upon application and reasonable proofs proof
24 of the necessity therefor, allow and order other care. In an
25emergency, the employee may choose the employee’s care at the
26employer’s expense, provided the employer or the employer’s
27agent cannot be reached immediately. An application made under
28this subsection shall be considered an original proceeding
29for purposes of commencement and contested case proceedings
30under section 85.26. The hearing shall be conducted pursuant
31to chapter 17A. Before a hearing is scheduled, the parties
32may choose a telephone hearing or an in-person hearing. A
33request for an in-person hearing shall be approved unless the
34in-person hearing would be impractical because of the distance
35between the parties to the hearing. The workers’ compensation
-1-1commissioner shall issue a decision within ten working days of
2receipt of an application for alternate care made pursuant to a
3telephone hearing or within fourteen working days of receipt of
4an application for alternate care made pursuant to an in-person
5hearing.
6(3) The employer shall notify an injured employee of the
7employee’s ability to contest the employer’s choice of care
8pursuant to this subsection paragraph “a”.
9b. (1) An injured employee has the right to choose care,
10unless care needs to be provided at the job site in response to
11a life-threatening emergency, if the employee has predesignated
12a physician who is a primary care provider, who has previously
13provided medical treatment to the employee and has retained
14the employee’s medical records, to provide treatment for the
15injury. Upon hire and periodically during employment, an
16employer shall provide written notice to all employees who have
17not yet predesignated a physician, of their right under this
18paragraph “b” to predesignate such a physician for treatment of
19an injury, in a manner prescribed by the workers’ compensation
20commissioner by rule. The employer or the employer’s insurer
21shall not coerce or otherwise attempt to influence an injured
22employee’s choice of a physician to provide care. An employee
23shall, as soon as practicable, notify the employer of an
24injury, and upon receiving such notice of an injury from an
25employee, the employer shall again provide written notice to
26that employee of the employee’s right under this paragraph
27“b” in a manner prescribed by the workers’ compensation
28commissioner by rule. If an employer fails to notify an
29employee of the employee’s right to choose a physician as
30provided in this paragraph “b”, the employee has the right to
31choose any physician to provide treatment for the injury and
32the treatment shall be considered care authorized under this
33section.
34(2) For the purposes of this paragraph “b”, “physician”
35 includes an individual physician, a group of physicians, or
-2-1a clinic. For the purposes of this paragraph “b”, “primary
2care provider” means an employee’s personal physician licensed
3to practice medicine and surgery or osteopathic medicine and
4surgery in this state or in another state who provides primary
5care and is a family or general practitioner, a pediatrician,
6an internist, an obstetrician, or a gynecologist. A physician
7who practices in another state shall not be predesignated by an
8employee unless the physician’s office is located within sixty
9miles of where the employee is employed or was injured unless
10the workers’ compensation commissioner allows otherwise. A
11physician chosen by an injured employee to provide treatment
12is authorized to arrange for any consultation, surgical
13consultation, referral, emergency care, or other specialized
14medical services as the physician deems necessary to treat the
15injury. The employer shall pay for all such care, unless the
16workers’ compensation commissioner determines otherwise.
17(3) If the employer has reason to be dissatisfied with the
18care chosen by the employee, the employer should communicate
19the basis of such dissatisfaction to the employee, in writing
20if requested, following which the employee and the employer may
21agree to alternate care reasonably suited to treat the injury.
22If the employee and employer cannot agree on such alternate
23care, the commissioner may, upon application and reasonable
24proof of the necessity therefor, allow and order other care.
25c. An application made to the commissioner under paragraph
26“a” or “b” shall be considered an original proceeding for
27purposes of commencement and contested case proceedings under
28section 85.26. The hearing shall be conducted pursuant to
29chapter 17A. Before a hearing is scheduled, the parties may
30choose a telephone hearing, an audio-video conference hearing,
31or an in-person hearing. A request for an in-person hearing
32shall be approved unless the in-person hearing would be
33impractical because of the distance between the parties to the
34hearing. The workers’ compensation commissioner shall issue a
35decision within ten working days of receipt of an application
-3-1for alternate care if a telephone hearing or audio-video
2conference hearing is held or within fourteen working days of
3receipt of an application for alternate care if an in-person
4hearing is held.
5 Sec. 2. Section 85.39, Code 2023, is amended to read as
6follows:
785.39 Examination of injured employees.
81. a. After an injury, the employee, if requested by the
9employer, shall submit for examination at some reasonable
10time and place and as often as reasonably requested, to a
11physician or physicians authorized to practice under the laws
12of this state or another state, without cost to the employee;
13but if the employee requests, the employee, at the employee’s
14own cost, is entitled to have a physician or physicians
15of the employee’s own selection present to participate in
16the examination. If an employee is required to leave work
17for which the employee is being paid wages to attend the
18requested examination, the employee shall be compensated at
19the employee’s regular rate for the time the employee is
20required to leave work, and the employee shall be furnished
21transportation to and from the place of examination, or the
22employer may elect to pay the employee the reasonable cost of
23the transportation. The refusal of the employee to submit
24to the examination shall forfeit the employee’s right to any
25compensation for the period of the refusal. Compensation shall
26not be payable for the period of refusal.
272. b. If an evaluation of permanent disability has been
28made by a physician retained by the employer and the employee
29believes this evaluation to be too low, the employee shall,
30upon application to the commissioner and upon delivery of a
31copy of the application to the employer and its insurance
32carrier, be reimbursed by the employer the reasonable fee for
33a subsequent examination by a physician of the employee’s
34own choice, and reasonably necessary transportation expenses
35incurred for the examination. The physician chosen by the
-4-1employee has the right to confer with and obtain from the
2employer-retained physician sufficient history of the injury
3to make a proper examination. An employer is only liable to
4reimburse an employee for the cost of an examination conducted
5pursuant to this subsection paragraph “b” if the injury for
6which the employee is being examined is determined to be
7compensable under this chapter or chapter 85A or 85B. An
8employer is not liable for the cost of such an examination
9if the injury for which the employee is being examined is
10determined not to be a compensable injury. A determination of
11the reasonableness of a fee for an examination made pursuant to
12this subsection paragraph “b”, shall be based on the typical fee
13charged by a medical provider to perform an impairment rating
14in the local area where the examination is conducted.
152. If the employee has chosen a physician to provide care
16as provided in section 85.27, subsection 4, paragraph “b”, when
17it is medically indicated that no significant improvement from
18an injury is anticipated, the employee may obtain a medical
19opinion from the employee’s physician, at the employer’s
20expense, regarding the extent of the employee’s permanent
21disability. If the employee obtains such an evaluation and the
22employer believes this evaluation of permanent disability to be
23too high, the employer may arrange for a medical examination of
24the injured employee by a physician of the employer’s choice
25for the purpose of obtaining a medical opinion regarding the
26extent of the employee’s permanent disability. If an employee
27is required to leave work for which the employee is being paid
28wages to attend an examination under this subsection, the
29employee shall be compensated at the employee’s regular rate
30for the time the employee is required to leave work, and the
31employee shall be furnished transportation to and from the
32place of examination, or the employer may elect to pay the
33employee the reasonable cost of transportation. The physician
34chosen by the employer to conduct the examination has the right
35to confer with and obtain from any physician who has treated
-5-1the injured employee sufficient history of the injury to make
2a proper examination. The refusal by the employee to submit
3to the examination shall forfeit the employee’s right to any
4compensation for the period of the refusal. Compensation shall
5not be payable for the period of refusal.
6 Sec. 3. EFFECTIVE DATE. This Act takes effect January 1,
72024.
8 Sec. 4. APPLICABILITY. This Act applies to injuries
9occurring on or after January 1, 2024.
10EXPLANATION
11The inclusion of this explanation does not constitute agreement with
12the explanation’s substance by the members of the general assembly.
13This bill relates to the choice of a physician to treat an
14injured employee under the state’s workers’ compensation laws.
15The bill allows the employer to choose care unless the employee
16has predesignated a physician as provided in the bill.
17The bill gives an employee the right to predesignate a
18physician who is a primary care provider, who has previously
19provided treatment to the employee and has retained the
20employee’s medical records, to provide treatment for a
21work-related injury. The employer is required to provide
22written notice to employees of this right upon hire, and
23periodically during employment, and upon receiving notice
24of an injury from an employee who has not yet predesignated
25a physician of the employee’s right to do so, in a manner
26prescribed by the workers’ compensation commissioner. An
27employer or an employer’s insurer shall not coerce or otherwise
28attempt to influence an injured employee’s choice of a
29physician.
30If the employer fails to provide such notification, an
31injured employee has the right to choose any physician to
32provide treatment for the work-related injury and that
33treatment shall be considered authorized care.
34If the employer or employee is dissatisfied with the care
35chosen by the other party, the dissatisfied party should
-6-1communicate the basis of dissatisfaction to the other party, in
2writing if requested, and the parties may agree to alternate
3care reasonably suited to treat the injury. If the parties
4cannot agree to such alternate care, the dissatisfied party may
5make an application for alternate care to the commissioner.
6An application for alternate care is an original proceeding
7and is treated as a contested case. A party may request that
8the hearing be held in person, by telephone, or by audio-video
9conference. The commissioner is required to issue a decision
10within 10 working days of receipt of an application if a
11telephone hearing or audio-video conference hearing is held or
12within 14 days if an in-person hearing is held.
13The bill provides that if the employee has chosen care, when
14it is medically indicated that no significant improvement from
15an injury is anticipated, the employee may obtain a medical
16opinion regarding the extent of the employee’s permanent
17disability. If the employer believes that the evaluation of
18permanent disability obtained by the employee is too high, the
19employer has the right to obtain another medical opinion from a
20physician of the employer’s choosing.
21The bill takes effect and applies to injuries occurring on or
22after January 1, 2024.
-7-je/rn
2employees under workers’ compensation laws and including
3effective date and applicability provisions.
4BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. Section 85.27, subsection 4, Code 2023, is
2amended to read as follows:
34. a. (1) For purposes of this section, the employer is
4obliged to furnish reasonable services and supplies to treat an
5injured employee, and has the right to choose the care unless
6the employee has predesignated a physician as provided in
7paragraph “b”. If the employer chooses the care, the employer
8shall hold the employee harmless for the cost of care until the
9employer notifies the employee that the employer is no longer
10authorizing all or any part of the care and the reason for
11the change in authorization. An employer is not liable for
12the cost of care that the employer arranges in response to a
13sudden emergency if the employee’s condition, for which care
14was arranged, is not related to the employment. The treatment
15must be offered promptly and be reasonably suited to treat the
16injury without undue inconvenience to the employee.
17(2) If the employee has reason to be dissatisfied with the
18care offered, the employee should communicate the basis of
19such dissatisfaction to the employer, in writing if requested,
20following which the employer and the employee may agree to
21alternate care reasonably suited to treat the injury. If the
22employer and employee cannot agree on such alternate care, the
23commissioner may, upon application and reasonable proofs proof
24 of the necessity therefor, allow and order other care. In an
25emergency, the employee may choose the employee’s care at the
26employer’s expense, provided the employer or the employer’s
27agent cannot be reached immediately. An application made under
28this subsection shall be considered an original proceeding
29for purposes of commencement and contested case proceedings
30under section 85.26. The hearing shall be conducted pursuant
31to chapter 17A. Before a hearing is scheduled, the parties
32may choose a telephone hearing or an in-person hearing. A
33request for an in-person hearing shall be approved unless the
34in-person hearing would be impractical because of the distance
35between the parties to the hearing. The workers’ compensation
-1-1commissioner shall issue a decision within ten working days of
2receipt of an application for alternate care made pursuant to a
3telephone hearing or within fourteen working days of receipt of
4an application for alternate care made pursuant to an in-person
5hearing.
6(3) The employer shall notify an injured employee of the
7employee’s ability to contest the employer’s choice of care
8pursuant to this subsection paragraph “a”.
9b. (1) An injured employee has the right to choose care,
10unless care needs to be provided at the job site in response to
11a life-threatening emergency, if the employee has predesignated
12a physician who is a primary care provider, who has previously
13provided medical treatment to the employee and has retained
14the employee’s medical records, to provide treatment for the
15injury. Upon hire and periodically during employment, an
16employer shall provide written notice to all employees who have
17not yet predesignated a physician, of their right under this
18paragraph “b” to predesignate such a physician for treatment of
19an injury, in a manner prescribed by the workers’ compensation
20commissioner by rule. The employer or the employer’s insurer
21shall not coerce or otherwise attempt to influence an injured
22employee’s choice of a physician to provide care. An employee
23shall, as soon as practicable, notify the employer of an
24injury, and upon receiving such notice of an injury from an
25employee, the employer shall again provide written notice to
26that employee of the employee’s right under this paragraph
27“b” in a manner prescribed by the workers’ compensation
28commissioner by rule. If an employer fails to notify an
29employee of the employee’s right to choose a physician as
30provided in this paragraph “b”, the employee has the right to
31choose any physician to provide treatment for the injury and
32the treatment shall be considered care authorized under this
33section.
34(2) For the purposes of this paragraph “b”, “physician”
35 includes an individual physician, a group of physicians, or
-2-1a clinic. For the purposes of this paragraph “b”, “primary
2care provider” means an employee’s personal physician licensed
3to practice medicine and surgery or osteopathic medicine and
4surgery in this state or in another state who provides primary
5care and is a family or general practitioner, a pediatrician,
6an internist, an obstetrician, or a gynecologist. A physician
7who practices in another state shall not be predesignated by an
8employee unless the physician’s office is located within sixty
9miles of where the employee is employed or was injured unless
10the workers’ compensation commissioner allows otherwise. A
11physician chosen by an injured employee to provide treatment
12is authorized to arrange for any consultation, surgical
13consultation, referral, emergency care, or other specialized
14medical services as the physician deems necessary to treat the
15injury. The employer shall pay for all such care, unless the
16workers’ compensation commissioner determines otherwise.
17(3) If the employer has reason to be dissatisfied with the
18care chosen by the employee, the employer should communicate
19the basis of such dissatisfaction to the employee, in writing
20if requested, following which the employee and the employer may
21agree to alternate care reasonably suited to treat the injury.
22If the employee and employer cannot agree on such alternate
23care, the commissioner may, upon application and reasonable
24proof of the necessity therefor, allow and order other care.
25c. An application made to the commissioner under paragraph
26“a” or “b” shall be considered an original proceeding for
27purposes of commencement and contested case proceedings under
28section 85.26. The hearing shall be conducted pursuant to
29chapter 17A. Before a hearing is scheduled, the parties may
30choose a telephone hearing, an audio-video conference hearing,
31or an in-person hearing. A request for an in-person hearing
32shall be approved unless the in-person hearing would be
33impractical because of the distance between the parties to the
34hearing. The workers’ compensation commissioner shall issue a
35decision within ten working days of receipt of an application
-3-1for alternate care if a telephone hearing or audio-video
2conference hearing is held or within fourteen working days of
3receipt of an application for alternate care if an in-person
4hearing is held.
5 Sec. 2. Section 85.39, Code 2023, is amended to read as
6follows:
785.39 Examination of injured employees.
81. a. After an injury, the employee, if requested by the
9employer, shall submit for examination at some reasonable
10time and place and as often as reasonably requested, to a
11physician or physicians authorized to practice under the laws
12of this state or another state, without cost to the employee;
13but if the employee requests, the employee, at the employee’s
14own cost, is entitled to have a physician or physicians
15of the employee’s own selection present to participate in
16the examination. If an employee is required to leave work
17for which the employee is being paid wages to attend the
18requested examination, the employee shall be compensated at
19the employee’s regular rate for the time the employee is
20required to leave work, and the employee shall be furnished
21transportation to and from the place of examination, or the
22employer may elect to pay the employee the reasonable cost of
23the transportation. The refusal of the employee to submit
24to the examination shall forfeit the employee’s right to any
25compensation for the period of the refusal. Compensation shall
26not be payable for the period of refusal.
272. b. If an evaluation of permanent disability has been
28made by a physician retained by the employer and the employee
29believes this evaluation to be too low, the employee shall,
30upon application to the commissioner and upon delivery of a
31copy of the application to the employer and its insurance
32carrier, be reimbursed by the employer the reasonable fee for
33a subsequent examination by a physician of the employee’s
34own choice, and reasonably necessary transportation expenses
35incurred for the examination. The physician chosen by the
-4-1employee has the right to confer with and obtain from the
2employer-retained physician sufficient history of the injury
3to make a proper examination. An employer is only liable to
4reimburse an employee for the cost of an examination conducted
5pursuant to this subsection paragraph “b” if the injury for
6which the employee is being examined is determined to be
7compensable under this chapter or chapter 85A or 85B. An
8employer is not liable for the cost of such an examination
9if the injury for which the employee is being examined is
10determined not to be a compensable injury. A determination of
11the reasonableness of a fee for an examination made pursuant to
12this subsection paragraph “b”, shall be based on the typical fee
13charged by a medical provider to perform an impairment rating
14in the local area where the examination is conducted.
152. If the employee has chosen a physician to provide care
16as provided in section 85.27, subsection 4, paragraph “b”, when
17it is medically indicated that no significant improvement from
18an injury is anticipated, the employee may obtain a medical
19opinion from the employee’s physician, at the employer’s
20expense, regarding the extent of the employee’s permanent
21disability. If the employee obtains such an evaluation and the
22employer believes this evaluation of permanent disability to be
23too high, the employer may arrange for a medical examination of
24the injured employee by a physician of the employer’s choice
25for the purpose of obtaining a medical opinion regarding the
26extent of the employee’s permanent disability. If an employee
27is required to leave work for which the employee is being paid
28wages to attend an examination under this subsection, the
29employee shall be compensated at the employee’s regular rate
30for the time the employee is required to leave work, and the
31employee shall be furnished transportation to and from the
32place of examination, or the employer may elect to pay the
33employee the reasonable cost of transportation. The physician
34chosen by the employer to conduct the examination has the right
35to confer with and obtain from any physician who has treated
-5-1the injured employee sufficient history of the injury to make
2a proper examination. The refusal by the employee to submit
3to the examination shall forfeit the employee’s right to any
4compensation for the period of the refusal. Compensation shall
5not be payable for the period of refusal.
6 Sec. 3. EFFECTIVE DATE. This Act takes effect January 1,
72024.
8 Sec. 4. APPLICABILITY. This Act applies to injuries
9occurring on or after January 1, 2024.
10EXPLANATION
11The inclusion of this explanation does not constitute agreement with
12the explanation’s substance by the members of the general assembly.
13This bill relates to the choice of a physician to treat an
14injured employee under the state’s workers’ compensation laws.
15The bill allows the employer to choose care unless the employee
16has predesignated a physician as provided in the bill.
17The bill gives an employee the right to predesignate a
18physician who is a primary care provider, who has previously
19provided treatment to the employee and has retained the
20employee’s medical records, to provide treatment for a
21work-related injury. The employer is required to provide
22written notice to employees of this right upon hire, and
23periodically during employment, and upon receiving notice
24of an injury from an employee who has not yet predesignated
25a physician of the employee’s right to do so, in a manner
26prescribed by the workers’ compensation commissioner. An
27employer or an employer’s insurer shall not coerce or otherwise
28attempt to influence an injured employee’s choice of a
29physician.
30If the employer fails to provide such notification, an
31injured employee has the right to choose any physician to
32provide treatment for the work-related injury and that
33treatment shall be considered authorized care.
34If the employer or employee is dissatisfied with the care
35chosen by the other party, the dissatisfied party should
-6-1communicate the basis of dissatisfaction to the other party, in
2writing if requested, and the parties may agree to alternate
3care reasonably suited to treat the injury. If the parties
4cannot agree to such alternate care, the dissatisfied party may
5make an application for alternate care to the commissioner.
6An application for alternate care is an original proceeding
7and is treated as a contested case. A party may request that
8the hearing be held in person, by telephone, or by audio-video
9conference. The commissioner is required to issue a decision
10within 10 working days of receipt of an application if a
11telephone hearing or audio-video conference hearing is held or
12within 14 days if an in-person hearing is held.
13The bill provides that if the employee has chosen care, when
14it is medically indicated that no significant improvement from
15an injury is anticipated, the employee may obtain a medical
16opinion regarding the extent of the employee’s permanent
17disability. If the employer believes that the evaluation of
18permanent disability obtained by the employee is too high, the
19employer has the right to obtain another medical opinion from a
20physician of the employer’s choosing.
21The bill takes effect and applies to injuries occurring on or
22after January 1, 2024.
-7-je/rn