85.27 SERVICES -- RELEASE OF INFORMATION -- CHARGES
-- PAYMENT -- DEBT COLLECTION PROHIBITED.
1. The employer, for all injuries compensable under this chapter
or chapter 85A, shall furnish reasonable surgical, medical, dental,
osteopathic, chiropractic, podiatric, physical rehabilitation,
nursing, ambulance and hospital services and supplies therefor and
shall allow reasonably necessary transportation expenses incurred for
such services. The employer shall also furnish reasonable and
necessary crutches, artificial members and appliances but shall not
be required to furnish more than one set of permanent prosthetic
devices.
2. Any employee, employer or insurance carrier making or
defending a claim for benefits agrees to the release of all
information to which the employee, employer, or carrier has access
concerning the employee's physical or mental condition relative to
the claim and further waives any privilege for the release of the
information. The information shall be made available to any party or
the party's representative upon request. Any institution or person
releasing the information to a party or the party's representative
shall not be liable criminally or for civil damages by reason of the
release of the information. If release of information is refused the
party requesting the information may apply to the workers'
compensation commissioner for relief. The information requested
shall be submitted to the workers' compensation commissioner who
shall determine the relevance and materiality of the information to
the claim and enter an order accordingly.
3. Notwithstanding section 85.26, subsection 4, charges believed
to be excessive or unnecessary may be referred by the employer,
insurance carrier, or health service provider to the workers'
compensation commissioner for determination, and the commissioner may
utilize the procedures provided in sections 86.38 and 86.39, or set
by rule, and conduct such inquiry as the commissioner deems
necessary. Any health service provider charges not in dispute shall
be paid directly to the health service provider prior to utilization
of procedures provided in sections 86.38 and 86.39 or set by rule. A
health service provider rendering treatment to an employee whose
injury is compensable under this section agrees to be bound by such
charges as allowed by the workers' compensation commissioner and
shall not recover in law or equity any amount in excess of charges
set by the commissioner. When a dispute under this chapter, chapter
85A, or chapter 85B regarding reasonableness of a fee for medical
services arises between a health service provider and an employer or
insurance carrier, the health service provider, employer, or
insurance carrier shall not seek payment from the injured employee.
A health service provider shall not seek payment for fees in dispute
from the insurance carrier or employer until the commissioner finds,
pursuant to informal dispute resolution procedures established by
rule by the commissioner, that the disputed amount is reasonable.
This section does not affect the responsibility of an insurance
carrier or an employer to pay amounts not in dispute or a health
service provider's right to receive payment from an employee's
nonoccupational plan as provided in section 85.38, subsection 2.
4. For purposes of this section, the employer is obliged to
furnish reasonable services and supplies to treat an injured
employee, and has the right to choose the care. If the employer
chooses the care, the employer shall hold the employee harmless for
the cost of care until the employer notifies the employee that the
employer is no longer authorizing all or any part of the care and the
reason for the change in authorization. An employer is not liable
for the cost of care that the employer arranges in response to a
sudden emergency if the employee's condition, for which care was
arranged, is not related to the employment. The treatment must be
offered promptly and be reasonably suited to treat the injury without
undue inconvenience to the employee. If the employee has reason to
be dissatisfied with the care offered, the employee should
communicate the basis of such dissatisfaction to the employer, in
writing if requested, following which the employer and the employee
may agree to alternate care reasonably suited to treat the injury.
If the employer and employee cannot agree on such alternate care, the
commissioner may, upon application and reasonable proofs of the
necessity therefor, allow and order other care. In an emergency, the
employee may choose the employee's care at the employer's expense,
provided the employer or the employer's agent cannot be reached
immediately. An application made under this subsection shall be
considered an original proceeding for purposes of commencement and
contested case proceedings under section 85.26. The hearing shall be
conducted pursuant to chapter 17A. Before a hearing is scheduled,
the parties may choose a telephone hearing or an in-person hearing.
A request for an in-person hearing shall be approved unless the
in-person hearing would be impractical because of the distance
between the parties to the hearing. The workers' compensation
commissioner shall issue a decision within ten working days of
receipt of an application for alternate care made pursuant to a
telephone hearing or within fourteen working days of receipt of an
application for alternate care made pursuant to an in-person hearing.
The employer shall notify an injured employee of the employee's
ability to contest the employer's choice of care pursuant to this
subsection.
5. When an artificial member or orthopedic appliance, whether or
not previously furnished by the employer, is damaged or made unusable
by circumstances arising out of and in the course of employment other
than through ordinary wear and tear, the employer shall repair or
replace it. When any crutch, artificial member or appliance, whether
or not previously furnished by the employer, either is damaged or
made unusable in conjunction with a personal injury entitling the
employee to disability benefits, or services as provided by this
section or is damaged in connection with employee actions taken which
avoid such personal injury, the employer shall repair or replace it.
6. While a contested case proceeding for determination of
liability for workers' compensation benefits is pending before the
workers' compensation commissioner relating to an injury alleged to
have given rise to treatment, no debt collection, as defined by
section 537.7102, shall be undertaken against an employee or the
employee's dependents for the collection of charges for that
treatment rendered an employee by any health service provider. If
debt collection is undertaken after a creditor receives actual notice
that a contested case proceeding for determination of liability for
workers' compensation benefits is pending, such debt collection shall
constitute a prohibited practice under section 537.7103, and the
employee or the employee's dependents are entitled to the remedies
provided in section 537.5201. However, the health service provider
may send one itemized written bill to the employee setting forth the
amount of the charges in connection with the treatment after
notification of the contested case proceeding.
7. If, after the third day of incapacity to work following the
date of sustaining a compensable injury which does not result in
permanent partial disability, or if, at any time after sustaining a
compensable injury which results in permanent partial disability, an
employee, who is not receiving weekly benefits under section 85.33 or
section 85.34, subsection 1, returns to work and is required to leave
work for one full day or less to receive services pursuant to this
section, the employee shall be paid an amount equivalent to the wages
lost at the employee's regular rate of pay for the time the employee
is required to leave work. For the purposes of this subsection,
"day of incapacity to work" means eight hours of accumulated
absence from work due to incapacity to work or due to the receipt of
services pursuant to this section. The employer shall make the
payments under this subsection as wages to the employee after making
such deductions from the amount as legally required or customarily
made by the employer from wages. Payments made under this subsection
shall be required to be reimbursed pursuant to any insurance policy
covering workers' compensation. Payments under this subsection shall
not be construed to be payment of weekly benefits.
85.27 SERVICES -- RELEASE OF INFORMATION -- CHARGES
-- PAYMENT -- DEBT COLLECTION PROHIBITED.
1. The employer, for all injuries compensable under this chapter
or chapter 85A, shall furnish reasonable surgical, medical, dental,
osteopathic, chiropractic, podiatric, physical rehabilitation,
nursing, ambulance and hospital services and supplies therefor and
shall allow reasonably necessary transportation expenses incurred for
such services. The employer shall also furnish reasonable and
necessary crutches, artificial members and appliances but shall not
be required to furnish more than one set of permanent prosthetic
devices.
2. Any employee, employer or insurance carrier making or
defending a claim for benefits agrees to the release of all
information to which the employee, employer, or carrier has access
concerning the employee's physical or mental condition relative to
the claim and further waives any privilege for the release of the
information. The information shall be made available to any party or
the party's representative upon request. Any institution or person
releasing the information to a party or the party's representative
shall not be liable criminally or for civil damages by reason of the
release of the information. If release of information is refused the
party requesting the information may apply to the workers'
compensation commissioner for relief. The information requested
shall be submitted to the workers' compensation commissioner who
shall determine the relevance and materiality of the information to
the claim and enter an order accordingly.
3. Notwithstanding section 85.26, subsection 4, charges believed
to be excessive or unnecessary may be referred by the employer,
insurance carrier, or health service provider to the workers'
compensation commissioner for determination, and the commissioner may
utilize the procedures provided in sections 86.38 and 86.39, or set
by rule, and conduct such inquiry as the commissioner deems
necessary. Any health service provider charges not in dispute shall
be paid directly to the health service provider prior to utilization
of procedures provided in sections 86.38 and 86.39 or set by rule. A
health service provider rendering treatment to an employee whose
injury is compensable under this section agrees to be bound by such
charges as allowed by the workers' compensation commissioner and
shall not recover in law or equity any amount in excess of charges
set by the commissioner. When a dispute under this chapter, chapter
85A, or chapter 85B regarding reasonableness of a fee for medical
services arises between a health service provider and an employer or
insurance carrier, the health service provider, employer, or
insurance carrier shall not seek payment from the injured employee.
A health service provider shall not seek payment for fees in dispute
from the insurance carrier or employer until the commissioner finds,
pursuant to informal dispute resolution procedures established by
rule by the commissioner, that the disputed amount is reasonable.
This section does not affect the responsibility of an insurance
carrier or an employer to pay amounts not in dispute or a health
service provider's right to receive payment from an employee's
nonoccupational plan as provided in section 85.38, subsection 2.
4. For purposes of this section, the employer is obliged to
furnish reasonable services and supplies to treat an injured
employee, and has the right to choose the care. If the employer
chooses the care, the employer shall hold the employee harmless for
the cost of care until the employer notifies the employee that the
employer is no longer authorizing all or any part of the care and the
reason for the change in authorization. An employer is not liable
for the cost of care that the employer arranges in response to a
sudden emergency if the employee's condition, for which care was
arranged, is not related to the employment. The treatment must be
offered promptly and be reasonably suited to treat the injury without
undue inconvenience to the employee. If the employee has reason to
be dissatisfied with the care offered, the employee should
communicate the basis of such dissatisfaction to the employer, in
writing if requested, following which the employer and the employee
may agree to alternate care reasonably suited to treat the injury.
If the employer and employee cannot agree on such alternate care, the
commissioner may, upon application and reasonable proofs of the
necessity therefor, allow and order other care. In an emergency, the
employee may choose the employee's care at the employer's expense,
provided the employer or the employer's agent cannot be reached
immediately. An application made under this subsection shall be
considered an original proceeding for purposes of commencement and
contested case proceedings under section 85.26. The hearing shall be
conducted pursuant to chapter 17A. Before a hearing is scheduled,
the parties may choose a telephone hearing or an in-person hearing.
A request for an in-person hearing shall be approved unless the
in-person hearing would be impractical because of the distance
between the parties to the hearing. The workers' compensation
commissioner shall issue a decision within ten working days of
receipt of an application for alternate care made pursuant to a
telephone hearing or within fourteen working days of receipt of an
application for alternate care made pursuant to an in-person hearing.
The employer shall notify an injured employee of the employee's
ability to contest the employer's choice of care pursuant to this
subsection.
5. When an artificial member or orthopedic appliance, whether or
not previously furnished by the employer, is damaged or made unusable
by circumstances arising out of and in the course of employment other
than through ordinary wear and tear, the employer shall repair or
replace it. When any crutch, artificial member or appliance, whether
or not previously furnished by the employer, either is damaged or
made unusable in conjunction with a personal injury entitling the
employee to disability benefits, or services as provided by this
section or is damaged in connection with employee actions taken which
avoid such personal injury, the employer shall repair or replace it.
6. While a contested case proceeding for determination of
liability for workers' compensation benefits is pending before the
workers' compensation commissioner relating to an injury alleged to
have given rise to treatment, no debt collection, as defined by
section 537.7102, shall be undertaken against an employee or the
employee's dependents for the collection of charges for that
treatment rendered an employee by any health service provider. If
debt collection is undertaken after a creditor receives actual notice
that a contested case proceeding for determination of liability for
workers' compensation benefits is pending, such debt collection shall
constitute a prohibited practice under section 537.7103, and the
employee or the employee's dependents are entitled to the remedies
provided in section 537.5201. However, the health service provider
may send one itemized written bill to the employee setting forth the
amount of the charges in connection with the treatment after
notification of the contested case proceeding.
7. If, after the third day of incapacity to work following the
date of sustaining a compensable injury which does not result in
permanent partial disability, or if, at any time after sustaining a
compensable injury which results in permanent partial disability, an
employee, who is not receiving weekly benefits under section 85.33 or
section 85.34, subsection 1, returns to work and is required to leave
work for one full day or less to receive services pursuant to this
section, the employee shall be paid an amount equivalent to the wages
lost at the employee's regular rate of pay for the time the employee
is required to leave work. For the purposes of this subsection,
"day of incapacity to work" means eight hours of accumulated
absence from work due to incapacity to work or due to the receipt of
services pursuant to this section. The employer shall make the
payments under this subsection as wages to the employee after making
such deductions from the amount as legally required or customarily
made by the employer from wages. Payments made under this subsection
shall be required to be reimbursed pursuant to any insurance policy
covering workers' compensation. Payments under this subsection shall
not be construed to be payment of weekly benefits.
85.27 SERVICES -- RELEASE OF INFORMATION -- CHARGES
-- PAYMENT -- DEBT COLLECTION PROHIBITED.
1. The employer, for all injuries compensable under this chapter
or chapter 85A, shall furnish reasonable surgical, medical, dental,
osteopathic, chiropractic, podiatric, physical rehabilitation,
nursing, ambulance and hospital services and supplies therefor and
shall allow reasonably necessary transportation expenses incurred for
such services. The employer shall also furnish reasonable and
necessary crutches, artificial members and appliances but shall not
be required to furnish more than one set of permanent prosthetic
devices.
2. Any employee, employer or insurance carrier making or
defending a claim for benefits agrees to the release of all
information to which the employee, employer, or carrier has access
concerning the employee's physical or mental condition relative to
the claim and further waives any privilege for the release of the
information. The information shall be made available to any party or
the party's representative upon request. Any institution or person
releasing the information to a party or the party's representative
shall not be liable criminally or for civil damages by reason of the
release of the information. If release of information is refused the
party requesting the information may apply to the workers'
compensation commissioner for relief. The information requested
shall be submitted to the workers' compensation commissioner who
shall determine the relevance and materiality of the information to
the claim and enter an order accordingly.
3. Notwithstanding section 85.26, subsection 4, charges believed
to be excessive or unnecessary may be referred by the employer,
insurance carrier, or health service provider to the workers'
compensation commissioner for determination, and the commissioner may
utilize the procedures provided in sections 86.38 and 86.39, or set
by rule, and conduct such inquiry as the commissioner deems
necessary. Any health service provider charges not in dispute shall
be paid directly to the health service provider prior to utilization
of procedures provided in sections 86.38 and 86.39 or set by rule. A
health service provider rendering treatment to an employee whose
injury is compensable under this section agrees to be bound by such
charges as allowed by the workers' compensation commissioner and
shall not recover in law or equity any amount in excess of charges
set by the commissioner. When a dispute under this chapter, chapter
85A, or chapter 85B regarding reasonableness of a fee for medical
services arises between a health service provider and an employer or
insurance carrier, the health service provider, employer, or
insurance carrier shall not seek payment from the injured employee.
A health service provider shall not seek payment for fees in dispute
from the insurance carrier or employer until the commissioner finds,
pursuant to informal dispute resolution procedures established by
rule by the commissioner, that the disputed amount is reasonable.
This section does not affect the responsibility of an insurance
carrier or an employer to pay amounts not in dispute or a health
service provider's right to receive payment from an employee's
nonoccupational plan as provided in section 85.38, subsection 2.
4. For purposes of this section, the employer is obliged to
furnish reasonable services and supplies to treat an injured
employee, and has the right to choose the care. If the employer
chooses the care, the employer shall hold the employee harmless for
the cost of care until the employer notifies the employee that the
employer is no longer authorizing all or any part of the care and the
reason for the change in authorization. An employer is not liable
for the cost of care that the employer arranges in response to a
sudden emergency if the employee's condition, for which care was
arranged, is not related to the employment. The treatment must be
offered promptly and be reasonably suited to treat the injury without
undue inconvenience to the employee. If the employee has reason to
be dissatisfied with the care offered, the employee should
communicate the basis of such dissatisfaction to the employer, in
writing if requested, following which the employer and the employee
may agree to alternate care reasonably suited to treat the injury.
If the employer and employee cannot agree on such alternate care, the
commissioner may, upon application and reasonable proofs of the
necessity therefor, allow and order other care. In an emergency, the
employee may choose the employee's care at the employer's expense,
provided the employer or the employer's agent cannot be reached
immediately. An application made under this subsection shall be
considered an original proceeding for purposes of commencement and
contested case proceedings under section 85.26. The hearing shall be
conducted pursuant to chapter 17A. Before a hearing is scheduled,
the parties may choose a telephone hearing or an in-person hearing.
A request for an in-person hearing shall be approved unless the
in-person hearing would be impractical because of the distance
between the parties to the hearing. The workers' compensation
commissioner shall issue a decision within ten working days of
receipt of an application for alternate care made pursuant to a
telephone hearing or within fourteen working days of receipt of an
application for alternate care made pursuant to an in-person hearing.
The employer shall notify an injured employee of the employee's
ability to contest the employer's choice of care pursuant to this
subsection.
5. When an artificial member or orthopedic appliance, whether or
not previously furnished by the employer, is damaged or made unusable
by circumstances arising out of and in the course of employment other
than through ordinary wear and tear, the employer shall repair or
replace it. When any crutch, artificial member or appliance, whether
or not previously furnished by the employer, either is damaged or
made unusable in conjunction with a personal injury entitling the
employee to disability benefits, or services as provided by this
section or is damaged in connection with employee actions taken which
avoid such personal injury, the employer shall repair or replace it.
6. While a contested case proceeding for determination of
liability for workers' compensation benefits is pending before the
workers' compensation commissioner relating to an injury alleged to
have given rise to treatment, no debt collection, as defined by
section 537.7102, shall be undertaken against an employee or the
employee's dependents for the collection of charges for that
treatment rendered an employee by any health service provider. If
debt collection is undertaken after a creditor receives actual notice
that a contested case proceeding for determination of liability for
workers' compensation benefits is pending, such debt collection shall
constitute a prohibited practice under section 537.7103, and the
employee or the employee's dependents are entitled to the remedies
provided in section 537.5201. However, the health service provider
may send one itemized written bill to the employee setting forth the
amount of the charges in connection with the treatment after
notification of the contested case proceeding.
7. If, after the third day of incapacity to work following the
date of sustaining a compensable injury which does not result in
permanent partial disability, or if, at any time after sustaining a
compensable injury which results in permanent partial disability, an
employee, who is not receiving weekly benefits under section 85.33 or
section 85.34, subsection 1, returns to work and is required to leave
work for one full day or less to receive services pursuant to this
section, the employee shall be paid an amount equivalent to the wages
lost at the employee's regular rate of pay for the time the employee
is required to leave work. For the purposes of this subsection,
"day of incapacity to work" means eight hours of accumulated
absence from work due to incapacity to work or due to the receipt of
services pursuant to this section. The employer shall make the
payments under this subsection as wages to the employee after making
such deductions from the amount as legally required or customarily
made by the employer from wages. Payments made under this subsection
shall be required to be reimbursed pursuant to any insurance policy
covering workers' compensation. Payments under this subsection shall
not be construed to be payment of weekly benefits.
