Alternate Care in Iowa Workers’ Compensation: What It Takes to Succeed
March 26, 2026
Employees can request alternate care in Iowa workers’ compensation cases — but meeting the legal standard is often more difficult than expected.
By: Thania Rios
Under Iowa law, employers are required to provide injured employees with reasonable healthcare to treat their workplace injuries. Additionally, Iowa law grants employers the authority to select the physicians who provide that healthcare. However, under certain circumstances, employees can pick their own providers and at their employer’s expense. As explained in Iowa Code section 85.27,
If the employee has reason to be dissatisfied with the care offered, the employee should communicate the basis of such dissatisfaction to the employer, in writing if requested, following which the employer and the employee may agree to alternate care reasonably suited to treat the injury. If the employer and employee cannot agree on such alternate care, the commissioner may, upon application and reasonable proofs of the necessity therefor, allow and order other care.
However, any employee interested in seeking a provider of their own choosing should be aware of what it takes to prevail. In alternate care actions, claimants have the burden of proof of proving that the care provided by defendant-employer was unreasonable. Long v. Roberts Dairy Co., 528 N.W.2d 122, 123 (Iowa 1997). To meet this burden of proof, “the claimant must show that the care was not offered promptly, was not reasonably suited to treat the injury, or that the care was unduly inconvenient for the claimant.” Id. at 122. As stated by the Supreme Court of Iowa, a “choice [of provider] does not become disagreeable just because the employee disagreed with it.” Harned v. Farmland Foods, Inc., 331 N.W.2d 98, 101 (Iowa 1996).
Under Iowa law, determining what ‘reasonable’ means for purpose of Iowa Code section 85.27 is a question of fact to be decided by the assigned deputy. As Commissioner Grell articulated in Herrera de Gonzalez v. Seaboard Triumph Foods, “[r]easonable care includes care necessary to diagnose the condition.” Herrera de Gonzalez, File No. 19002660.01 (Arb. 9/3/2020) at 4. Additionally, as the Supreme Court of Iowa stated in Pirelli-Armstrong Tire Co. v. Reynolds, “[w]hen evidence has been presented to the commissioner that the employer-authorized medical care has not been effective and that such care is ‘inferior or less extensive’ than other available care requested by the employee, the commissioner is justified by section 85.27 to order the alternate care.” Pirelli-Armstrong Tire Co., 433, 437 (Iowa 1997).
When filing a petition for alternate care, claimants must be mindful to ensure that they offer proof that the care provided by their defendant-employer was not suitable to treat their injuries. Likewise, when confronted with an alternate care petition, defendant-employers should ensure that the employee communicated their dissatisfaction with their treatment in accordance with the requirements of Iowa Code section 85.27. In Iowa workers’ compensation cases, alternate care petitions usually fail due to a lack of communication or a lack of proof of the unreasonableness of the care.
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