What is the Definition of ‘Benefits’ in Iowa?

Glossary Check

Des Moines, IA (WorkersCompensation) -- Subscribers of Simply Research recently saw on the "What's New" page some information out of Iowa that breaks down, among other things, terms regarding benefits to those who might be new to or unfamiliar with workers' compensation benefits. Here's a look at that vocabulary.

Medical benefits. The employer must pay for all reasonable and necessary medical care required to treat an injury. This includes reasonable and necessary travel expenses for treatment. Mileage for use of a private car is reimbursed at 67 cents per mile. Under certain circumstances, if an employee is required to leave work for medical treatment, the employee may receive payment of lost wages. A medical care provider cannot seek payment of charges for treatment from an employee while a contested case proceeding or a disputed as to the reasonableness of a medical treatment fee is pending before the workers' compensation commissioner.

Temporary total disability. When an employee is off work for more than three calendar days on account of injury, she may be entitled to TTD benefits beginning on the fourth day and continuing until the employee returns to work or is medically recovered enough to return to similar work, whichever happens first. If the employee is off work for more than 14 calendar days, she may be entitled to payment for the three-day waiting period.

Temporary partial disability. If an employee returns to work at a lesser paying job because of an injury, she may be entitled to benefits. The benefit amount is 66 2/3% of the difference between the average gross weekly earnings when injured and the actual earnings while temporarily working at the lesser paying job. The three-day waiting period also applies to temporary partial disability.

Healing period. An employee may be entitled to HP benefits while recovering from an injury that produces a permanent impairment. No waiting period applies to HP benefits. These benefits begin on the first calendar after the date of injury and continue until when the first of the following occurs:

+ The employee returns to work.

+ The employee recovers as much as anticipated from the injury.

+ The employee is medically capable of returning to the same kind of work she did when injured.

Permanent partial disability. When a work injury results in a permanent impairment, permanent restriction, or an inability to earn wages similar to those earned before the injury, the employee may be entitled to PPD benefits, which are in addition to HP benefits.

Scheduled member disabilities. If an employee's injury is to a scheduled member, her PPD benefits are based on functional impairment. If the impairment is less than a full loss, the number of weeks of PPD benefits the employee may receive is a percentage of loss or loss of use multiplied by the full number of weeks for the member.

Body as a whole disabilities. When a work injury results in permanent disability to a part of the body not included as a scheduled member, the disability is considered industrial and is determined by assessing the difference between what the employee was able to earn prior to the injury and what the employee is able to earn after the injury. A variety of factors influence the assessment of lost earning capacity, including:

+ The medical condition before the injury, immediate after the injury, and currently.

+ The part of the body injured.

+ How long the employee needed to recover from the injury.

+ The employee's work experience and qualifications intellectually, emotionally, and physically to learn to perform other work.

+ The employee's earnings before and after the injury.

+ The employee's age, education, motivation, functional impairment related to the injury and loss of ability to do her old job.

+ The employee's loss of earnings because of the injury.

Industrial disability is calculated on a 500-week basis with the percentage rating multiplied by 500 weeks. If the employer offers work at the same or greater wage, an injured employee is only entitled to the functional rating until terminated.

Permanent total disability. If the employee's work related injury leaves her incapable of returning to any type of wage earning employment, she may be entitled to permanent total disability benefits during the time when she cannot return to any gainful work.

Second injury fund benefits. If an employee had a permanent disability to a hand, arm, foot, leg, or eye, and then had a job-related injury that resulted in PPD to another hand, arm, foot, leg, or eye, she may be entitled to SIF benefits, which are paid for any amount that industrial disability is greater than the combined scheduled member disability from both the first and second disabled member. SIF benefits are paid for any amount that industrial disability is greater than the combined scheduled member disability from both the first and second disabled member. These benefits are paid only after the employer or its insurance carrier has paid all scheduled member permanent partial disability benefits due on account of the second injury.

Vocational rehabilitation benefits. An employee may be entitled to payment of $100 per week for up to 13 weeks if she is actively participating in a vocational rehabilitation program. If the employee continues in VR, the $100 may be extended for an additional 13 weeks.

Death benefits. Surviving spouses may receive death benefits for life or until remarriage. Child are entitled to death benefits until age 18 or, if actually dependent, age 25. If a surviving spouse remarries and the deceased worker has no dependent children at the time of the remarriage, the surviving spouse is entitled to a two-year lump sum settlement. Additionally, the employer or its insurance carrier must pay reasonable burial expenses, which may not exceed 12 times the statewide average weekly wage in effect at the time of death.

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