Attorneys at Nelson Hall Parry Tucker have substantial experience in workers’ compensation, both in representing employers and representing injured workers. Our attorneys have handled over 750 workers’ compensation cases and are considered some of the most experienced workers’ compensation attorneys in the State of Idaho.
Workers’ compensation is highly specialized and is governed by a variety of statutes and rules which differ from normal injury claims.
If you are an employer or an injured worker who believes that you may be involved in a workers’ compensation claim, the following will provide you with a basic understanding of workers’ compensation. You are encouraged to seek the help of competent attorneys in the workers’ compensation field, as there are strict timelines and notice requirements, which, if not met, may expose an employer to liability or which may prohibit an injured worker from receiving workers’ compensation benefits.
What is workers’ compensation insurance and who is covered?
Idaho’s workers’ compensation insurance is Idaho’s no fault system that provides lost wage benefits (temporary total disability (TTD) and/or temporary partial disability (TPD)) and medical benefits to workers with job related injuries or job related diseases. Nearly all employees in Idaho are protected by workers’ compensation insurance. State law requires most employers to have workers’ compensation insurance.
Workers’ compensation insurance must be in place prior to the time an employee begins work. Independent contractors may not be deemed employees of a specific employer if they meet certain criteria. These situations are quite limited. Independent employers must carry the insurance on their employees. Employees who otherwise may not be covered by workers’ compensation, such as the owners of businesses, may elect workers’ compensation insurance.
A workers’ compensation claim is generally the sole remedy an employee has against an employer for job related injuries or diseases. Workers’ compensation insurance protects the employer from most civil liabilities.
What if workers’ compensation insurance is not provided by the employer?
If an employee is injured and the employer does not have workers’ compensation insurance at the time of the injury, the employer may become personally liable for the workers’ compensation benefits due to the injured worker, including the medical and disability benefits, as well as being liable for an additional 10% penalty. Further, failure to carry workers’ compensation insurance is a misdemeanor under Idaho law. Additionally, the Industrial Commission may file a lawsuit in District Court seeking an injunction to prohibit the employer from operating a business.
What should the employee do in the event they suffer a work related injury or disease.
- Tell the employer immediately. Report to the medical facility where your employer directs you, or if not directed, seek medical attention and report the injury to the medical care provider.
- If you want to change physicians, you must seek permission from the Industrial Commission.
- Assist the employer in filling out a First Report of Injury (FROI). This form can be obtained either from the Industrial Commission or from your employer. Submit the form immediately to the Idaho Industrial Commission, the workers’ compensation insurance company, and the employer.
- Contact the insurance company for your employer (the name of the insurance company may be obtained either from the employer or the Industrial Commission), and make sure that they are aware of your claim. If your employer does not have insurance, you should contact the Idaho Industrial Commission Compliance Department.
- Follow the directions and recommendations of your physician.
What do I do if I am an employer and an injury is reported?
Direct the employee to your designated health care provider, or if you do not have a health care provider, instruct the employee to get appropriate medical attention.
Complete the First Report of Injury (FROI) and submit the same to the Industrial Commission and to your workers’ compensation insurance carrier.
Work with your insurance company and with the Industrial Commission Rehabilitation Division in assisting the Claimant in return to work, if possible.
What are workers’ compensation benefits?
“TTD” – Temporary Disability Benefits: If a medical provider states that the employee cannot work because of a job related injury or disease, the employee may be entitled to temporary total disability (“TTD”) or temporary partial disability (“TPD”) benefits until the employee is released to return to work. Return to work generally occurs at the point in time when the employee reaches maximum medical improvement (“MMI”). The employee may be entitled to temporary total disability (TTD/TPD) benefits if the injury or disease causes the employee to miss more than five days of work, or if the employee is hospitalized. Temporary total disability (TTD/TPD) benefits will then run from the time of the injury until the employee is released by their doctor as having reached maximum medical improvement (MMI). (Maximum medical improvement does not mean that you are one hundred percent returned to your pre-injury health, it simply means that you have reached your likely maximum recovery.)
Medical Benefits: If the injury is work related, the employer’s workers’ compensation insurance is responsible for the “reasonable and necessary” medical care to treat the employee’s job related injury or disease. The employee is not responsible for the medical costs. In certain circumstances, the insurance company is able to reduce the amount owed to the employer to “reasonable and customary” expense and the medical care provider cannot bill the employee for the difference between the medical care provider’s billing and the reasonable adjusted bill. The medical benefits generally continue until the employee reaches maximum medical improvement (MMI).
“PPI” – Permanent Partial Impairment: Impairment is the extent to which the injured worker’s body or physical or emotional faculties are left less than whole as a result of the work injury. If it is determined that the employee has sustained a permanent impairment, less than whole, the employer’s workers’ compensation insurance carrier is required to pay to the injured worker the statutory value of that benefit. Permanent impairment is generally the effect of the injury to the injured worker’s body or mind and may either be a statutory impairment or an impairment as outlined by the AMA Guidelines.
PPD – Permanent Partial Disability: If an injured worker does not have an impairment, they cannot have any permanent disability. If the injured worker has a permanent impairment (PPI), then, the employee may have sustained a permanent disability, which is determined, generally, by the effect which the injury has upon the worker’s ability to earn income, ability to re-engage in employment, and may be based on a number of other factors, including age.
Other benefits may also exist, including total permanent disability (TPD) and/or death benefits.
What is the Idaho Industrial Commission?
The Idaho Industrial Commission is a state agency which administers the Idaho Workers’ Compensation Laws. The Industrial Commission has various divisions which may be of assistance to the employer or the employee, including the Benefits Division (which assists in determining what benefits may be due); Rehabilitation Division (which assists employees and employers in assisting the Claimant, to hopefully return to work for the employer, but if the employer is unable to return the Claimant to work, to assist the employee in finding work elsewhere); Mediation Division (which assists the employer and employee in reaching a resolution of the claim); Judiciation Division (which ultimately rules on Motions/Petitions brought before the Industrial Commission, and then holds the actual Hearing/Trial of cases, and renders decisions).
The Idaho Industrial Commissioners are three persons appointed by the Governor of the State of Idaho. One Commissioner is designated as a lawyer representative, one is designated as the employer representative, and one is designated as the employee representative.
As an employer, how do I obtain workers’ compensation insurance?
There are four primary means by which employers can obtain workers’ compensation insurance. Usually, workers’ compensation insurance can be obtained through the Idaho State Insurance Fund, or through private insurance with several hundred insurance companies authorized to write workers’ compensation insurance in the State of Idaho. If you are unable to obtain workers’ compensation insurance through the Idaho State Insurance Fund, or private insurance, an assigned risk pool is established whereby your insurance agent will be able to assist you in obtaining workers’ compensation insurance. Some large employers with large payrolls, and who meet specific requirements, may be able to obtain self insurance.
A Final Important Note.
Because workers’ compensation insurance is highly specialized and governed specifically by separate rules codified in Idaho Code Title 72, by various administrative rules, and by Rules of Judicial Procedure adopted by the Idaho Industrial Commission, as an employer or as an injured worker, you are strongly encouraged to seek legal advice from an attorney with a strong background in workers’ compensation.
**The information above is general guidance regarding principals of law in Idaho. The foregoing is not intended as legal advice in any particular matter. Because all cases are dynamic and deserve special planning, we encourage you to contact the attorneys at our firm to answer questions regarding your specific case**