PROGRAM OPERATIONS MANUAL SYSTEMPart DI – Disability InsuranceChapter 521 – Workers' Compensation/Public Disability Benefit (WC/PDB) OffsetSubchapter 20 – State Specific Workers' Compensation (WC) ProceduresTransmittal No. 15, 10/25/2018
This is a minor update to Iowa WC POMS to include a reminder to check available online resources for WC payment information in DI 52140.020.
This a Quick Action Transmittal (QAT). This revision does not change or introduce new policy or procedure.
Summary of Changes
DI 52120.090 Iowa Workers' Compensation (WC)
Subsection G.1. - added second paragraph.
The Iowa Workforce Development, Division of Workers Compensation, is the custodian of the state WC records. WC insurance is provided through private carriers but employers may self-insure.
Iowa WC benefits are generally limited to 200 percent of the State average weekly wage. Once WC payments have started the employer/carrier must give the worker 30 days notice before stopping payment, unless he has returned to work.
Weekly TT benefits equal 80 percent of the worker’s ‘spendable earnings’ up to the State maximum.
An individual may be entitled to TP benefits if he returns to work at a lower paying job because of his injury. TP benefits equal 66 2/3 percent of the difference between the individual’s average gross weekly wages when injured and his actual earnings at the lower paying job. Benefits end with any of the following events:
the individual returns to his regular job, or
he is found medically capable of returning to a similar job, or
he recuperates from his injury
HP benefits are paid to an individual recuperating from an injury that produced a permanent impairment. Weekly HP benefits equal 80 percent of the worker’s “spendable earnings”, up to the State maximum. Benefits end with any of the following events:
the individual returns to work, or
he is medically capable of returning to employment similar to his old job, or
he reaches maximum medical improvement
PP benefits are in addition to HP benefits and begin when the HP benefits period ends. They equal 80 percent of the individual’s spendable weekly earnings subject to a lower maximum of 184 percent of the state average weekly wage. PP benefits are awarded for just a certain number of weeks and then end. There are two types of PP benefits:
SCHEDULED MEMBER DISABILITIES – The chart below shows the number of weeks of PP benefits paid for the full loss of scheduled body members (i.e. arm, leg, etc.) If the impairment is less than a full loss, the number of weeks of PP is a percentage of loss (or loss of use) multiplied by the full number of weeks for the member. Note that this type of PP benefit includes disfigurement payments, which DO cause offset.
Loss of thumb
Loss of first finger
Loss of second finger
Loss of third finger
Loss of fourth finger
Loss of hand
Loss of arm
Loss of great toe
Loss of any other toe
Loss of foot
Loss of leg
Loss of eye
Loss of hearing in one ear
Loss of hearing in both ears
Permanent disfigurement, face or head
BODY AS A WHOLE DISABILITIES – When a work injury results in permanent disability to the body as a whole, Iowa refers to it as industrial disability. The degree of permanent disability is assigned a percentage by assessing the difference between the individual’s health and earnings before and after the injury. That percentage rating is then multiplied by 500 weeks to determine the number of weeks of PP payable.
Weekly PT benefits equal 80% of the individual’s spendable earnings, up to the State maximum. These payments continue as long as the individual remains permanently disabled.
An individual may be entitled to $100.00 per week ($20.00 per week for injuries occurring prior to 09/07/2004) for up to 13 weeks if he is actively participating in a vocational rehabilitation program. An additional 13 weeks may then be paid if approved by the WC commissioner. However, as these payments are made in addition to WC and only for bona fide VR programs, VR benefits do not cause offset. For more information on VR payments see DI 52110.005.
Iowa law provides for 6 types of settlements, all of which must be approved by the State. The Agreement for Settlement and Compromise Settlement are the 2 fundamental types of settlements. The other 4 are used in conjunction with them.
All settlements must be submitted on prescribed forms.
This is a voluntary agreement between the individual and employer/carrier as to the amount and extent of compensation due. Approval of an Agreement for Settlement does not end the individual’s right to additional weekly WC.
When there is a dispute about the individual's entitlement to compensation, a Compromise Settlement may be filed. Approval of the Compromise Settlement ends the individual’s rights to any future benefits for the settled injury.
Any settlement made contingent upon a subsequent specified event occurring is a Contingent Settlement. If the expected event does not occur, the settlement and its approval may be vacated. This type of settlement is commonly used when a court or Medicare must also approve the settlement.
A Combination Settlement establishes part of a WC claim as compensable using an Agreement for Settlement while disposing of the balance of the claim using a Compromise Settlement.
In Iowa, lump sum payments are the exception and not the rule when compensation is awarded. The law does, however, provide for two types of lump sum payments in the form of commutations (a commutation is a lump sum payment of future benefits). A commutation may be part of an Agreement for Settlement or used after an award is made in a contested case decision. In order for a commutation to be approved by the State, it must be shown that the employee has a specific need and that the lump sum is in the employee’s best interest (there are other filing requirements that must be met as well). When commuting benefits, the amount of the future benefits is discounted to present value. There are two types of commutations:
This is a lump sum payment of ALL remaining future benefits. When approved, a Full Commutation ends all of the individual’s future rights to any additional benefits.
This is a lump sum payment of a portion of the remaining future benefits. When approved, a Partial Commutation establishes the individual’s entitlement to WC benefits but it does not end his future rights.
Iowa does not give COLAs on its WC.
Attorney fees are determined on a case-by-case basis.
Iowa does not offset WC for receipt of RIB.
The individual must receive weekly WC or file an application for arbitration within 2 years of the alleged injury or the WC claim may be denied. Within this 2-year period his claim remains technically open, even when no payments are being made.
When weekly WC payments were made, the individual has 3 years from the last weekly payment to receive additional benefits voluntarily, or to file a contested case proceeding for benefits. Additional weekly WC payments may be denied if he does not file within this 3-year period.
NOTE: It is not necessary to keep an ACR live and in DHF for the entire two-year or three-year period just to check for additional WC payments. Use a stand-alone diary to redevelop every six months during each period.
SSA has signed an agreement with the state agency for online access to Iowa’s WC records. Certain designated SSA personnel in ODO, MAMPSC, and Iowa Field Offices can obtain Iowa workers compensation verification from their workstations. Technicians should use this online verification before contacting the state agency. In addition to available payment records, the designated technicians have access to information on insurance carriers in case further development is required.
Once you are certain the WC evidence is not in file, check the Workers' Compensation (WC) Resource Page in DI
52140.020 since Iowa is a State that provides SSA with access to its online records. The value of online records can vary from State to State and some development may still be required. However, the sites available usually provide contact information for the employer, WC carrier or the WC attorney, which can jump-start the development process. Also included in the WC resources intranet site is a list of individuals with online access to those individual State records.
The timeliness and entirety of information on the screens depends on the carrier reporting the information to the state agency. Records may vary in the data available and the stage of case completion. It is important that users evaluate each case individually and apply SSA evidentiary standards to the information located in the state screens.
Normally, the carrier will have more complete and current information.
See ‘Exhibits’ below for WC forms containing payment information.
Agreement for Settlement form: http://www.iowaworkforce.org/wc/forms/14-0021-agreement.pdf
Compromise Settlement form: http://www.iowaworkforce.org/wc/forms/14-0025-compromise.pdf
Contingent Settlement form: http://www.iowaworkforce.org/wc/forms/14-0161contingent.pdf
Combination Settlement form: http://www.iowaworkforce.org/wc/forms/14-0159combination.pdf
Form 9 – Full Commutation form: http://www.iowaworkforce.org/wc/forms/14-0013.pdf
Form 9A – Partial Commutation form: http://www.iowaworkforce.org/wc/forms/14-0017.pdf
Maximum WC Rates Chart
Iowa Maximum Weekly WC Rates
Iowa WC Board website: http://www.iowaworkforce.org/wc/
Iowa Law (scroll down to ‘Workers’ Compensation’): http://search.legis.state.ia.us/NXT/gateway.dll/ic/2009code/1/3309/3441/3459