Once again, the Iowa General Assembly is being asked to consider who should choose treating doctors for injured workers. For many years, insurance carriers in Iowa have been able to tell injured workers what doctors they can see for treatment. Iowa labor organizations and others feel that workers should be trusted to make their own decisions on health care.

There are obviously arguments for either side. First, insurance carriers argue that they have an incentive to return injured workers to full duty quickly, to reduce the benefits that they have to pay for workers’ lost time. Proponents of carrier choice say that the carriers have a vested interest in providing the best care. Advocates for change argue that the carriers want to find doctors who overlook serious injuries and send workers back to work while they are still hurting, sometimes resulting in further injuries. Carriers and employers respond that, if injured workers can choose their own doctors, they will look for doctors who will let them stay off work longer, rather than obtaining the best care. They also argue that injured workers will stick with their own primary care physicians instead of seeing a specialist. On the other hand, advocates for workers’ choice of doctors cite many stories of injured workers receiving months of care from a local primary care doctor or nurse practitioner who has been chosen by the employer or insurance carrier. By the time they see a specialist, they argue, it may be too late to receive optimum care.

Some doctors who treat a lot of patients who are sent to them by carriers support the change, so that injured workers can pick their own doctor. One such doctor argued that many injured workers who are sent to him by a workers’ compensation carrier are suspicious that he is a “company doctor;” as a result, it is difficult to establish a working doctor-patient relationship under those circumstances.

At the base of the argument seems to be a mutual distrust between workers and employers and insurance carriers. Employers and carriers argue that they should control the care, because workers will choose to stay off work, rather than choose the best care for their injury. Advocates of workers choosing their doctors argue that patients have a greater vested interest in the patient’s full recovery than the insurance carrier, and that work injuries are the only personal injuries in Iowa in which someone is not able to choose his or her own doctor.

The Iowa General Assembly is expected to debate the bills, Senate File 155 and House File 530, to allow for worker choice in March or April. Similar measures were passed in the 1990s, and were vetoed by Governor ranstad. However, this year, Iowa Governor Chet Culver has indicated that he supports the measure, allowing injured workers to choose their own doctors. 

ADDENDUM 4/20/2009: It appears that the Iowa General Assembly is nearing an end, and that the attempts to change Section 85.27 of the Iowa Code, so that workers could choose their own medical care, will not succeed this year. While the issue appears straightforward, the power to choose the medical provider has also placed considerable pressure on workers’ compensation carriers to accept claims as compensable, since they could then control the medical care. Under Iowa law, if a carrier does not accept the injury as a compensable claim, the injured worker can arrange his or her own medical care under health insurance or some public medical care provider, and if it is later found to be a work injury, the carrier has to pay for the medical care. If the law is changed, the carrier no longer has that incentive. It is possible that carriers would be less likely to accept claims as compensable under a worker-choice system.

Once again, this is an issue of trust, but claimants’ attorneys and defense attorneys have seen carriers deny work injuries which are clearly covered under Iowa law. If the carriers don’t have the power to choose care, they may accept less claims at the outset, which could make things worse for injured workers and could encourage litigation.