When choosing a doctor after a workplace injury, who knows best?

A Cedar Rapids iron worker injured his back on the job about four years ago.

The 42-year-old father of two, who asked not to be named because his case is still active, receives workers' compensation, but feels he's been stuck in a system where the cards are stacked against him.

Before his injury he was an active man who liked to hunt and fish and to play catch with his son.

After his injury, he's had to undergo an operation, take multiple visits to the emergency room and was prescribed to several different medications - some of which he still takes.

At the time, he believed his doctor cleared him to go back to work before he was ready.

“You have to use their doctors and medical professionals,” he said, referring to company-determined doctors.

Once he was back at work, his employer assigned him to tasks he was unable to do, he said.

“They didn't want to make any concessions, and cast me aside and said do this or that, things above my restrictions,” he said.

He was later fired from his job and has filed to receive Social Security benefits due to his disability. He is now working with his lawyer to request a second opinion on his injuries from a doctor of his choosing, not of his employer's.

The Company Doctor

The state of Iowa is still using a workers' compensation law it passed in 1913 - 100 years ago. Under that law, the employer has the right to choose the physician and medical care for employees injured at work.

If an employee wishes to receive alternate care, he or she can petition to the workers' compensation commissioner, a state administrator who is appointed by the governor and serves a six-year term.

Kerry Koonce, spokeswoman for the Iowa Workforce Development, the state agency that oversees the workers' compensation division, said while disagreements between employers and employees over terms of care do happen, they are more unusual than they are the norm.

“Iowa employers are pretty good and pretty fair,” she said.

The state does not keep record of the total number of workers' compensation cases, only the number of adjudicated cases, which makes it difficult to gain an idea of how common this occurs.

“Think about the context of 1913, and how this law was originally envisioned,” said Matthew Glasson, an educator with the University of Iowa Labor Center.

In those days, companies would hire a doctor to work on site in order to be closer to injured workers, he said.  Company doctors also could become experts on the types of injuries that occur in coal mines, steel mills or other industrialized work sites.

And as the law was passed before employees were self-insured, it was seen as a benefit because employers could control costs and employees could be treated by an expert, Glasson said.

“But this is an antique provision,” he added.

Over time, many states with similar provisions have made changes to their laws as problems arose, he said.

Big Labor Verses Big Business

Charlie Wishman, secretary-treasurer for the Iowa Federation of Labor AFL CIO, said Iowa is now in the minority when it comes to employer or employee choice. More than 30 states allow workers to choose their medical care, he said.

“We believe that a basic tenant of adequate health care is the right for individuals to choose their doctor,” he said. “Your doctor knows you best - your body, your medical history.

"If you are injured at work, that injury shouldn't be treated any differently.”

Wishman said employees can be sent back to work before they're ready so employers don't have to pay any or as much workers' comp benefits. He added that decisions can be made more out of a concern on the bottom line rather than employee health.

“It's important that any worker has the option to seek care from their primary-care doctor,” he said “They go there for any other injury or health problems, this would allow for continuity of care.”

But Nicole Crain, vice president of government relations for the Iowa Association of Business and Industry (ABI), which represents 1,400 Iowa businesses, said employer input can ensure the injured employee receives the right type of care.

“A workplace injury is very different than being sick,” she said. “You need a doctor who knows how to treat" an injury.

One hundred years ago, ABI - then known as the Iowa Manufacturers Association - was instrumental in getting the workers' compensation law passed, Crain said. Today, it opposes any change made to how the system works.

“Employers pay for the care, employers take the blame or responsibility,” she said. “And if the employee is not happy, they can go to Iowa Workforce Development.”

Dennis Hoaglin, safety manager at Nichols Aluminum in Davenport, said the doctors his company use have toured the plant and are familiar with the activities employees do day-to-day. This makes them more effective, he said.

“We want to provide the best care because the expensive part is paying out for disability if there's a bad outcome,” he said.

Legislative Change

The issue of workers' compensation goes round and round in the state legislature, resurfacing every few years.

State Rep. Bruce Hunter, D-Des Moines, has introduced legislation to amend the state's workers' compensation laws several times, he said, but the bills have never made it out of subcommittee.

Last year, he introduced House File 33, which would allow employees the “right to pre-designate a physician who is a primary care provider, from whom the employee has previously received treatment for a non-occupational injury, illness or examination, to provide treatment for a work-related injury.”

“Part of the healing process is feeling comfortable with the care you receive and choosing your own doctor,” Hunter said.

But Former Rep. Lance Horbach, R-Tama, noted that employer choice gives the state a more competitive business environment. Iowa can't offer large metropolitan areas, beaches or mountains to attract employers - but it can provide a lower cost of doing business.

Horbach said statistics show that workers' compensation systems that allow employees to choose their care have higher premiums of between 20 to 25 percent. This is because employees may go to the wrong type of doctor, which would result in referrals to other specialists.

Instead, employers should use those savings to pay employees more, expand their companies or create new jobs.

“For those who say that employers are only out for profit, the only way to get the maximum profit is to have all employees be well trained and at 100 percent health,” he said.