An Employer’s Right to Choose Medical Care and Related Exceptions

The Iowa Workers’ Compensation Act provides for the payment of all reasonable and necessary medical care incurred to treat the injury. IOWA CODE §85.27. An employer must furnish all reasonable surgical, medical, dental, osteopathic, chiropractic, podiatric, physical rehabilitation, nursing, ambulance and hospital services and supplies for all compensable injuries. The employer must also furnish reasonable and necessary crutches, artificial members and appliances. The employer is not required, however, to furnish more than one set of permanent prosthetic devices. IOWA CODE §85.27 provides that the employer has to pay the medical bills for treating a work-related injury.

If the employer is providing payment for medical care, the employer gets to choose the doctor. IOWA CODE §85.27 gives the employer the right to choose medical care which must be offered promptly and be reasonably suited to treat the injury without undue inconvenience. The rationale for giving the employer this right is as follows:

If the injured employee has completely unlimited free choice of doctor, in some cases he or she may select a doctor, because of personal relationship or acquaintance, who is not qualified to deal with the particular kind of case, or who at any rate is incapable of providing service of the quality required for the optimum rehabilitation process. Bell Bros. Heating & Air Conditioning v. Gwinn, 779 N.W.2d 193, 203 (Iowa 2010), citing 5 Larson § 94.02[2], at 94-13.

If the injured worker incurs medical expenses treating with an “unauthorized” doctor, the employer will not be obligated to pay the bill. However, there are exceptions to this rule. First, an employee may choose his own medical care or physician in an emergency when the employer is not immediately available. Bell Bros., supra. Second, the employer may consent to alternative medical care at the employer’s expense. Id. Additionally, although IOWA CODE §85.27 gives the employer the right to choose medical care, the employee has the right to request alternate care. If the parties cannot agree on the care, the commissioner can order alternate care. If the employee is not satisfied with the care the employer has furnished and makes a showing that the care was unreasonable, the commissioner may order alternative medical care at the employer’s expense, following a hearing. Id.

An employee may also choose medical care at his own expense, under two circumstances. Id. First, employee can choose his own medical when an employer has denied compensability of the injury. Id. This is due to the fact that the employer’s duty to furnish medical care is tied to compensable injuries. Id. Essentially, an employer waives the right to choose and loses any subsequent lack of authorization defense by either abandoning care or denying liability for the worker’s medical condition. Second, an employee may choose medical care at his own expense when he disagrees with the care provided or rejects the care provided by an employer. Id. This generally occurs when there is a dispute over diagnosis or treatment. Id.

For questions or additional information on this topic, please contact Iowa Workers’ Compensation attorney Emily R. Motto at EMotto@baylorevnen.com or 402.475.1075.