Iowa Administrative Code › Agency 876 - Workers' Compensation Division › Chapter 4 - Contested Cases › Rule 876-4.48 - Application for Alternate Care

Current through Register Vol. 47, No. 3, July 24, 2024
(1)
Purpose.
The purpose of this rule is to establish the
			 procedures for issuing decisions on applications for alternate care within the
			 time provided in Iowa Code section 85.27.
(2)
Definitions.
The
			 following definitions apply to this rule:
"Application for alternate care,"
hereinafter
				referred to as "application," shall mean a contested case proceeding filed with
				the workers' compensation commissioner which requests alternate care pursuant
				to Iowa Code section 85.27.
"Employer"
means the person or entity who is
				liable for payment of medical services provided pursuant to the Iowa workers'
				compensation laws and includes an employer, an employer who has been relieved
				from insurance pursuant to Iowa Code section 87.11, and an insurance carrier
				which provides an employer with workers' compensation insurance.
"Proper application"
means an application for
				alternate care that complies with the requirements of this rule.
(3)
Dissatisfaction-basis.
Prior to filing the application the
			 employee must communicate the basis of dissatisfaction of the care to the
			 employer.
(4)
Application.
The application shall: be filed on the form
			 provided by the workers' compensation commissioner; concern only the issue of
			 alternate care; state the reasons for the employee's dissatisfaction with the
			 care chosen by the employer; be served on the employer; contain proof of
			 service on the employer; and specify whether a telephone or in-person hearing
			 is requested.
(5)
Fee.
No filing fee is due. See 4.8(2)
"a."
(6)
Employer
			 liability.
Application cannot be filed under this rule if the
			 liability of the employer is an issue. If an application is filed where the
			 liability of the employer is an issue, the application will be dismissed
			 without prejudice. (Petitions for alternate care where liability of the
			 employer is an issue should be filed pursuant to rule
			 876-4.1 (85,85A,85B,86,87,17A).)
(7)
Notice of hearing.
The workers' compensation commissioner will
			 notify the parties by ordinary mail, by facsimile transmission (fax) or by WCES
			 of the time, place and nature of the hearing. No notice will be made until a
			 proper application is received by the workers' compensation commissioner. The
			 notice will specify whether the hearing will be by telephone, in person or by
			 other digital means.
(8)
Appearance or answer.
After being served with an application
			 for alternate care, the employer shall file an appearance of answer as soon as
			 practicable before the time of the hearing.
(9)
Discovery and evidence.
All discovery must be completed prior to the contested case hearing. See
			 subrule 4.48(10) on motions on discovery matters. Any written evidence to be
			 used by the employer or the employee must be exchanged prior to the hearing.
			 All written evidence must be filed with the agency before the date of the
			 hearing. Written evidence shall be limited to ten pages per party.
(10)
Motions.
All motions
			 except as provided in this subrule will be considered at the hearing. A timely
			 motion to change the type of hearing (telephone or in-person) may be considered
			 prior to the hearing. The workers' compensation commissioner will make no
			 rulings on discovery matters or motions.
(11)
Briefs.
Hearing briefs,
			 if any, must be filed with the agency before the date of the hearing and shall
			 be limited to three pages.
(12)
Hearing.
The hearing will be held by telephone, in person or
			 by other digital means in Des Moines, Iowa. The employer shall have the right
			 to request an in-person hearing if the employee has requested a telephone
			 hearing in the application. The employer shall on the record respond to the
			 allegations contained in the application. The hearing will be electronically
			 recorded. If there is an appeal of a proposed decision or judicial review of
			 final agency action, the appealing party is responsible for filing a transcript
			 of the hearing.
Copies of the recording will be provided to the parties upon
				notice of appeal. A transcript shall be provided by the appealing party
				pursuant to Iowa Code section 86.24(4)  and a copy thereof shall be served on
				the opposing party at the time the transcript is filed with the workers'
				compensation commissioner unless the parties submit an agreed-upon transcript.
				If a party disputes the accuracy of any transcript prepared by the opposing
				party, that party shall submit its contentions to the workers' compensation
				commissioner for resolution. Any transcription charges incurred by the workers'
				compensation commissioner in resolving the dispute shall be initially paid
				pursuant to Iowa Code section 86.19(1)  by the party who disputes the accuracy
				of the transcript prepared by the appellant.
(13)
Represented party.
A
			 party may be represented as provided in Iowa Code section 631.14. The presiding
			 deputy workers' compensation commissioner may permit a party who is a natural
			 person to be assisted during a hearing by any person who does so without cost
			 to that party if the assistance promotes full and fair disclosure of the facts
			 or otherwise enhances the conduct of the hearing. The employer and its
			 insurance carrier shall be treated as one party unless their interests appear
			 to be in conflict and a representative of either the employer or its insurance
			 carrier shall be deemed to be a representative of both unless notice to the
			 contrary is given.
(14)
Decision.
A decision will be issued within 10 working days of
			 receipt of a proper application when a telephone hearing is held or within 14
			 working days of receipt of a proper application when an in-person hearing is
			 held.
This rule is intended to implement Iowa Code sections 17A.12,
				85.27, 86.8 and 86.17.