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Iowa Supreme Court Provides an Opinion on IME Reimbursement Fees Under Iowa Code Section 85.39

In Mid American Construction LCC v Sandlin, Claimant Sandlin sustained an injury to two toes while at work. Claimant went to undergo an independent medical examination and was given an impairment rating of 2% to his left leg. Claimant determined he was entitled for reimbursement for the IME, which was granted by the Deputy. Defendants filed a motion for rehearing stating that the impairment was to his foot, not leg and that the IME costs should be denied. The Deputy granted the motion for the location of the injury but denied the IME motion.  Defendants appealed the decision up to the Court of Appeals of Iowa. 

 

The Court looked to Iowa Code § 85.39(2) to determine if the Claimant was entitled to reimbursement for the IME which states:

If an evaluation of permanent disability has been made by a physician retained by the employer and the employee believes this evaluation to be too low, the employee shall, upon application to the commissioner and upon delivery of a copy of the application to the employer and its insurance carrier, be reimbursed by the employer the reasonable fee for a subsequent examination by a physician of the employee’s own choice, and reasonably necessary transportation expenses incurred for the examination.

Because Defendant’s medical case manager created the appointment, the Court determined that the Claimant was entitled to reimbursement.

            The Court then evaluated if the reimbursement amount was reasonable. Defendants argue that only a fraction of the evaluation fee was reimbursable because the exam went beyond what was necessary to perform an impairment rating. To determine this, the Court looked at the language added to Iowa Code § 85.39(2) which states in part:

An employer is only liable to reimburse an employee for the cost of an examination conducted pursuant to this subsection if the injury for which the employee is being examined is determined to be compensable under this chapter or chapter 85A or 85B. An employer is not liable for the cost of such an examination if the injury for which the employee is being examined is determined not to be a compensable injury. A determination of the reasonableness of a fee for an examination made pursuant to this subsection, shall be based on the typical fee charged by a medical provider to perform an impairment rating in the local area where the examination is conducted.

Using the language in the statute, the Court determined that the reasonable fee authorized by the statute was only the fee for an impairment rating.

By examining the specific language added to the statute in 2017, the Court came to the conclusion that that language was added for a reason. Given the added language in 2017, the statute now allows for reimbursement of an examination fee charged for an impairment rating, not the full extent of an IME.

 

                Case Summary by Mikayla B. Ganan, Summer Law Clerk. If you have any questions, please contact Smith Mills Law.