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House File 97 - IntroducedA Bill ForAn Act 1relating to the state’s workers’ compensation laws
2by modifying alternate care procedures for medical
3treatment, creating registries of physicians who treat
4and evaluate work-related injuries, providing for the
5retention of a medical director, creating a state workplace
6injury care providers registry fund, establishing a
7workers’ compensation advisory council, providing for and
8appropriating fees, and including effective date provisions.
9BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. Section 85.27, subsection 4, Code 2019, is
2amended by striking the subsection and inserting in lieu
3thereof the following:
44. a. For purposes of this section, the employer is
5obligated to furnish reasonable services and supplies to
6treat an injured employee and has the right to predesignate
7the initial provider of medical care. Upon receiving
8notification of an injury, the employer is also obligated
9to provide the injured employee with written information on
10the state’s workers’ compensation laws, including the rights
11and responsibilities of the employee and the employer and to
12document in writing that the employee received the information
13in a timely manner. The commissioner shall provide, by
14administrative rule, the format, content, and procedure for the
15predesignation of the initial provider of medical care by the
16employer and the provision of this information to the injured
17employee.
18(1) The employer shall promptly provide medical care for
19the injury and may predesignate a licensed physician to treat
20the injury and any condition the physician believes is causally
21related to the injury. If the employer has not predesignated
22a licensed physician to treat the injury and any condition
23causally related to the injury, the employee may designate a
24licensed physician of the employee’s choosing to provide that
25treatment.
26(2) The employer may predesignate a physician listed in the
27state registry of workplace injury care providers, as provided
28in section 85.73, to treat the injury and any condition
29causally related to the injury.
30(3) The physician predesignated by the employer or
31designated by the employee shall be authorized by the employer
32to treat the injury at the employer’s expense in any manner
33deemed appropriate by the physician, without a requirement of
34preapproval for such referrals by the employer, an agent or
35representative of the employer, or the employer’s insurer.
-1- 1(4) The physician predesignated by the employer or
2designated by the employee shall be authorized to make
3referrals to other physicians, therapists, or health care
4providers of specialized services at the employer’s expense
5without a requirement of preapproval for such referrals by the
6employer, an agent or representative of the employer, or the
7employer’s insurer.
8b. The physician predesignated by the employer or designated
9by the employee to treat the injured employee shall provide
10ongoing written documentation of the physician’s opinions,
11treatment recommendations, and care plan to the employee. Such
12documentation shall indicate whether or not the physician’s
13opinions, treatment recommendations, and care plan are in
14accord with the most recent edition of either the official
15disability guidelines and treatment guidelines in workers’
16compensation published by the work loss data institute or the
17American college of occupational and environmental medicine
18practice guidelines published by the American college of
19occupational and environmental medicine, and if so, shall cite
20the appropriate guidelines.
21c. (1) If an employee receives treatment for an injury
22from a physician predesignated by the employer and prior to
23an evaluation of permanent disability by that predesignated
24physician, the injured employee may be examined by and obtain a
25second opinion, treatment recommendations, or a care plan from
26another licensed physician of the employee’s choosing. The
27employee may request and the employer shall pay the reasonable
28costs associated with this examination, including reimbursement
29for transportation expenses incurred by the employee for
30the examination. The employee shall notify the physician
31predesignated by the employer that the employee is consulting
32with another physician of the employee’s choosing.
33(2) If an employee receives treatment for an injury from
34a physician designated by the employee, the employer is not
35responsible for the costs of obtaining a second opinion,
-2-1treatment recommendations, or a care plan from an additional
2licensed physician of the employee’s choosing.
3d. If the employer or employee has reason to be dissatisfied
4with the care of a treating physician predesignated or
5designated by the other party or with any referral made by that
6physician, the employer and employee may mutually agree upon
7alternate care.
8e. If the employer and employee cannot agree on alternate
9care, either the employer or employee may notify an insurance
10claims specialist within the division of workers’ compensation,
11who shall, within five working days schedule a conference
12between the employer and employee by any reasonable manner
13available to review the basis for dissatisfaction and provide
14an advisory opinion to resolve the medical care dispute.
15f. If, following the conference with the insurance claims
16specialist, the employer and employee cannot agree on such
17alternate care, the workers’ compensation commissioner, upon
18application and reasonable proof of the necessity therefor, may
19allow and order alternate care.
20(1) The employee is responsible to make the application
21for alternate care and to provide reasonable proof for the
22necessity of alternate care if all of the following actions
23occurred:
24(a) The employer provided written information about the
25state’s workers’ compensation laws as provided in paragraph
26“a”.
27(b) The employer predesignated a treating physician listed
28on the state registry of workplace injury care providers as
29provided in paragraph “a”, subparagraph (2).
30(c) The treating physician predesignated by the employer
31provided written documentation of the physician’s opinions,
32treatment recommendations, and care plan to the employee along
33with a citation to appropriate treatment guidelines as provided
34in paragraph “b”.
35(2) The employer is responsible to make the application
-3-1for alternate care and to provide reasonable proof for the
2necessity of alternate care if any of the actions specified in
3subparagraph (1) did not occur or if the employee designated
4the treating physician to treat the injury.
5(3) The commissioner shall not be bound by the advisory
6opinion of the insurance claims specialist. Upon application,
7the workers’ compensation commissioner shall conduct a hearing
8in any reasonable manner to effectuate a prompt resolution of
9the alternate care dispute. The commissioner shall issue a
10decision within ten working days of receipt of an application
11for alternate care.
12(4) The employer or its insurer is liable for the costs of
13all medical care provided by a physician predesignated by the
14employer or designated by the employee pursuant to paragraph
15“a”, subparagraph (1), or from referrals from the predesignated
16or designated physician, and shall hold the employee harmless
17for the cost of care by the predesignated or designated care
18providers.
19(5) In an emergency, the employee may choose the employee’s
20care at the employer’s expense, provided the employer or the
21employer’s agent cannot be immediately contacted to indicate
22who the employer has predesignated as a treating physician.
23(6) The employer shall notify an injured employee of the
24employee’s ability to contest the employer’s choice of the
25predesignated treating physician or other provider of medical
26care as part of the information given to the employee as
27required under paragraph “a”.
28g. (1) The employer has the right to request an employee
29to submit, as often as is reasonable and at a reasonable time
30and place, to an examination by a licensed physician chosen
31by the employer for any purpose relevant to the employer’s
32duties to provide benefits to the employee under this chapter,
33or chapters 85A, 85B, and 86. If the employer makes such a
34request to an employee in writing and offers to advance or
35reimburse the employee’s transportation expenses incurred
-4-1in traveling to and from the place of the examination, the
2employee shall submit to the examination.
3(2) Each time that an employee is requested to and submits
4to an examination requested by the employer as provided in
5subparagraph (1), the employee has the right to be examined by
6a licensed physician chosen by the employee for any purpose
7relevant to the employer’s duties to provide benefits to the
8employee as described in subparagraph (1).
9(3) Each time that an employer obtains an evaluation of
10an employee’s permanent disability by a physician chosen
11by the employer, if the injured employee believes that the
12evaluation of the extent of the employee’s permanent disability
13is too low, the employee may obtain a subsequent examination
14and evaluation of the employee’s permanent disability by a
15physician of the employee’s choice. The physician chosen by
16the employee has the right to confer with and obtain sufficient
17medical history of the employee from the physician who examined
18the employee on behalf of the employer to make a proper
19evaluation of the employee’s permanent disability.
20(4) The employer shall promptly pay the costs of any
21examination obtained pursuant to this paragraph “g”, or if
22necessary to obtain the examination, advance the costs of
23the examination, and pay the employee’s reasonably necessary
24transportation expenses incurred in traveling to and from the
25place of any examination and shall hold the employee harmless
26for the cost of all examinations and medical care provided
27pursuant to this paragraph “g” and the employee’s reasonably
28necessary transportation expenses.
29 Sec. 2. NEW SECTION. 85.73 State workplace injury care
30providers — registry — fees.
311. The workers’ compensation commissioner shall establish
32and maintain a registry of physicians licensed in the state
33that offer or provide treatment of work-related injuries.
342. The commissioner, by administrative rule, shall
35establish requirements for a physician to be listed on the
-5-1registry and establish a registration fee.
23. This section shall not be construed to require a
3physician to be listed on the registry in order to offer or
4provide treatment of work-related injuries.
54. This section shall not be construed to prohibit an
6employer from predesignating or an employee from designating a
7physician to provide treatment of a work-related injury who is
8not listed on the registry.
9 Sec. 3. NEW SECTION. 85.74 Independent medical evaluations
10— providers — registry — fees.
111. The commissioner shall establish and maintain a separate
12registry of licensed physicians trained to perform independent
13medical evaluations and to issue impairment ratings of injured
14employees.
152. The commissioner shall establish, by administrative
16rule, minimum training requirements for a physician to be
17listed on the registry and establish a registration fee.
183. The commissioner shall also provide by administrative
19rule that a physician must be listed on the registry in order
20to perform independent medical evaluations and issue impairment
21ratings of injured employees in this state. The commissioner
22may prohibit an employer or employee from using an independent
23medical evaluation or an impairment rating of an injured
24employee from a physician who is not listed on the registry
25as evidence at a hearing to determine benefits under Iowa’s
26workers’ compensation laws.
27 Sec. 4. NEW SECTION. 85.75 Fees appropriated.
28All fees collected pursuant to sections 85.73 and 85.74
29shall be credited to the state workplace injury care providers
30registry fund created in section 85.77 and are appropriated to
31the division to be used to carry out the provisions of sections
3285.73, 85.74, 85.76, and 85.78, including but not limited
33to establishing and maintaining the registries described in
34sections 85.73 and 85.74, retaining a medical director as set
35forth in section 85.76, and providing for the expenses of the
-6-1workers’ compensation advisory council created in section
285.78.
3 Sec. 5. NEW SECTION. 85.76 Medical director.
4The workers’ compensation commissioner may retain the
5services of a medical director to assist the division of
6workers’ compensation in advancing occupational health in Iowa
7and to advise the commissioner on how to successfully apply and
8administer the state’s workers’ compensation laws, including
9assessments of the use of evidence-based care in treating
10work-related injuries.
11 Sec. 6. NEW SECTION. 85.77 State workplace injury care
12providers registry fund.
131. A state workplace injury care providers registry fund
14is created in the state treasury as a separate fund under the
15control of the division of workers’ compensation. All moneys
16appropriated or transferred to the fund shall be credited to
17the fund. All moneys deposited or paid into the fund shall
18only be appropriated to the workers’ compensation commissioner
19to be used for the purposes set forth in sections 85.73, 85.74,
2085.75, and 85.76.
212. Notwithstanding section 8.33, any balance in the fund
22on June 30 of each fiscal year shall not revert to the general
23fund of the state, but shall be available for purposes of
24sections 85.73, 85.74, 85.75, 85.76, and 85.78 in subsequent
25fiscal years. Notwithstanding section 12C.7, interest earnings
26on moneys in the fund shall be credited to the fund.
27 Sec. 7. NEW SECTION. 85.78 Workers’ compensation advisory
28council.
291. A workers’ compensation advisory council is established
30within the division of workers’ compensation. The council
31shall be composed of the following persons:
32a. Two members appointed by the governor and subject to
33confirmation by the senate pursuant to section 2.32, one
34representing employers, and one representing organized labor.
35b. Two members appointed jointly by the majority leader and
-7-1the minority leader of the senate, one representing employers,
2and one representing organized labor.
3c. Two members appointed jointly by the speaker and
4the minority leader of the house of representatives, one
5representing employers and one representing organized labor.
62. The members shall serve six-year terms beginning and
7ending as provided in section 69.19. However, the initial
8members shall be appointed to serve for less than six years to
9ensure members serve staggered terms. A member is eligible for
10reappointment. A vacancy on the council shall be filled for
11the unexpired portion of the regular term in the same manner as
12regular appointments are made.
133. One representative of employers and one of organized
14labor shall be elected as co-chairpersons by the council and
15shall serve for two-year staggered terms. However, one of
16the initial co-chairpersons shall be elected to serve for
17a three-year term to ensure that the co-chairpersons serve
18staggered terms.
194. Four members constitute a quorum. The affirmative
20vote of a majority of the voting members present as well as
21the approval of at least two employer representatives and two
22labor representatives is necessary for any substantive action
23to be taken by the council. The majority shall not include
24any member who has a conflict of interest and a statement by a
25member that the member has a conflict of interest is conclusive
26for this purpose. A vacancy in the membership does not impair
27the duties of the council.
285. The council shall meet on a regular basis and at the
29call of the co-chairpersons or upon the written request to the
30co-chairpersons of two or more members.
316. The members are entitled to receive a per diem allowance
32and actual expense reimbursement as specified in section 7E.6.
337. The purpose of the council is to assist the workers’
34compensation commissioner in the successful administration
35of the division of workers’ compensation and to make
-8-1recommendations to the governor and the general assembly
2regarding workplace safety and improvements to the state’s
3workers’ compensation system.
48. The responsibilities of the council are as follows:
5a. Monitor and support the successful implementation of the
6state’s workers’ compensation laws.
7b. Identify problems and recommend solutions and
8improvements with respect to the effectiveness of the state’s
9workers’ compensation system, to the division of workers’
10compensation, and to the governor and the general assembly.
11c. Assist the workers’ compensation commissioner in
12developing and implementing a program to train and certify
13claims adjusters for practice in Iowa.
14d. Work with all stakeholders, including the medical
15director retained pursuant to section 85.76, to develop and
16promote a system of high-performance, transparent, accountable,
17and evidence-based health care for the treatment and prevention
18of workplace injuries.
19e. Make recommendations to and receive recommendations from
20the nonprofit Iowa workers’ compensation advisory committee
21regarding topics for stakeholder and public education with
22respect to the application of workers’ compensation law and
23successful workers’ compensation programs and strategies, as
24well as the prevention of workplace injuries.
25 Sec. 8. EFFECTIVE DATE. The following provision or
26provisions of this Act take effect July 1, 2020:
271. The section of this Act amending section 85.27.
282. The section of this Act enacting section 85.74.
29 Sec. 9. EFFECTIVE DATE. The following provision or
30provisions of this Act take effect January 1, 2020:
311. The section of this Act enacting section 85.73.
322. The section of this Act enacting section 85.75.
333. The section of this Act enacting section 85.76.
344. The section of this Act enacting section 85.77.
355. The section of this Act enacting section 85.78.
-9-1EXPLANATION
2The inclusion of this explanation does not constitute agreement with
3the explanation’s substance by the members of the general assembly.
4This bill relates to the state’s workers’ compensation laws
5by modifying alternate care procedures for medical treatment,
6creating registries of physicians who treat and evaluate
7work-related injuries, providing for the retention of a medical
8director, creating a state workplace injury care providers
9registry fund, establishing a workers’ compensation advisory
10council, providing for fees, and providing effective dates.
11ALTERNATE CARE. Amended Code section 85.27(4), concerning
12the provision of medical services, requires an employer
13to provide written information about the state’s workers’
14compensation laws to an employee upon receiving notification
15that the employee has suffered a work-related injury. The
16employer has the right to predesignate a licensed physician
17to treat the injury and make necessary referrals and may
18predesignate a physician listed on the state registry of
19workplace injury care providers. If the employer does not
20predesignate a treating physician, the employee may designate a
21physician of the employee’s choosing to provide the treatment.
22Currently, an employer has the right to choose care for
23workplace injuries and an employee does not have the right
24to designate a physician to provide treatment for workplace
25injuries, whether or not the employer has predesignated a
26treating physician, except in certain emergency situations.
27The physician predesignated by the employer or designated
28by the employee is required to provide ongoing written
29documentation of the physician’s opinions, treatment
30recommendations, and care plan to the employee along with
31information about whether the opinions, recommendations, and
32care plan are in accord with either the official disability
33guidelines and treatment guidelines in workers’ compensation
34published by the work loss data institute or the American
35college of occupational and environmental medicine practice
-10-1guidelines (ACOEM), and if so, citation to the appropriate
2guidelines. The employee has the right to request and obtain
3a second opinion from another licensed physician of the
4employee’s choosing at the employer’s expense.
5If the employer or employee is dissatisfied with the care
6of a treating physician predesignated or designated by the
7other party or with any referral made by that physician, the
8employer and employee may mutually agree to alternate care. If
9they cannot agree on alternate care, either party may notify
10an insurance claims specialist within the division of workers’
11compensation, who shall, within five working days, schedule
12a conference between the parties to review the basis for
13dissatisfaction and provide an advisory opinion to resolve the
14dispute. If the parties still cannot agree on alternate care
15after this conference, the workers’ compensation commissioner,
16upon application and reasonable proof of the necessity, may
17allow and order alternate care.
18The employee is responsible to make the application for
19alternate care and to provide such reasonable proof to the
20commissioner if the employer provided written information
21about the state’s workers’ compensation laws at the time of
22notification of the employee’s injury, and predesignated a
23treating physician listed on the state registry of workplace
24injury care providers, and if the treating physician
25predesignated by the employer provided written documentation
26to the employee of the physician’s opinions, treatment
27recommendations, and care plan along with citation to the
28appropriate treatment guidelines.
29The employer is responsible for making the application for
30alternate care and providing reasonable proof if the employer
31and predesignated treating physician did not act as described
32above or if the employee designated the treating physician to
33treat the work injury.
34The commissioner is not bound by the advisory opinion of
35the claims specialist and must conduct a hearing and issue
-11-1a decision within 10 days of receipt of an application for
2alternate care.
3The employer has the right to request an employee to submit,
4as often as is reasonable and at a reasonable time and place
5to an examination by a licensed physician chosen by the
6employer for any purpose relevant to the employer’s duties to
7provide benefits to the employee under the state’s workers’
8compensation laws and at the employer’s expense. If the
9employer makes the request in writing and pays all expenses,
10including transportation, the employee shall submit to the
11examination. Each time that the employer obtains an evaluation
12of an employee’s permanent disability by a physician chosen by
13the employer, if the employee believes that the evaluation of
14disability is too low, the employee may obtain a subsequent
15examination and evaluation by a physician of the employee’s
16choosing at the employer’s expense, including transportation
17expenses to and from the place of the examination.
18PROVIDER REGISTRIES — FEES — MEDICAL DIRECTOR. New Code
19section 85.73 requires the workers’ compensation commissioner
20to establish and maintain a registry of licensed physicians
21that offer or provide treatment of work-related injuries.
22The commissioner shall establish, by administrative rule,
23requirements for a physician to be listed on the registry and
24establish a registration fee. The provision shall not be
25construed to require a physician to be listed on the registry
26in order to offer or provide treatment of work-related injuries
27or to prohibit an employer or employee from predesignating or
28designating a physician to provide treatment who is not listed
29on the registry.
30New Code section 85.74 requires the commissioner to
31establish and maintain a separate registry of licensed
32physicians trained to perform independent medical evaluations
33and to issue impairment ratings of injured employees. The
34commissioner shall establish, by administrative rule, minimum
35training requirements for a physician to be listed on the
-12-1registry and establish a fee. A physician must be listed
2on the registry in order to perform independent medical
3evaluations and issue impairment ratings of injured employees
4in this state. The commissioner may prohibit an employer
5or employee from using an independent medical evaluation or
6impairment rating of an injured employee from a physician who
7is not listed on the registry as evidence at a hearing to
8determine benefits under Iowa’s workers’ compensation laws.
9New Code section 85.76 authorizes the commissioner to
10retain the services of a medical director to assist the
11division of workers’ compensation in advancing the field of
12occupational health in Iowa and to advise the commissioner on
13how to successfully apply and administer the state’s workers’
14compensation laws.
15STATE WORKPLACE INJURY CARE PROVIDERS REGISTRY FUND. All
16registration fees collected pursuant to new Code sections 85.73
17and 85.74 shall be credited to the state workplace injury care
18providers registry fund created in new Code section 85.77 and
19are appropriated to the division of workers’ compensation by
20new Code section 85.75 to carry out the provisions of new Code
21sections 85.73, 85.74, 85.75, and 85.76 including establishing
22and maintaining the two physician registries, retaining
23a medical director, and for the expenses of the workers’
24compensation advisory council created in new Code section
2585.78.
26WORKERS’ COMPENSATION ADVISORY COUNCIL. New Code section
2785.78 establishes a workers’ compensation advisory council
28within the division of workers’ compensation that is composed
29of six members, three representing employers and three
30representing organized labor. The governor appoints two of the
31members, the majority leader and the minority leader of the
32senate jointly appoint two members, and the speaker and the
33minority leader of the house of representatives jointly appoint
34two members. The members serve six-year staggered terms. The
35purpose of the council is to assist the workers’ compensation
-13-1commissioner in the successful administration of the division
2of workers’ compensation and to make recommendations to the
3governor and the general assembly regarding workplace safety
4and improvements to the state’s workers’ compensation system.
5EFFECTIVE DATES. The sections of the bill creating the
6provider registry for treatment of work injuries, the provider
7registry fund, the position of medical director, and the
8advisory council, and appropriating fees, take effect January
91, 2020. The sections of the bill pertaining to alternate care
10procedures and required registration of physicians performing
11independent medical evaluations and impairment ratings take
12effect July 1, 2020.
-14-asf/rn
2by modifying alternate care procedures for medical
3treatment, creating registries of physicians who treat
4and evaluate work-related injuries, providing for the
5retention of a medical director, creating a state workplace
6injury care providers registry fund, establishing a
7workers’ compensation advisory council, providing for and
8appropriating fees, and including effective date provisions.
9BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. Section 85.27, subsection 4, Code 2019, is
2amended by striking the subsection and inserting in lieu
3thereof the following:
44. a. For purposes of this section, the employer is
5obligated to furnish reasonable services and supplies to
6treat an injured employee and has the right to predesignate
7the initial provider of medical care. Upon receiving
8notification of an injury, the employer is also obligated
9to provide the injured employee with written information on
10the state’s workers’ compensation laws, including the rights
11and responsibilities of the employee and the employer and to
12document in writing that the employee received the information
13in a timely manner. The commissioner shall provide, by
14administrative rule, the format, content, and procedure for the
15predesignation of the initial provider of medical care by the
16employer and the provision of this information to the injured
17employee.
18(1) The employer shall promptly provide medical care for
19the injury and may predesignate a licensed physician to treat
20the injury and any condition the physician believes is causally
21related to the injury. If the employer has not predesignated
22a licensed physician to treat the injury and any condition
23causally related to the injury, the employee may designate a
24licensed physician of the employee’s choosing to provide that
25treatment.
26(2) The employer may predesignate a physician listed in the
27state registry of workplace injury care providers, as provided
28in section 85.73, to treat the injury and any condition
29causally related to the injury.
30(3) The physician predesignated by the employer or
31designated by the employee shall be authorized by the employer
32to treat the injury at the employer’s expense in any manner
33deemed appropriate by the physician, without a requirement of
34preapproval for such referrals by the employer, an agent or
35representative of the employer, or the employer’s insurer.
-1- 1(4) The physician predesignated by the employer or
2designated by the employee shall be authorized to make
3referrals to other physicians, therapists, or health care
4providers of specialized services at the employer’s expense
5without a requirement of preapproval for such referrals by the
6employer, an agent or representative of the employer, or the
7employer’s insurer.
8b. The physician predesignated by the employer or designated
9by the employee to treat the injured employee shall provide
10ongoing written documentation of the physician’s opinions,
11treatment recommendations, and care plan to the employee. Such
12documentation shall indicate whether or not the physician’s
13opinions, treatment recommendations, and care plan are in
14accord with the most recent edition of either the official
15disability guidelines and treatment guidelines in workers’
16compensation published by the work loss data institute or the
17American college of occupational and environmental medicine
18practice guidelines published by the American college of
19occupational and environmental medicine, and if so, shall cite
20the appropriate guidelines.
21c. (1) If an employee receives treatment for an injury
22from a physician predesignated by the employer and prior to
23an evaluation of permanent disability by that predesignated
24physician, the injured employee may be examined by and obtain a
25second opinion, treatment recommendations, or a care plan from
26another licensed physician of the employee’s choosing. The
27employee may request and the employer shall pay the reasonable
28costs associated with this examination, including reimbursement
29for transportation expenses incurred by the employee for
30the examination. The employee shall notify the physician
31predesignated by the employer that the employee is consulting
32with another physician of the employee’s choosing.
33(2) If an employee receives treatment for an injury from
34a physician designated by the employee, the employer is not
35responsible for the costs of obtaining a second opinion,
-2-1treatment recommendations, or a care plan from an additional
2licensed physician of the employee’s choosing.
3d. If the employer or employee has reason to be dissatisfied
4with the care of a treating physician predesignated or
5designated by the other party or with any referral made by that
6physician, the employer and employee may mutually agree upon
7alternate care.
8e. If the employer and employee cannot agree on alternate
9care, either the employer or employee may notify an insurance
10claims specialist within the division of workers’ compensation,
11who shall, within five working days schedule a conference
12between the employer and employee by any reasonable manner
13available to review the basis for dissatisfaction and provide
14an advisory opinion to resolve the medical care dispute.
15f. If, following the conference with the insurance claims
16specialist, the employer and employee cannot agree on such
17alternate care, the workers’ compensation commissioner, upon
18application and reasonable proof of the necessity therefor, may
19allow and order alternate care.
20(1) The employee is responsible to make the application
21for alternate care and to provide reasonable proof for the
22necessity of alternate care if all of the following actions
23occurred:
24(a) The employer provided written information about the
25state’s workers’ compensation laws as provided in paragraph
26“a”.
27(b) The employer predesignated a treating physician listed
28on the state registry of workplace injury care providers as
29provided in paragraph “a”, subparagraph (2).
30(c) The treating physician predesignated by the employer
31provided written documentation of the physician’s opinions,
32treatment recommendations, and care plan to the employee along
33with a citation to appropriate treatment guidelines as provided
34in paragraph “b”.
35(2) The employer is responsible to make the application
-3-1for alternate care and to provide reasonable proof for the
2necessity of alternate care if any of the actions specified in
3subparagraph (1) did not occur or if the employee designated
4the treating physician to treat the injury.
5(3) The commissioner shall not be bound by the advisory
6opinion of the insurance claims specialist. Upon application,
7the workers’ compensation commissioner shall conduct a hearing
8in any reasonable manner to effectuate a prompt resolution of
9the alternate care dispute. The commissioner shall issue a
10decision within ten working days of receipt of an application
11for alternate care.
12(4) The employer or its insurer is liable for the costs of
13all medical care provided by a physician predesignated by the
14employer or designated by the employee pursuant to paragraph
15“a”, subparagraph (1), or from referrals from the predesignated
16or designated physician, and shall hold the employee harmless
17for the cost of care by the predesignated or designated care
18providers.
19(5) In an emergency, the employee may choose the employee’s
20care at the employer’s expense, provided the employer or the
21employer’s agent cannot be immediately contacted to indicate
22who the employer has predesignated as a treating physician.
23(6) The employer shall notify an injured employee of the
24employee’s ability to contest the employer’s choice of the
25predesignated treating physician or other provider of medical
26care as part of the information given to the employee as
27required under paragraph “a”.
28g. (1) The employer has the right to request an employee
29to submit, as often as is reasonable and at a reasonable time
30and place, to an examination by a licensed physician chosen
31by the employer for any purpose relevant to the employer’s
32duties to provide benefits to the employee under this chapter,
33or chapters 85A, 85B, and 86. If the employer makes such a
34request to an employee in writing and offers to advance or
35reimburse the employee’s transportation expenses incurred
-4-1in traveling to and from the place of the examination, the
2employee shall submit to the examination.
3(2) Each time that an employee is requested to and submits
4to an examination requested by the employer as provided in
5subparagraph (1), the employee has the right to be examined by
6a licensed physician chosen by the employee for any purpose
7relevant to the employer’s duties to provide benefits to the
8employee as described in subparagraph (1).
9(3) Each time that an employer obtains an evaluation of
10an employee’s permanent disability by a physician chosen
11by the employer, if the injured employee believes that the
12evaluation of the extent of the employee’s permanent disability
13is too low, the employee may obtain a subsequent examination
14and evaluation of the employee’s permanent disability by a
15physician of the employee’s choice. The physician chosen by
16the employee has the right to confer with and obtain sufficient
17medical history of the employee from the physician who examined
18the employee on behalf of the employer to make a proper
19evaluation of the employee’s permanent disability.
20(4) The employer shall promptly pay the costs of any
21examination obtained pursuant to this paragraph “g”, or if
22necessary to obtain the examination, advance the costs of
23the examination, and pay the employee’s reasonably necessary
24transportation expenses incurred in traveling to and from the
25place of any examination and shall hold the employee harmless
26for the cost of all examinations and medical care provided
27pursuant to this paragraph “g” and the employee’s reasonably
28necessary transportation expenses.
29 Sec. 2. NEW SECTION. 85.73 State workplace injury care
30providers — registry — fees.
311. The workers’ compensation commissioner shall establish
32and maintain a registry of physicians licensed in the state
33that offer or provide treatment of work-related injuries.
342. The commissioner, by administrative rule, shall
35establish requirements for a physician to be listed on the
-5-1registry and establish a registration fee.
23. This section shall not be construed to require a
3physician to be listed on the registry in order to offer or
4provide treatment of work-related injuries.
54. This section shall not be construed to prohibit an
6employer from predesignating or an employee from designating a
7physician to provide treatment of a work-related injury who is
8not listed on the registry.
9 Sec. 3. NEW SECTION. 85.74 Independent medical evaluations
10— providers — registry — fees.
111. The commissioner shall establish and maintain a separate
12registry of licensed physicians trained to perform independent
13medical evaluations and to issue impairment ratings of injured
14employees.
152. The commissioner shall establish, by administrative
16rule, minimum training requirements for a physician to be
17listed on the registry and establish a registration fee.
183. The commissioner shall also provide by administrative
19rule that a physician must be listed on the registry in order
20to perform independent medical evaluations and issue impairment
21ratings of injured employees in this state. The commissioner
22may prohibit an employer or employee from using an independent
23medical evaluation or an impairment rating of an injured
24employee from a physician who is not listed on the registry
25as evidence at a hearing to determine benefits under Iowa’s
26workers’ compensation laws.
27 Sec. 4. NEW SECTION. 85.75 Fees appropriated.
28All fees collected pursuant to sections 85.73 and 85.74
29shall be credited to the state workplace injury care providers
30registry fund created in section 85.77 and are appropriated to
31the division to be used to carry out the provisions of sections
3285.73, 85.74, 85.76, and 85.78, including but not limited
33to establishing and maintaining the registries described in
34sections 85.73 and 85.74, retaining a medical director as set
35forth in section 85.76, and providing for the expenses of the
-6-1workers’ compensation advisory council created in section
285.78.
3 Sec. 5. NEW SECTION. 85.76 Medical director.
4The workers’ compensation commissioner may retain the
5services of a medical director to assist the division of
6workers’ compensation in advancing occupational health in Iowa
7and to advise the commissioner on how to successfully apply and
8administer the state’s workers’ compensation laws, including
9assessments of the use of evidence-based care in treating
10work-related injuries.
11 Sec. 6. NEW SECTION. 85.77 State workplace injury care
12providers registry fund.
131. A state workplace injury care providers registry fund
14is created in the state treasury as a separate fund under the
15control of the division of workers’ compensation. All moneys
16appropriated or transferred to the fund shall be credited to
17the fund. All moneys deposited or paid into the fund shall
18only be appropriated to the workers’ compensation commissioner
19to be used for the purposes set forth in sections 85.73, 85.74,
2085.75, and 85.76.
212. Notwithstanding section 8.33, any balance in the fund
22on June 30 of each fiscal year shall not revert to the general
23fund of the state, but shall be available for purposes of
24sections 85.73, 85.74, 85.75, 85.76, and 85.78 in subsequent
25fiscal years. Notwithstanding section 12C.7, interest earnings
26on moneys in the fund shall be credited to the fund.
27 Sec. 7. NEW SECTION. 85.78 Workers’ compensation advisory
28council.
291. A workers’ compensation advisory council is established
30within the division of workers’ compensation. The council
31shall be composed of the following persons:
32a. Two members appointed by the governor and subject to
33confirmation by the senate pursuant to section 2.32, one
34representing employers, and one representing organized labor.
35b. Two members appointed jointly by the majority leader and
-7-1the minority leader of the senate, one representing employers,
2and one representing organized labor.
3c. Two members appointed jointly by the speaker and
4the minority leader of the house of representatives, one
5representing employers and one representing organized labor.
62. The members shall serve six-year terms beginning and
7ending as provided in section 69.19. However, the initial
8members shall be appointed to serve for less than six years to
9ensure members serve staggered terms. A member is eligible for
10reappointment. A vacancy on the council shall be filled for
11the unexpired portion of the regular term in the same manner as
12regular appointments are made.
133. One representative of employers and one of organized
14labor shall be elected as co-chairpersons by the council and
15shall serve for two-year staggered terms. However, one of
16the initial co-chairpersons shall be elected to serve for
17a three-year term to ensure that the co-chairpersons serve
18staggered terms.
194. Four members constitute a quorum. The affirmative
20vote of a majority of the voting members present as well as
21the approval of at least two employer representatives and two
22labor representatives is necessary for any substantive action
23to be taken by the council. The majority shall not include
24any member who has a conflict of interest and a statement by a
25member that the member has a conflict of interest is conclusive
26for this purpose. A vacancy in the membership does not impair
27the duties of the council.
285. The council shall meet on a regular basis and at the
29call of the co-chairpersons or upon the written request to the
30co-chairpersons of two or more members.
316. The members are entitled to receive a per diem allowance
32and actual expense reimbursement as specified in section 7E.6.
337. The purpose of the council is to assist the workers’
34compensation commissioner in the successful administration
35of the division of workers’ compensation and to make
-8-1recommendations to the governor and the general assembly
2regarding workplace safety and improvements to the state’s
3workers’ compensation system.
48. The responsibilities of the council are as follows:
5a. Monitor and support the successful implementation of the
6state’s workers’ compensation laws.
7b. Identify problems and recommend solutions and
8improvements with respect to the effectiveness of the state’s
9workers’ compensation system, to the division of workers’
10compensation, and to the governor and the general assembly.
11c. Assist the workers’ compensation commissioner in
12developing and implementing a program to train and certify
13claims adjusters for practice in Iowa.
14d. Work with all stakeholders, including the medical
15director retained pursuant to section 85.76, to develop and
16promote a system of high-performance, transparent, accountable,
17and evidence-based health care for the treatment and prevention
18of workplace injuries.
19e. Make recommendations to and receive recommendations from
20the nonprofit Iowa workers’ compensation advisory committee
21regarding topics for stakeholder and public education with
22respect to the application of workers’ compensation law and
23successful workers’ compensation programs and strategies, as
24well as the prevention of workplace injuries.
25 Sec. 8. EFFECTIVE DATE. The following provision or
26provisions of this Act take effect July 1, 2020:
271. The section of this Act amending section 85.27.
282. The section of this Act enacting section 85.74.
29 Sec. 9. EFFECTIVE DATE. The following provision or
30provisions of this Act take effect January 1, 2020:
311. The section of this Act enacting section 85.73.
322. The section of this Act enacting section 85.75.
333. The section of this Act enacting section 85.76.
344. The section of this Act enacting section 85.77.
355. The section of this Act enacting section 85.78.
-9-1EXPLANATION
2The inclusion of this explanation does not constitute agreement with
3the explanation’s substance by the members of the general assembly.
4This bill relates to the state’s workers’ compensation laws
5by modifying alternate care procedures for medical treatment,
6creating registries of physicians who treat and evaluate
7work-related injuries, providing for the retention of a medical
8director, creating a state workplace injury care providers
9registry fund, establishing a workers’ compensation advisory
10council, providing for fees, and providing effective dates.
11ALTERNATE CARE. Amended Code section 85.27(4), concerning
12the provision of medical services, requires an employer
13to provide written information about the state’s workers’
14compensation laws to an employee upon receiving notification
15that the employee has suffered a work-related injury. The
16employer has the right to predesignate a licensed physician
17to treat the injury and make necessary referrals and may
18predesignate a physician listed on the state registry of
19workplace injury care providers. If the employer does not
20predesignate a treating physician, the employee may designate a
21physician of the employee’s choosing to provide the treatment.
22Currently, an employer has the right to choose care for
23workplace injuries and an employee does not have the right
24to designate a physician to provide treatment for workplace
25injuries, whether or not the employer has predesignated a
26treating physician, except in certain emergency situations.
27The physician predesignated by the employer or designated
28by the employee is required to provide ongoing written
29documentation of the physician’s opinions, treatment
30recommendations, and care plan to the employee along with
31information about whether the opinions, recommendations, and
32care plan are in accord with either the official disability
33guidelines and treatment guidelines in workers’ compensation
34published by the work loss data institute or the American
35college of occupational and environmental medicine practice
-10-1guidelines (ACOEM), and if so, citation to the appropriate
2guidelines. The employee has the right to request and obtain
3a second opinion from another licensed physician of the
4employee’s choosing at the employer’s expense.
5If the employer or employee is dissatisfied with the care
6of a treating physician predesignated or designated by the
7other party or with any referral made by that physician, the
8employer and employee may mutually agree to alternate care. If
9they cannot agree on alternate care, either party may notify
10an insurance claims specialist within the division of workers’
11compensation, who shall, within five working days, schedule
12a conference between the parties to review the basis for
13dissatisfaction and provide an advisory opinion to resolve the
14dispute. If the parties still cannot agree on alternate care
15after this conference, the workers’ compensation commissioner,
16upon application and reasonable proof of the necessity, may
17allow and order alternate care.
18The employee is responsible to make the application for
19alternate care and to provide such reasonable proof to the
20commissioner if the employer provided written information
21about the state’s workers’ compensation laws at the time of
22notification of the employee’s injury, and predesignated a
23treating physician listed on the state registry of workplace
24injury care providers, and if the treating physician
25predesignated by the employer provided written documentation
26to the employee of the physician’s opinions, treatment
27recommendations, and care plan along with citation to the
28appropriate treatment guidelines.
29The employer is responsible for making the application for
30alternate care and providing reasonable proof if the employer
31and predesignated treating physician did not act as described
32above or if the employee designated the treating physician to
33treat the work injury.
34The commissioner is not bound by the advisory opinion of
35the claims specialist and must conduct a hearing and issue
-11-1a decision within 10 days of receipt of an application for
2alternate care.
3The employer has the right to request an employee to submit,
4as often as is reasonable and at a reasonable time and place
5to an examination by a licensed physician chosen by the
6employer for any purpose relevant to the employer’s duties to
7provide benefits to the employee under the state’s workers’
8compensation laws and at the employer’s expense. If the
9employer makes the request in writing and pays all expenses,
10including transportation, the employee shall submit to the
11examination. Each time that the employer obtains an evaluation
12of an employee’s permanent disability by a physician chosen by
13the employer, if the employee believes that the evaluation of
14disability is too low, the employee may obtain a subsequent
15examination and evaluation by a physician of the employee’s
16choosing at the employer’s expense, including transportation
17expenses to and from the place of the examination.
18PROVIDER REGISTRIES — FEES — MEDICAL DIRECTOR. New Code
19section 85.73 requires the workers’ compensation commissioner
20to establish and maintain a registry of licensed physicians
21that offer or provide treatment of work-related injuries.
22The commissioner shall establish, by administrative rule,
23requirements for a physician to be listed on the registry and
24establish a registration fee. The provision shall not be
25construed to require a physician to be listed on the registry
26in order to offer or provide treatment of work-related injuries
27or to prohibit an employer or employee from predesignating or
28designating a physician to provide treatment who is not listed
29on the registry.
30New Code section 85.74 requires the commissioner to
31establish and maintain a separate registry of licensed
32physicians trained to perform independent medical evaluations
33and to issue impairment ratings of injured employees. The
34commissioner shall establish, by administrative rule, minimum
35training requirements for a physician to be listed on the
-12-1registry and establish a fee. A physician must be listed
2on the registry in order to perform independent medical
3evaluations and issue impairment ratings of injured employees
4in this state. The commissioner may prohibit an employer
5or employee from using an independent medical evaluation or
6impairment rating of an injured employee from a physician who
7is not listed on the registry as evidence at a hearing to
8determine benefits under Iowa’s workers’ compensation laws.
9New Code section 85.76 authorizes the commissioner to
10retain the services of a medical director to assist the
11division of workers’ compensation in advancing the field of
12occupational health in Iowa and to advise the commissioner on
13how to successfully apply and administer the state’s workers’
14compensation laws.
15STATE WORKPLACE INJURY CARE PROVIDERS REGISTRY FUND. All
16registration fees collected pursuant to new Code sections 85.73
17and 85.74 shall be credited to the state workplace injury care
18providers registry fund created in new Code section 85.77 and
19are appropriated to the division of workers’ compensation by
20new Code section 85.75 to carry out the provisions of new Code
21sections 85.73, 85.74, 85.75, and 85.76 including establishing
22and maintaining the two physician registries, retaining
23a medical director, and for the expenses of the workers’
24compensation advisory council created in new Code section
2585.78.
26WORKERS’ COMPENSATION ADVISORY COUNCIL. New Code section
2785.78 establishes a workers’ compensation advisory council
28within the division of workers’ compensation that is composed
29of six members, three representing employers and three
30representing organized labor. The governor appoints two of the
31members, the majority leader and the minority leader of the
32senate jointly appoint two members, and the speaker and the
33minority leader of the house of representatives jointly appoint
34two members. The members serve six-year staggered terms. The
35purpose of the council is to assist the workers’ compensation
-13-1commissioner in the successful administration of the division
2of workers’ compensation and to make recommendations to the
3governor and the general assembly regarding workplace safety
4and improvements to the state’s workers’ compensation system.
5EFFECTIVE DATES. The sections of the bill creating the
6provider registry for treatment of work injuries, the provider
7registry fund, the position of medical director, and the
8advisory council, and appropriating fees, take effect January
91, 2020. The sections of the bill pertaining to alternate care
10procedures and required registration of physicians performing
11independent medical evaluations and impairment ratings take
12effect July 1, 2020.
-14-asf/rn