Your Rights and Responsibilities Under Idaho's Worker's Compensation System
Is my injury or illness covered by worker's compensation?
Worker's Compensation insurance is a no fault insurance policy which provides medical benefits and wage loss to workers with job related injuries or diseases. As a general rule, if you work for wages, whether your employer is a public entity or a private business, and suffer an injury or occupational disease that arises out of and in the course of your employment, you are covered by the Idaho Worker's Compensation Act. Coverage is afforded even if you have been fired or are no longer working for the same employer.
What are my responsibilities once I have suffered a job related injury or an occupational disease?
If you have suffered a job related injury or an occupational disease you should:
- Immediately notify your employer of the accident and fill our an accident report.
- If you feel that you have been injured, seek medical attention as soon as possible. Be certain to tell your doctor how the accident occurred and what symptoms you have been experiencing.
- If your injury or occupational disease results in medical care or lost time from work, you should also request that your employer file a Notice of Injury and Claim for Benefits.
How can I insure prompt payment of my medical and related benefits?
- You should tell your employer about the facts of your accident and the extent of your injury in as much detail as possible and provide them with the names of any witnesses. Even though it may not seem serious at the time, the injury may cause future medical problems or complications. Therefore, you should report all of your injuries, even minor injuries, to protect your right to receive worker's compensation benefits.
- Make sure you tell your doctor that you believe your condition is work related and ask that the medical bills for your treatment be sent directly to your employers workers compensation insurance company. Do not allow your employer to convince you to send the bills solely to your health insurance. Rather, be certain that the medical bills are also forwarded to their workers compensation carrier as well.
- You must make sure that a notice of injury and claim for benefits is filed so that your medical expenses and other benefits can be processed. Your employer is obligated to file this notice with his insurance company and the Idaho Industrial Commission as soon as practicable, but not later than ten (10) days following your accident. However, if your employer declines or delays in doing so, file the form yourself.
- Your employer and his insurance company are obligated to conduct a reasonable investigation of your claim and to notify you of their acceptance or rejection in a timely manner. If they acknowledge liability then they are normally required to pay your medical bills within thirty (30) days from the time they receive them.
What can I do if they insurance company denies my claim?
If your employer or his insurance company denies your worker's compensation claim, you have the right to file a complaint and request that the Idaho Industrial Commission hear and decide compensability of your injury. If no benefits of any kind have been paid, you only have one year from the date you made a claim for benefits to file a Complaint or you will be forever barred from pursuing any further relief.
What are my worker's compensation benefits?
If you have suffered a job related injury or an occupational disease, you are generally entitled to receive benefits for:
Your employer and his insurance company are obligated to pay for all medical care that is reasonably necessary as a result of your accident or occupational disease which is required by your treating physician. In the event that your employer fails to provide you with medical care, you may do so at his expense. Your medical benefits include not only the cost of doctors appointments and treatment, but also any appliance or prosthesis that may be required as well. In addition, your employer and his insurance company are also obligated to pay for any consultations or referrals arranged by your treating physician.
Total Temporary Disability
If you are temporarily totally disabled from returning to work for more than five days or hospitalized, you are entitled to a portion of your lost wages during the period of your medical recovery. The amount of these benefits depends on various factors including your average weekly wage and the state average weekly wage at the time of your injury. These income benefits are paid during the period of your medical recovery until you are released to return to work or until you reach maximum medical improvement.
Permanent Physical Impairment
Once you reach maximum medical rehabilitation following your injury, if your accident or occupational disease has caused a permanent injury, you may be entitled to be rated for permanent physical impairment. A permanent physical impairment rating is a medical appraisal of the functional abnormality or loss that you have suffered. Permanent physical impairment, if one is found, is payable over a fixed period of time at a set statutory rate.
What if my injury or illness prevents me from returning to work at my usual job?
Unfortunately, our worker's compensation law does not require your employer to hold open your job or rehire you after you recover from your injury or illness. In the event that you cannot return to your former occupation or have suffered a loss in your ability to earn wages, you may be entitled to additional disability benefits and/or retraining into another occupation.
If the insurance company sends me to an independent medical evaluation, am I bound by their findings and conclusions?
Under Idaho's Worker's Compensation system, you are required to submit yourself to all reasonable medical examinations requested by your employer provided that you are reimbursed for your expenses of travel and subsistence as well as any lost wages that may occur. However, the opinions expressed by those panel doctors are not conclusive. Normally, the Industrial Commission will consider the findings and opinions reached by all of the doctors who have seen you, including your own treating physician. Often times, they may even place greater weight on the opinions drawn by your own doctor in view of the fact that he or she may have been in a better position to have assessed the nature of your injuries and its affect on your ability to work.
Who can I contact if I still have questions?
The Idaho Industrial Commission is the state agency which hears and resolves all worker's compensation disputes. They have claims consultants who from time to time can be of help in answering your general questions. However, they cannot give you any legal advice. In addition, there are also many qualified attorneys who will see you for an initial consultation at no charge and who accept cases on a contingency fee basis where if there is no recovery there are no attorney fees.