Workers’ Compensation for Employers 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 with out 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. The Workers’ Compensation system in Idaho is administered by an administrative agency known as the Industrial Commission. The Industrial Commission supervises the routine administration of claims and also serves as the decision maker in disputed matters arising out of the Idaho Workers’ Compensation Act.
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 benefits 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. Failure to have Workers’ Compensation insurance can have catastrophic consequences. If the business is uninsured and is not a self-insured employer that has been approved by the Industrial Commission, then the owner in the case of a sole proprietorship, or each of the partners in the case of a partnership, or the officers of a corporation are likely to be found personally liable for the benefits owed to the injured worker as well as penalties and attorney fees. A worker cannot be charged for benefits provided or any portion of their employer's Workers’ Compensation insurance premium. 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. The processing of claims may be handled by a third party administrator. Some of the third party administrators in Idaho include GAB Robbins, Crawford & Company, Idaho Intermountain Claims, and Industrial Claims Management.
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 potential Workers’ Compensation claim. 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 basic benefits are generally provided. The matter may become more complicated if the worker has permanent impairment (functional or anatomic loss) or disability factors 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 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 providers, 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 suitable availability of 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 (non-medical factors such as lost access to the labor market, diminished wage earning capacity and the like).
What should I do if one of my employees is injured on the job or develops a condition they believe is caused by their job? If emergency medical care is needed, arrange for it immediately and if possible have a supervisor or Human Relations staff member accompany the injured worker to the hospital or follow in another vehicle. If medical attention is required but emergency transportation is not, we believe the best practice is for the employer to arrange for the employee to be transported to your company doctor by their supervisor or a person from the employer's human relations department. If only on-site first aid is required then it should be provided promptly. Once medical attention or first aid is provided, the employee should assist in the preparation of a First Report of Injury and once it is completed it should be signed by the employee. This process will identify the "who, what, when, where, why and how" information relating to the accident. If the employee obtains medical attention or misses work within 10 days following the accident then a completed First Report of Injury must be filed with the Industrial Commission. Employers usually work with their insurers to arrange for the filing of the First Report. We believe that the First Report of Injury is a good tool for the employer's safety committee to use to start to analyze the accident and see what should be done in the future to avoid similar injuries. An aggressive safety program can provide benefits that far exceed the costs associated with it.
What should I do if one of my employees is killed on the job? As soon as you are aware of an occupational death that has occurred on your premises you should notify law enforcement personnel to institute an investigation. They will respond with emergency personnel to address the situation. When you are made aware of an occupational death, regardless of where it occurred, you must notify OSHA. The reporting "window" is eight (8) hours from the time you receive notice of the death. OHSHA's Boise numbers are voice 208-321-2960, fax 208-321-2966, and the number for statewide use in Idaho is 1-800-482-1370. After regular business hours in Idaho 8a.m. to 5p.m., you should call the national OSHA hotline at 1-800-321-6742. The average OSHA penalty for the failure to report within 8 hours is $5000.00 and there are reports of fines well over $50,000.00 for an intentional failure to report. After calling law enforcement personnel and OSHA you should notify your insurer. You should work with law enforcement on notification of the deceased's next of kin.
Should an employer utilize a "company doctor"? As a general rule, yes. Even small employers can benefit by utilizing a "company doctor" that is familiar with the Workers’ Compensation system, the employer's business and the employer's return to work program. If the doctor treating an injured worker does not know that the employer has an aggressive return to work program and that the employer is willing to provide modified duty employment, then a doctor may be less willing to release an injured worker to return to work. As well, a knowledgeable company doctor can act as a "gate keeper" on referrals to specialists. The doctor an employer selects should work with the employer to establish a group of specialists for referrals as needed. These specialists should be familiar with the Workers’ Compensation system and willing to work with the company doctor and the employer in returning an injured worker to modified work when appropriate.
Should an employer have a return to work program for injured employees? Yes! The Idaho Workers’ Compensation Law is designed to assist an employee to return to work for his or her pre-injury employer. Modified work including light duty is encouraged. Providing employees with a return to work program helps them maintain the self-respect that a worker feels when they earn a wage. As well, many workers who are capable of performing modified work can provide valuable services to their employers. Providing modified duty work even on a part-time basis reduces the time loss benefits paid to the employee which will reduce the employer's loss history.
Can I fire an employee for filing a Workers’ Compensation claim? Public policy prohibits an employer from discharging or discriminating against an employee for filing Workers’ Compensation claim. If there are facts to show that an employer fired or forced any injured worker to resign just as retaliation for filing a Workers’ Compensation claim, the worker could file a civil lawsuit against the employer seeking damages in court. However, 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.
If an injured worker receives Workers’ Compensation, can he/she also sue the 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.
What are total temporary disability (TTD) payments? If the injured worker is unable to work for more than the five day waiting period, he/she will get paid part of their lost wages. The "waiting period" will be paid if the worker is unable to work for more than ten calendar days or is hospitalized as an in-patient. The total temporary disability benefit rate is 67% of the employee's average weekly wage, subject to minimums and maximums too complex to address in the space we have available here. These income benefits stops when the treating doctor releases the worker for their regular work, or the treating doctor releases the employer for modified duty work and the employer provides work consistent with the limitations identified by the physician, or says that the injury has reached a point of maximum improvement.
What are temporary partial disability (TPD) payments? When the worker is released to return to work, the doctor may initially limit the number of hours they work on a daily or weekly basis. When returned to work on this limited basis, the worker is entitled to receive 67% of their 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 maximal medical rehabilitation has been attained. The condition must be considered medically stable. Idaho law has a "schedule" 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 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 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.
Are there things an employer can do to reduce the likelihood of injury for their employees? This is an unequivocal yes! It is in the employer’s best interest to prevent accidents. Even small employers should have a safety program that identifies risks in the workplace, work to eliminate those risks, train employees on those risks that cannot be eliminated and investigate accident to determine the cause of any injury. An accident that is avoided is the best kind.
What are some tips to help reduce an employer's exposure after an accident occurs? This is a topic that deserves hours to address. Some good suggestions include: Have a supervisor accompany the employee to the initial doctor/emergency room visit. This shows the employee that the employer is willing to provide him/her with support following the accident. The employer may be able to obtain input from the physician concerning return to work issues or time loss dates. If a company doctor is in place, the doctor can get a reality check from the supervisor of the employees duties and the availability of modified work; If the employer believes the accident is suspicious the employer should communicate this to the claim supervisor for the insurance company along with the notice of injury. This will allow the claim supervisor to give it extra attention in the investigation phase of the claim; Maintain regular contact with the employee. The vast majority of injured workers are good people who just want to work, make a living, and support their families. A supervisor or human resource person should regularly follow up with the employee to let them know what is happening in the work place and reinforce the availability of the employer's return to work program. It is also a real morale booster for the injured employee to get a "get well" card from supervisors and co-employees; Maintain contact with the treating physician. This is easy if you have a company doctor. The company doctor should be contacting the employer after every visit to update them on the employee's status. If you do not have a company doctor, you should follow-up with the treating health care provider and reinforce the availability of modified work and the employer's willingness to work with the injured employee. If an employee has been off work for more than 2 weeks, then contact the claims professional working on the claim and get an update. Reinforce your willingness to work with the employee and the doctor to develop suitable employment. Maintain regular contact with the claims professional working on the case.
What should an employer do if contacted by a vocational case worker employed by the Idaho Industrial Commission? Work with them, as their goal is to get the injured worker back to work. Idaho is fortunate to have vocational rehabilitation case workers that are employed by the Industrial Commission Rehabilitation Division (ICRD). These individuals are neutral and do not "take sides" with the injured worker or the employer. They act to implement the stated goals of their program. The first "goal" is to return the injured worker to work with their pre-injury employer at their pre-injury job and the pre-injury wage. Other goals include return to work at modified employment with the same employer; return to the same type of work; work with other employers, etc. These case workers will work with the injured worker, the health care provider, and the employer to facilitate the employee's return to work.
What should an employer do if they are contacted by a vocational consultant not employed by the Idaho Industrial Commission Rehabilitation Division? If the Claims Supervisor working with you on the claim has not notified you that your insurer has retained a vocational consultant and the "consultant" is not an employee of the Idaho Industrial Commission Rehabilitation Division, you should be very suspicious. Before allowing the consultant to talk with any of the injured workers' co-employees, inspect the work site, or obtain information from you for a "job site evaluation" you should immediately notify the claims professional assigned to the case and obtain guidance.
What are some things an employer should be on the lookout to identify a "suspicious" claim? This is a tough question because the vast majority of the claims that are made are valid. However, there are a few "bad apples" that may take advantage of the Workers’ Compensation system. Possible tip offs include:
- An "injury" that occurs in close proximity in time to a disciplinary action, strike, lay off or plant closure;
- An un-witnessed accident where the manner of injury is not consistent with the injuries claimed;
An untimely notice when the employer has a written policy in an employee handbook requiring immediate notice of an accident causing an injury, signs posted in the work place to reinforce the handbook, and the employer has trained their employees that injured employees must immediately notify their supervisor of an accident/injury, and fill out the paperwork;
Inconsistencies between the description of the accident given to the supervisor and that given to the treating physician. Detecting this is made easier where the employer has an employee manual requiring notice of an accident to a supervisor, a policy of having a supervisor accompany the injured worker to the doctor and a company doctor who will obtain a detailed history of the claimed accident and accurately record it in their notes;
Efforts by supervisory staff and/or human relations staff to follow-up with the injured worker at home when they are off work due to an injury are unsuccessful. An employer should have supervisory personnel and/or human resource staff follow-up with the injured employee who is off work to communicate the employer's concern about the injured worker, express the employer's desire for the employee's speedy recovery, and prompt return to work. However an ancillary benefit of this contact may arise if the injured worker never responds to the phone. This type of occurrence is suspicious and should be reported to the claims professional handling the case.
This is not meant to be all inclusive. If you have suspicions notify the claims professional handling the claim; then follow-up with them to ascertain whether action has been taken on your suspicions.
(Last Updated 01-16-07)
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