(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.
