Here’s what you need to know if you’re considering filing an Idaho workers’ compensation claim
The Idaho Industrial Commission (IIC) has a single mission: to administer the Idaho Workers’ Compensation Law fairly.
The IIC requires notification of any Idaho workplace injury that results in the treatment of more than basic first aid. When the Commission receives an injury report, it sends adjuster information to the injured worker to reach a settlement.
Before you reach that point, though, let’s review some basics of the Idaho workers’ compensation system.
Who is eligible for Idaho workers’ compensation benefits?
An Idaho public or private employer that has one or more employees is required to carry workers’ compensation insurance.
There a few exceptions to this rule:
- household domestic workers
- family member employee of a sole proprietor
- sole proprietors or corporate officers who own at least 10% of stock in the company
- real estate brokers who are paid by commission only
- volunteer ski patrol personnel
- employees covered under federal workers’ compensation laws (for example, railroad workers)
- some pilots of agricultural spraying or dusting planes
- sports officials for athletic competitions of children in grades 7-12
- casual employees (i.e. occasional or irregular work)
- outworkers, or people who work on materials at an off-site location
The workers’ compensation system benefits both the employee and the employer. For the employee, it’s a method for receiving fast benefits so you’re not responsible for paying costly medical bills out of pocket for an injury that happened at work.
For the employer, it allows for benefits to be paid to an employee without requiring time-consuming and expensive legal costs. Workers’ compensation is no-fault insurance, which means you don’t need to prove liability to recover costs, but you can’t file a personal injury lawsuit against your employer for damages related to the injury.
What you need to prove to recover workers’ compensation benefits in Idaho
You don’t need to prove fault — it doesn’t matter if a condition caused the injury at your workplace, a coworker or even by yourself.
You need to prove:
- That the injury happened while you were physically present at your workplace; or
- The injury happened while you were off-site but engaged in duties related to your job; or
- The illness or disease developed over time due to ongoing activities or a condition at your workplace or for your job.
If there’s a specific accident or incident that leads to injury, it’s easy to prove that it was work-related.
If your injury or illness developed gradually, this can be more difficult.
There are two primary categories of gradual conditions: injury and illness. An injury might be something like a musculoskeletal condition resulting from strain or overuse, like carpal tunnel syndrome or other strain or pain. If your job involves lifting, stretching, reaching or repetitive motion, you could be at risk for this type of injury. Even people who have sedentary jobs—like desk jobs or driving—can suffer pain from being in a single position for too long, or from poor positioning at their desk or in their chair.
An occupational illness or disease happens because you were exposed to a chemical or toxin at work, noise pollution, or some other hazard that affected your body after the exposure. This is especially risky in construction industries or other professions where workers handle chemicals or hazardous substances.
Do you need an Idaho workers’ compensation lawyer?
If your injury was from a one-time accident or incident and you’ve received treatment, recovered, returned to work and received your workers’ compensation benefits, you likely don’t need additional help from a workers’ compensation lawyer.
However, if your injury is severe or results in long-term illness, it would be beneficial to have a workers’ compensation attorney in your corner. If you’re going to require future treatment for the illness or injury, you need to be sure that the settlement amount is enough to cover both present and future medical treatment costs.
In addition, if the injury has left you disabled, it’s important to know how workers’ compensation benefits will mesh with other kinds of disability payments.
Finally, if you’re experiencing symptoms of an occupational disease or injury that isn’t from a specific accident, you should contact a lawyer. The insurer will look for every reason why your injury or illness happened some other way—that is, not because of work—so it can avoid providing benefits. Your lawyer will work with you to have your benefits are covered.
Workers compensation benefits in Idaho
Workers’ compensation insurance covers your work-related medical treatment, including doctor or hospital visits, surgery, diagnostics like MRIs or CT scans, prescription medication, assistive devices (like wheelchairs, hearing aids, or prosthetics) and ongoing rehabilitative or physical therapy.
If your employer has a designated medical provider, you need to receive approval before treating with a different provider.
Disability lost wages
There are a few ways to qualify for compensation for wage loss from a work injury.
Temporary total disability (TTD)
You qualify for TTD if you are unable to work for more than five days or you’re hospitalized because of the injury or illness. Your income benefit allowance is 67% of your average weekly wage, to a maximum that is adjusted yearly. Your first payment is 28 days after the date of your injury.
Temporary partial disability (TPD)
You can claim TPD if you’re recovering but limited in the type or amount of work you can perform because of your injuries. If you’re receiving a lower rate of pay than your usual wage, you can claim TPD, which is ⅔ of the difference in your earnings.
Permanent impairment disability
If the work-related injury leaves you partially or totally permanently disabled, you can receive permanent disability benefits. The amount and duration of benefits depends on the type and severity of your disability. The doctor determines your level of impairment and assigns a percentage. That percentage is multiplied by 500 weeks.
You can receive permanent partial impairment benefits for that number of weeks at a rate of 55% of the state average weekly wage. These benefits are paid monthly or as a lump sum.
If you’re able to work while disabled but not at the job you held prior to the accident, you can claim the costs for vocational retraining.
If you reach maximum medical improvement (MMI), which means you’ve recovered as much as the doctor expects you to, the insurance might want to settle the remainder of the claim as a lump sum payment. All Idaho lump sums must be approved by the Industrial Commission.
What if your claim is denied (or partially denied)?
Everyone hopes that if they need to make a claim, it will be swiftly granted and you can move forward. After all, you’re already dealing with an injury or illness, so you don’t need financial worries on top of it.
But it doesn’t always work out that way.
Just like a car insurance claim, homeowners insurance claim, health insurance or anything else, your workers’ compensation insurer could determine that the amount you’re claiming is more than it wants to cover. There could be other issues like authorizing medical treatment or other decisions that you don’t agree with.
If this happens, you can:
- File a complaint with the IIC (the Commission). You’ll provide a copy to your employer and the workers’ compensation insurer. The IIC appoints a commissioner to handle your appeal; that person will be your contact for the appeals process.
- Participate in mediation. The commissioner usually recommends mediation in order to help parties reach agreement. An independent mediator would work with each party to help negotiate a settlement.
- Request an IIC hearing. This is like a civil trial, but handled by an IIC commissioner rather than a judge. You can represent yourself or be represented by a lawyer. Like a trial, there can be witnesses and evidence that would support each party. Unlike a trial, there’s no jury—the IIC commissioner would review the evidence and determine whether you’re entitled to benefits and for how much.
- Make a reconsideration request. If you disagree with the commissioner’s decision, you have 20 days in which to request a different outcome.
- Appeal. If you are dissatisfied with the outcome of the reconsideration, you have 42 days in which to file an appeal with the Idaho Supreme Court.
This can be a complicated process, and you might benefit from the assistance of an Idaho workers’ compensation lawyer. You don’t need to pay out of pocket up front for a lawyer; your lawyer earns a percentage of the benefits you receive. If you were injured at work and have questions about the process, need to negotiate with an uncooperative employer or insurance company, or believe you’re not being offered the full benefits, contact an Idaho workers’ comp lawyer today.
The basis for personal injury law is fairly straightforward:
If you're injured because of someone's negligence, then you're entitled to recover for your financial losses related to the injury.
The premise for the workers' compensation system is similar:
Your employer is required to have specific insurance that provides benefits if you're injured at work.