Most employers in Idaho are required to have workers’ compensation insurance for their employees. Workers’ compensation insurance is a no-fault policy that provides employees injured on the job with medical and wage loss benefits. There are also benefits provided for the worker’s family members in the event that the job-related disease or injury results in death.
Data from the U.S. Bureau of Labor Statistics shows that in 2021, there were 30 recorded workplace fatalities in Idaho. This is slightly lower than the previous year’s 32 recorded deaths. Despite a drop in workplace fatalities, it remains important for people in Idaho to know their rights in case they sustain a workplace injury, regardless of whether it is minor or fatal.
This article aims to help Idaho residents know more about the workers’ compensation law in the state by discussing policy requirements, different types of benefits for injured employees, and potential penalties for employers without proper coverage.
Idaho Workers’ Compensation Insurance Requirements
Idaho requires every business with one or more employees to maintain a workers’ compensation policy. This obligation applies to every business regardless of whether its employees are part-time, full-time, seasonal, or occasional workers.
The following individuals are exempt from worker’s compensation coverage in Idaho:
Household domestic workers.
Volunteer ski patrollers.
Athletic contest officials in secondary schools.
Real estate brokers.
Agricultural spraying pilots.
A sole proprietor’s family members living in the same household.
A sole proprietor’s family members who don’t reside in the same household — the owner can apply for exemption with the Idaho Industrial Commission.
How To Obtain Workers’ Compensation Insurance
Self-Insurance: Under Idaho workers’ compensation law, employers with large payrolls may be eligible to self-insure if certain requirements are met. Self-insurance must be granted approval by the Idaho Industrial Commission.
Private Insurance: Idaho has more than 300 insurance companies authorized to offer workers’ compensation coverage to business owners. Employers may contact an insurance company representative or agent for more information.
State Insurance Fund: The Idaho State Insurance Fund offers workers’ compensation coverage to agencies in the state. This quasi-governmental entity has field offices throughout Idaho.
Assigned Risk Pool: Employers who cannot acquire coverage through the State Insurance Fund or private insurance carriers may apply for coverage through the assigned risk pool. It is administered by the National Council on Compensation Insurance. Businesses that want to apply can contact NCCI at 800-622-4123 or through their own insurance agents.
Idaho residents who need to work in another state for a temporary period must have an extraterritorial certificate of coverage. To apply for an extraterritorial certificate, their employer should contact an Idaho Industrial Commission compliance representative at 208-334-6060 or send an email to firstname.lastname@example.org.
If the reciprocating state approves the extraterritorial certificate, the employer won’t need to pay for two separate workers’ compensation insurance premiums. The certificate is valid for only six months. Before it expires, the employer must contact a compliance representative to submit a new request for an extraterritorial certificate. No extraterritorial certificate will be considered valid unless approved by the reciprocating state.
Penalties for Failing to Comply with Idaho’s Workers’ Compensation Requirements
Businesses that do not have workers’ compensation insurance are committing a misdemeanor under Idaho law and are subject to criminal penalties.
If an employee is injured at work without workers’ compensation coverage, the employer will be responsible for the following:
The injured worker’s medical bills and lost wages.
A penalty of 10% of the amount of medical and wage loss benefits.
The injured worker’s attorney’s fees.
$25 per day or $2 per day per employee, whichever is greater.
The Idaho Industrial Commission may also seek a court order to stop the business from operating.
Idaho Workers’ Compensation Benefits
Injured workers in Idaho are entitled to receive compensation if the injury or disease is job-related. Their employers’ insurance carriers are responsible for making the payments; meanwhile, the employers themselves carry out this task if they are self-insured.
If the job-related injury or disease requires necessary and reasonable medical care, the employer’s workers’ compensation policy will pay for it. The bills for the medical treatment will be directly sent to the employer or their insurance carrier.
Medical care such as emergency medical treatment, medications, crutches, hospitalization, and doctor’s fees are among the expenses covered by workers’ compensation insurance. Travel expenses required for medical care are also paid for by the employer’s insurance carrier.
Permanent Impairment or Disability Benefits
If the job-related injury or disease is diagnosed as permanent, the injured employee is eligible to receive income benefits for a certain period of time. The Industrial Special Indemnity Fund may pay some of the benefits if the permanent disability was caused in part by a previous condition.
If the job-related disease or injury is permanent, but the injured worker is able to either return to their previous job or perform other types of work, they may still receive permanent partial impairment or disability benefits, depending on the extent of their condition.
Temporary Disability Benefits
If a medical professional believes that the injured employee will not be able to return to work for a certain period because of their job-related disease or injury, the employee may be entitled to temporary total disability benefits. They will receive compensation for wages lost during their hospitalization and the days they missed work because of the job-related injury.
If the injured employee can perform modified work or return to their job part-time while recovering but would earn less than they used to, they will still be entitled to temporary partial disability benefits.
If an employee dies due to a job-related disease or injury, the surviving spouse and their children under the age of 18 will receive death benefits.
Surviving spouses typically receive benefits for 500 weeks, which could change if they remarry, and children usually receive benefits until they reach the age of 18. Siblings, parents, grandchildren, and grandparents may be eligible for death benefits if they were dependents of the deceased worker.
The law provides compensation for funeral expenses if the death happens within four years of the job-related disease or injury.
For more information about death benefits in Idaho, individuals can take a look at the online guide provided by the Idaho Industrial Commission. They may also call an Industrial Commission Benefit Analyst at 1-208-334-6000.
How to File a Workers’ Compensation Claim in Idaho
Idaho employers are required to have a workers’ compensation insurance policy to assist employees if they get injured while performing their jobs. A business operating without a workers’ compensation policy may be subject to criminal penalties.
For employees to receive compensation for their job-related disease or injury, they must comply with the filing requirements and reporting procedures in Idaho.
When Is the Deadline for Workers’ Compensation Claims in Idaho?
Injured workers in Idaho have 60 days to notify their employer or their employer’s insurance company of their job-related disease or injury. The time limit begins on the date that the employee was injured or was made aware of their condition. If they miss that deadline, they could lose all of the workers’ compensation benefits they are entitled to.
An injured employee can also consult with a workers’ compensation attorney to evaluate their options. There are some instances where an exception could be made, such as if the medical condition is hidden but can be linked to the work. However, such claims are difficult to prove.
A Step-By-Step Guide on Filing a Workers’ Compensation Claim in Idaho
This section of the article provides an overview of how an injured worker should file a workers’ compensation claim in Idaho.
1. Report the Injury to the Employer
It is important for employees to report their injuries and illnesses to their employers immediately. Even if an injury is minor, the worker must notify their employer to be able to receive immediate and appropriate care.
2. Seek Medical Care
Injured workers in Idaho must have their injuries or illnesses examined by a medical professional as soon as possible. It is beneficial for the employee to seek treatment immediately for their health and their workers’ compensation claim. It would be more likely for their claim to be approved if the worker did not delay seeking medical attention.
The injured employee should tell the medical care provider that they believe the disease or injury is job-related.
If the employer has a preferred doctor for treating work-related injuries, the employee should ask their employer for approval before treatment, except in emergency care cases. If the injured worker wants a different medical care provider to examine them, they must file a petition for a change of physician with the Industrial Commission.
3. Assist the Employer in Reporting the Injury to the Idaho Industrial Commission
After the injured worker reports the job-related disease or injury to the employer, the employer must complete and submit a First Report of Injury or Illness form to IIC. The injured worker can help fill out the form by explaining how the injury happened and ensuring that the information provided accurately reflects the event.
The employee must file the form themselves if the employer does not file the notice with IIC. They can also contact IIC for assistance in the filing process or request a form if the employer does not have it.
4. Gather Evidence
If a specific accident in the workplace caused the injury, the injured worker must gather evidence by taking pictures and obtaining the contact information of those who witnessed the accident. This helps strengthen the employee’s workers’ compensation claim.
5. Receive the Benefits
Insurance companies will most likely ask questions regarding the job-related injury or disease before approving the claim. The employee may call IIC at 1-208-334-6000 if they have questions or concerns about the claim that the employer or insurance company cannot assist them with.
After the workers’ compensation claim is approved, the employee will receive all the benefits granted to them.
What Should One Do If a Workers’ Compensation Claim in Idaho Has Been Denied?
The employer or their insurance company may deny a workers’ compensation claim for several reasons, such as the following:
The insurer believes the injury is a pre-existing condition.
The injury did not happen during the course of employment.
There is a dispute over when and where the injury occurred.
There is a dispute over whether the employee sustained injuries.
The medical evaluator hired by the insurance company determined that the worker’s condition was not job-related.
In the event that a workers’ compensation claim is denied, the injured employee should take the following steps:
File a Complaint
When a workers' compensation claim is denied, a letter will be sent to the injured employee explaining why they did not qualify for the benefits. The employee can then challenge the decision through the formal hearing process by filing a complaint with the IIC.
To have a successful appeal, it is advised that the injured worker consult with an attorney and gather all the documents and evidence related to the case. The documents may include pay stubs, time sheets, medical records, medical bills, witness statements, and copies of the notice of injury.
Schedule the Hearing
After filing a complaint and gathering the necessary evidence, the injured employee must request a hearing with the IIC. During the hearing, evidence and testimonies will be presented before a hearing officer. There will be examinations and cross-examinations. The hearing officer will issue a decision on the case within three months.
Appeal the Decision
If the complainant is not happy with the hearing decision, they have 42 days to file an appeal with the Idaho Supreme Court.
Alternatively, instead of taking the matter directly to the Idaho Supreme Court, the complainant may file a motion for reconsideration with IIC within 20 days of the hearing decision.
If IIC rules unfavorably on the motion, the claimant may then go to the Supreme Court to file an appeal.
Legal Resources for Injured Workers in Idaho
The workers’ compensation process can be difficult to navigate. Depending on the specifics of a case, the claimant may need to hire an attorney to represent them in court. The legal resources below contain information on the basics of workers’ compensation law in Idaho to help injured workers understand their current situation.
Idaho Industrial Commission
The Idaho Industrial Commission is the state agency that handles matters regarding workers’ compensation law. It regulates workers’ compensation activities in the state and settles disputes between employers, insurers, and injured workers. The Commission’s website has a detailed FAQ section for both employers and employees. It provides guidelines on how an injured employee can file for workers’ compensation benefits and explains the type of coverage an employer should have for their business. Injured workers may contact the Commission through their website or call 208-334-6000.
Idaho State Insurance Fund
The Idaho State Insurance Fund offers workers’ compensation coverage to employers throughout the state. It guides employees throughout the claims process, coordinating between all parties involved to avoid potential issues. The organization’s website provides answers to frequently asked questions on workers’ compensation claims, such as whether the injured worker can change physicians or what they should do if they have received their medical bills. Idahoans who wish to inquire about the claims process may contact SIF at 208-332-2100.
Idaho Division of Human Resources
The Idaho Division of Human Resources has a page dedicated to guiding employees and supervisors through the workers’ compensation process. It provides copies of forms required for workers’ compensation cases, such as supervisor incident reports and incident/injury witness statements. The page also has sample copies and instructional videos to help individuals complete their forms.
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