Workers’ Compensation for Employees F.A.Q.'s

These materials are for informational purposes only. They should not be construed as legal advice. This information is not intended to replace the assistance of an attorney in any particular situation. It is not intended to, and does not, create an attorney-client relationship.

What is Workers’ Compensation?

The Workers’ Compensation system exists both as a way to benefit injured workers and as a way to protect employers. Workers’ Compensation is a no-fault insurance system. Negligence on the part of worker or employer is not an issue in paying benefits. In exchange for the right to receive benefits without regard to fault on the part of the employer and without regard to the worker's own fault in the events giving rise to the accident, the worker gives up his or her right to sue the employer for damages arising out of the injury or disease.

What is Workers’ Compensation insurance?

Workers’ Compensation is insurance that by law virtually every Idaho employer is required to carry in case an employee is injured on the job, becomes ill due to circumstances surrounding their job or even if death results from their job. Benefits may include medical expenses and income benefits.

Who is responsible for providing the benefits under the Workers’ Compensation Act?

In Idaho, virtually every employer is responsible for providing Workers’ Compensation insurance to cover their employees. In some instances the employer provides benefits directly by being self-insured otherwise the employer provides the benefit indirectly through a Workers’ Compensation insurance company. A worker cannot be charged for benefits provided or any portion of their employer's Workers’ Compensation insurance premium.

What injuries are covered by the Act?

Any worker who has sustained an injury arising out of and in the course of their employment may have a Workers’ Compensation claim. As long as your injury is job-related, it's covered unless the worker was engaged in exempt employment. Idaho has exempted from coverage under the Workers’ Compensation Act household domestic server, casual employment, employment not carried on by the employer for pecuniary gain and a few other types of employment. A worker may be covered if they are injured while traveling on business, doing a work-related errand or even attending a required business-related social function. Any injury or illness that occurs due to covered employment is considered a compensable injury or condition. Injury cases are usually fairly straight forward under Idaho law. If an injury is caused by an accident occurring in the course of a worker's employment then benefits are generally provided. The matter may become more complicated if the worker has permanent impairment (functional or anatomic loss) or disability factors (non-medical factors such as age, education, training, transferable skill, loss of access to the labor market, decreased wage earning capacity and the like).that may warrant additional income benefits. Idaho law is much more complex when dealing with occupational diseases. An occupational disease may arise from exposure to harmful substances in the workplace such as lead, mercury, chlorine, carbon monoxide, or the like. An occupational disease may also arise from over-use syndromes and cumulative trauma disorders. Examples include carpal tunnel syndrome and shoulder impingement syndrome.

What types of benefits are available under the Workers’ Compensation system?

A worker is entitled to reasonable and necessary medical care resulting from his or her work-related injury or occupational disease. Medical care generally includes: medical, surgical and hospital services, dental services, crutches, hearing aids, chiropractic treatment, physical therapy, nursing care, and prescribed medications. The right to receive medical treatment at the expense of the employer or the employer's insurance company continues as long as treatment is reasonable and necessary to treat the injury or disease. In Idaho, if a worker wants to change medical provider’s approval of the employer or insurance company is generally required. If it is not given it is possible to petition the Industrial Commission for its approval for a change in medical providers.

In addition to medical care, an injured worker may be entitled to receive income benefits for total or partial temporary disability if they have been directed to remain off work by their health care provider. An offer of suitable modified duty work or the general availability of suitable work may terminate a worker's right to receive income benefits. Once the injured worker has attained medical stability, they may be entitled to income benefits for permanent impairment (functional or anatomic loss) and disability. It is important to understand your rights as an injured worker under the Idaho Workers’ Compensation law.

What should I do if I get injured on the job or if I develop a condition I believe is caused by my job?

Seek medical attention if needed. Immediately report your injury to your employer. An injured worker must report any accident to their employer or an employee of the employer who is in a supervisory capacity (foreman, superintendent, company nurse, etc.). Notification must be done as soon as practicable but not later than 60 days after the occurrence or the right to recover benefits may be lost. If a condition occurs over time (for example, a breathing problem, shoulder impingement syndrome, or carpel tunnel syndrome), you must report your condition within 60 days after you realize that it is caused by your work or you have been advised by your health care provider that the condition is work related which ever occurs first. Your employer will provide you with a claim form on which you must describe your injury and how, when, and where it occurred. Make sure you save copies of all correspondence with your employer, its insurance carrier, and your doctor concerning your Workers’ Compensation claim.

How long after an injury do I have to report it to my employer?

The best practice is to immediately report your injury or illness to an employee who is in a supervisory capacity. This could include a lead man/person, foreman, superintendent, plant nurse, or a designated person in the human resource department. Idaho law directs an injured worker to report the occurrence of an accident causing injury to their employer as soon as practicable and notice is generally found to be timely if given within 60 days from the occurrence of an accident. If notice is given more than 60 days after the accident, then the employee may have to show that the delay in giving notice did not cause prejudice to the employer and this is a difficult burden.

Employees are required to promptly report the onset of an occupational disease (including repetitive trauma induced conditions, cumulative trauma disorders and other gradual onset type conditions within 60 days of manifestation, which is when the employee has reason to believe the condition is caused by work or when advised by a physician that the condition is work related).

Can I lose my job because of a Workers’ Compensation injury?

Laws prohibit your employer from discharging or discriminating against you only because you filed Workers’ Compensation claim. If it is proven that an employer fires or forces an injured worker to resign just as retaliation for filing a Workers’ Compensation claim, the worker could file a civil lawsuit against his employer seeking damages in court. This type of claim can be very difficult to prove. Under Idaho Workers’ Compensation law an employer is not required to hold a job for an injured worker, nor is the employer required to rehire an injured employee.

What Workers’ Compensation benefits am I entitled to?

You may be entitled to receive all reasonable and necessary medical treatment, benefits for lost wages at 67% of your average weekly rate of pay subject to minimums and maximums; benefits for permanent impairment (functional or anatomic loss), if any, and permanent disability from non-medical factors which may include loss of access to the labor market, diminished wage earning capacity, the cumulative effect of multiple injuries, age, education, occupational history and transferable skills, among others, are paid at a specific rate based on the year of injury. These payments are free from income taxes. You may also qualify to participate in vocational rehabilitation programs such as the services offered by the Idaho Industrial Commission Rehabilitation Division. If the accident or disease causes the death of the worker, burial expenses are covered and the dependents of the deceased worker are entitled to certain benefits.

If you become permanently unable to do any work at all, you may be eligible to receive lifetime benefits. If you believe you are totally and permanently disabled it would probably be in your best interest to consult an attorney who has had significant experience with the Workers’ Compensation law. These cases can be very complex.

Can I recover for pain and suffering?

Idaho's Workers’ Compensation laws do not allow an injured employee to recover damages from his or her employer for pain and suffering resulting from a work-related injury. However, pain may be considered as a factor in determining the extent of permanent partial impairment (functional or anatomical loss) the employee has after maximum medical improvement has been attained. For more information on permanent partial impairment you may want to contact a qualified attorney experienced in Workers’ Compensation law.

If I receive Workers’ Compensation, can I also sue my employer in a court with a jury?

Generally, no. In exchange for giving up the right to sue an employer in court, the injured worker receives Workers’ Compensation benefits without regard to who was at fault. You may be able to sue in court if your injury was caused by someone other than your employer such as a visitor or outside contractor or if it was caused by a defective product.

What medical benefits does the Act provide to a worker after they have sustained an on-the-job injury?

An injured worker is generally entitled to receive 100% of all necessary and reasonable medical expenses incurred as a result of a job-related accident or occupational disease. These include first aid, emergency room services, in-patient and/or out-patient hospital care, doctor's fees, prescriptions and other related expenses. An injured worker may risk losing these benefits through an unauthorized change of physicians. If the employer/insurance company refuses to authorize a change of physicians on a voluntary basis then a Petition for Change of Physicians must be pursued through the Idaho Industrial Commission.

What happens if my family member suffers a work-related death?

Idaho Workers’ Compensation law provides a way of compensating dependent family members of an employee killed in a work-related accident. If an employee is killed in an accident in the course of his or her employment, dependents of the deceased employee are entitled to certain funeral expenses and income benefits under the Workers’ Compensation laws. A "dependent" is generally defined as a surviving spouse, minor child, or person who has relied upon the decedent for support. The amount of the benefit paid to a dependent may vary depending on whether there is a surviving spouse, the number of other dependents and the family relationship between the dependent and the deceased worker. One of the "problems" with Workers’ Compensation is that the benefits allowed by law are limited. However, in the death of an employee case, benefits owed to the dependents can be substantial. In addition to Workers’ Compensation benefits, there may be a potential for a recovery against a person who is not the deceased workers' employer. The potential for this type of claim is usually an issue that an experienced Workers’ Compensation attorney will discuss with the surviving family member(s).

Can I recover for all my lost wages?

Idaho's Workers’ Compensation law identifies the amount of weekly wages used to determine your right to recover income benefits. These benefits are paid in lieu of your wage. There is a statutory maximum that is paid. Generally speaking, you are entitled to receive 67% of your average weekly wage. These income benefits are not subject to Federal or Idaho income taxes. Be sure that you receive the maximum amount of income benefits to which you are entitled. For more information on income benefits you may want to contact a qualified attorney experienced in Workers’ Compensation law.

Am I required to go to the company's doctor?

Frequently, an employer will direct an injured employee to a specific doctor, clinic, or emergency room for medical attention and care. If you are injured on the job, have notified your employer of injury, and your employer has a doctor, clinic, or emergency room, to provide you with care, you should follow that direction or you could face having to pay for a physician you choose. After initially seeking treatment from the company doctor you may be able to change your health care provider by securing the approval of the employer or insurance company. If they do not approve a different health care provider you may petition the Industrial Commission for a Change of Physician. Upon proper proof the Commission may approve a change of physicians. For more information on a "change of physician", "medical benefits", or "income benefits" you may want to contact a qualified attorney experienced in Workers’ Compensation law.

How do I change doctors?

Once you have been to a health care provider for your initial treatment (be it a company doctor or the provider of your choice) you should not change without one of the following:

1. A specific referral from the health care provider treating you to another provider (it is best to have this in writing); or
2. Specific approval of the employer or the insurance company (it is best to have this in writing); or
3. The filing of a Petition to Change Physicians with the Industrial Commission followed by the failure to respond by the employer or insurance company; or
4. The Order of the Industrial Commission approving a change of physicians after a hearing has been held.

The failure to follow the law on this point may result in you being responsible to pay for all of your medical care after the unauthorized change of physicians. If the employer or insurance company does not approve your initial request for a change of physicians it would be wise to consult an experienced Workers’ Compensation attorney before you seek other treatment.

What are total temporary disability (TTD) payments?

If you are unable to work for more than the five day waiting period, you will get paid part of your lost wages. The "waiting period" will be paid if you are unable to work for more than ten calendar days or you are hospitalized as an in-patient. Your total temporary disability benefit rate is 67% of your average weekly wage, subject to minimums and maximums too complex to address in the space we have available here. You will receive these temporary total disability payments during the time you qualify for the benefit. This compensation stops when the treating doctor releases you for your work, or the doctor releases you to modified work and the employer provides modified work, or the doctor says that your injury has reached a point of maximum improvement.

What are temporary partial disability (TPD) payments?

When you are released for work your doctor may initially limit the number of hours you work on a daily or weekly basis. When you return to work on this limited basis, you are entitled to receive 67% of your diminished earnings subject to certain maximums.

What is permanent physical impairment (PPI)?

Permanent physical impairment is an anatomic or functional abnormality or loss of a body part that remains after maximum medical rehabilitation has been attained. The condition must be considered medically stable. Idaho law has a schedule utilized for losses caused by amputations. In cases not involving amputations, an impairment rating is often provided by a physician using the American Medical Association (AMA) Guidelines to the Evaluation of Permanent Impairment (5th Edition). The rating is compared to the loss of a body part such as a leg or an arm or to the loss of the "whole person".

What is permanent partial disability (PPD)?

Some injured workers who suffer an injury or an occupational disease will have a permanent disability that exceeds their permanent impairment. A permanent disability includes the anatomic or functional loss (PPI) and analyzes its effect on the worker's ability to engage in gainful employment. Factors considered in this evaluation may include the worker's loss of access to the labor market, decreased wage earning capacity, age at the time of injury, the worker's occupation, and work history, transferable skills, education and the like. This issue is a complex one best addressed on an individualized basis for you by an experienced Workers’ Compensation attorney.

If I am unable to return to the type of work I did before I was injured, what happens?

If your employer makes employment available to you within your medical restrictions (modified work or light duty work) and you decline it, your income benefits are likely to be terminated. If you do return to work and wages are less than what you earned before the injury, you may be entitled to temporary partial disability (TPD) benefits. This will equal 67% of the difference between your current earnings and what you earned before your injury without exceeding the TTD benefit rate.

If you are unable to return to your regular job due to a Workers’ Compensation injury, you may qualify for vocational assistance through the Industrial Commission Rehabilitation Division. A trained case worker will work with you and your employer to reduce the length of your temporary disability and to facilitate your return to work. Your rehabilitation plan may be as simple as modifying your current job to accommodate any limitations you have suffered or could, under certain circumstances, involve training for a new job.

Am I entitled to help with vocational rehabilitation?

Generally, you may be entitled to vocational rehabilitation services to assist you in returning to work. The Idaho Industrial Commission employs trained case workers to help with your rehabilitation. They are available to assist in reducing the length of your temporary total disability and/or your permanent partial disability. They will work with you to reduce the impact of your injury on your wage earning capacity. The primary goals of the Industrial Commission Rehabilitation Division (ICRD) case worker include the following:

1. Returning you to work with your pre-injury employer in your pre-injury job with no change in your wage; or
2. Return you to work with another employer in your pre-injury job and wage; or
3. Return you to work with your time of injury employer in a modified job; or
4. Return you to work with another employer in a modified job.
   

Do I have to accept rehabilitation?

Generally, it is to your advantage to accept rehabilitation to assist you in returning to work. If you do not cooperate with rehabilitation by refusing suitable work, this may be grounds for suspending your income benefits. However, if you are asked to participate in a vocational-rehabilitation program, and you are not physically able to do so, you may wish to consider hiring a Workers’ Compensation attorney. An experienced attorney will be able to assist you in all steps of the vocational rehabilitation procedure.

My claim has been denied, what do I do?

If you, your employer, or your employer's Workers’ Compensation insurance company has a dispute or disagreement about your claim, you should try to resolve the dispute among yourselves, if possible. Many times, disputes can be cleared up quickly and easily by communication. If the dispute cannot be resolved informally, you may be required to pursue the claim through litigation before the Idaho Industrial Commission to resolve disputed issues that cannot be informally resolved through negotiations. At this hearing, the worker has the opportunity to present medical evidence and witnesses in support of their claim for Workers’ Compensation benefits. Workers’ Compensation hearings can be complex. The insurance company will have an experienced attorney defending the claim and it is advisable that the injured worker retain a Workers’ Compensation attorney.

Do I have to settle my claim?

In Idaho, you are not required to settle your claim if you do not want to do so. Your employer is required to provide you with the benefits required by law if your claim is accepted, but this does not include a forced settlement of your claim. If your claim has been accepted, and you believe you are receiving the correct amount of compensation, it may not be in your best interest to settle your claim. If you are uncertain as to whether or not you want to settle your claim, you should consider hiring a Workers’ Compensation attorney. You have the right to be represented by an attorney, whose fees are generally a percentage of the benefits you receive. If you consult an attorney, it is important that you discuss and understand the fee involved. Your attorney can assist you in determining whether or not a settlement is in your best interest. For more information on settlements, you may want to consult with an attorney who is knowledgeable in the area of Workers’ Compensation.

Can I settle my case?

An injured worker may agree to settle his or her case but is not required to do so. Likewise, a self-insured employer or an insurance company may settle a claim but they are not required to do so.

As an injured worker, under most circumstances, you should not agree to settle or compromise your Workers’ Compensation claim if you have not received an impairment rating from your doctor. You should know the extent of your permanent injuries, if any, before agreeing to settle your claim. If you agree to settle your Workers’ Compensation claim, you are compromising your right to future income and medical benefits. Be sure that you fully understand your rights under the Workers’ Compensation law before agreeing to settle your case. For more information on settlement of your Workers’ Compensation claim, you may want to contact a qualified attorney experienced in Workers’ Compensation law.

Am I entitled to a settlement of my claim?

A settlement is an agreement resolving a dispute between parties. You are not automatically entitled to a settlement which includes payment of compensation on your Workers’ Compensation claim. After you have filled out a claim form that requests information such as when, where, and how the accident happened, the extent of your injuries, and the provider for your treatment, you'll receive notification accepting or rejecting your claim. If the claim is accepted and you are entitled to medical benefits and possibly income benefits (TTD). If your claim is rejected or partly denied, you can start the adjudication process by filing a Workers’ Compensation complaint with the Industrial Commission and presenting evidence in a hearing that will be scheduled after a request for a hearing is made. If, after the hearing, the Industrial Commission rules against you, the decision may be appealed to the Idaho Supreme Court.

If you have been injured on the job and are filing a claim for Workers’ Compensation, you have the right to be represented by an attorney. If your claim for benefits is rejected, you should consider hiring an experienced Workers’ Compensation attorney.

What is the value of my work-related claim?

The value of your claim is determined to some extent by your anticipated future medical expenses. Another important factor is the extent of your permanent partial impairment (PPI), which is the functional or anatomic loss you have experienced as a result of your injuries. Idaho has a "schedule" of losses for anatomic loss. Another aspect of the value of a claim is whether you have experienced a diminished wage earning capacity that results in a permanent disability (PPD). Idaho does not have a "schedule" for determining the extent of an individual's disability in excess of impairment. The experienced Workers’ Compensation attorney will work to develop proof on this issue to help show to the insurance company or the Industrial Commission that you should be paid additional income benefits for disability in excess of your impairment.

When is a Workers’ Compensation claim considered settled and permanently closed?

A Workers’ Compensation claim is considered settled only after settlement documents are prepared and signed by the parties and approved by the Idaho Industrial Commission. After a Lump Sum Settlement has been properly approved, the worker's claim is closed and they are no longer entitled to any type of Workers’ Compensation benefits for their injuries. In the event of a subsequent accident, the worker would need to file a new claim for Workers’ Compensation benefits. If an injured worker has received Workers’ Compensation benefits from his employer but a Lump Sum Settlement has not been approved by the Industrial Commission, the worker may still have a viable Workers’ Compensation claim for medical benefits and/or income benefits if the statute of limitations has not expired.

If my injury results from the wrongful act of another person (not the employer) can I make a claim against the "third party"?

In addition to a Workers’ Compensation claim, you may also have a "third-party" claim. Two common examples of Workers’ Compensation claims giving rise to a third-party claim involves automobile accidents while on the job and defective products used on the job. Although Workers’ Compensation is your exclusive remedy against your employer there are certain instances when you may maintain a separate action against another party, such as the driver of the other automobile or the manufacturer of the defective product. An experienced Workers’ Compensation attorney will address with you whether there is a potential "third-party" claim and will assist you in determining whether you have any rights beyond a Workers’ Compensation claim. Note that if you recover from the "third-party" you may have to repay the Workers’ Compensation benefits you received.

Do I need an attorney?

You have the right to be represented by an attorney for your work related injury in any proceedings before the Industrial Commission. Whether an attorney will accept your case is up to the attorney. The attorney will evaluate your case and make a decision on whether or not to accept the case. Whether an attorney accepts a case may depend on a number of factors that may not necessarily relate to the merits of your case. If the first experienced Workers’ Compensation attorney you consult is not willing to undertake your case, you may want to consult with other attorneys who are knowledgeable in Workers’ Compensation law.

If you retain an attorney, your attorney will assist you in seeing that your benefits are properly protected. An attorney will be in a position to advise you in order to protect your rights. The attorney's fee for representing an injured employee is usually paid out of the settlement or award. These are usually a percentage of the monetary recovery obtained for the worker by the efforts of the attorney. The fee an attorney charges to an injured worker is subject to the approval of the Idaho Industrial Commission. At present the Commission usually approves fees of 25% of the recovery obtained by the attorney if the case is not tried and 30% if the case is tried. In addition to the attorney's fee, the injured worker may be responsible for costs and out-of-pocket expenses the attorney incurs in pursuing the Workers’ Compensation claim. These costs and out-of-pocket expenses are in addition to the fee charged by the attorney.

Do I need an attorney if I am receiving benefits?

Even if you are receiving Workers’ Compensation benefits, it may be wise to consult with an experienced Workers’ Compensation attorney to learn of your rights as an injured employee, and to ensure that you are receiving the maximum benefits available under the law. There may be additional benefits that you are entitled to receive of which you are not aware.

Choosing a Workers’ Compensation attorney.

Workers’ Compensation is an area of the law where it is very important that you choose a lawyer with experience and a proven track record. Written credentials may not tell you everything you really need to know. You should ask the lawyer how many Workers’ Compensation hearings he or she has had before the Industrial Commission. Ask what percentage of the lawyer's practice is devoted to Workers’ Compensation cases so that you can determine whether he or she is a person who takes an occasional case or one who devotes a substantial portion of their time to Workers’ Compensation. And, ask if the lawyer has full-time paralegals available to help process your claims in the most effective and efficient manner.

PAGE UPDATED 09-22-06