Iowa Administrative Code › Agency 876 - Workers' Compensation Division › Chapter 4 - Contested Cases › Rule 876-4.46 - Contested Case Proceedings-health Service Disputes

Current through Register Vol. 47, No. 3, July 24, 2024
(1) See
			 rule 876-10.3 (17A,85,86) for informal resolution procedures and definitions.
			 The following definition also applies to this rule:
"Petitioning party"
means the person who
				requests or initiates a contested case proceeding.
(2) If utilization of the procedures given in
			 rule 876-10.3 (17A,85,86) does not resolve the dispute and the parties have
			 complied with the good faith requirements of rule 876-10.1 (17A,85,86), a
			 contested case may be initiated. The procedures given in rule
			 876-10.3 (17A,85,86) must be used prior to initiation of a contested case. The
			 provider or the responsible party that is unwilling to accept the determination
			 of the person making a determination after reviewing the dispute as provided in
			 rule 876-10.3 (17A,85,86) shall initiate the contested case proceeding. The
			 proceeding shall be initiated as provided in this chapter and Iowa Code chapter
			 17A and shall follow the provisions of this rule. The proceeding must be
			 initiated within 30 days of the date of the determination made pursuant to rule
			 876-10.3 (17A,85,86). If a contested case proceeding is not initiated or is not
			 initiated within the time provided in this rule, the allowed amount of the
			 charge by the provider shall be the amount determined pursuant to rule
			 876-10.3 (17A,85,86).
(3) The
			 evidence submitted in the contested case proceeding shall be limited to the
			 evidence submitted pursuant to rule 876-10.3 (17A,85,86) and a copy of the
			 determination made pursuant to rule 876-10.3 (17A,85,86). This evidence shall be
			 filed by the party requesting the contested case proceeding at the time the
			 contested case proceeding is initiated. However, the workers' compensation
			 commissioner may request that additional evidence be submitted or may grant
			 submission of additional evidence if the workers' compensation commissioner is
			 satisfied that there exists additional material evidence, newly discovered,
			 which could not with reasonable diligence be discovered and produced pursuant
			 to rule 876-10.3 (17A,85,86). The issues of the contested case proceeding shall
			 be limited to the dispute considered in rule 876-10.3 (17A,85,86).
(4) The petitioning party has the burden of
			 proof.
(5) If the petitioning party
			 wishes to file a brief, it must be filed with the request for contested case
			 proceeding.
(6) The opposing party
			 must file a response within 30 days of the date of service of the request for
			 contested case proceeding.
(7) If
			 the opposing party wishes to file a brief, it must be filed with the
			 response.
(8) Sixty days after the
			 request for contested case is filed with the workers' compensation
			 commissioner, the workers' compensation commissioner will review the matter.
			 The notice of the review to the parties shall be the provisions of this rule
			 and no other notice will be given.
(9) The workers' compensation commissioner
			 shall review the matter and make a decision as soon as practicable after the
			 review. The decision shall be as provided in this chapter and Iowa Code chapter
			 17A.
This rule is intended to implement Iowa Code sections 17A.10,
				17A.12, 17A.14, 85.27, 86.8 and 86.39.