Idaho Workers' Compensation Claims: Eligibility, Filing, and Appeals

Workers' compensation in Idaho is a mandatory insurance program designed to compensate injured workers for medical care and lost wages. Employees who are involved in workplace accidents or who suffer from occupational diseases are eligible for benefits.

Idaho Workers' Comp: Covered Employees

In Idaho, both public and private employers must provide workers' compensation insurance for their employees. All businesses with one or more full-time or part-time employees are required to have a workers' compensation policy in place, unless the worker is specifically exempted by the Idaho Code (see below).

If you are not sure who your employer's insurance carrier is or whether your employer has workers' compensation insurance at all, you can check your employer's coverage at the Idaho Industrial Commission's website.

Exempt Workers

The following types of workers are exempt from workers' compensation coverage under Idaho law (meaning that employers do not have to provide workers' comp insurance for these individuals):

• household domestic workers
• family members living in the employer's household (sole proprietors only)
• sole proprietors; or working members of a partnership or limited liability company; or corporate officers who own at least 10% of the stock (and who are directors, if the corporation has directors)
• employees covered under Federal Workers' Compensation Laws
• pilots of agricultural spraying or dusting planes (under certain conditions)
• real estate brokers and salespersons when paid solely by commission
• volunteer ski patrollers
• officials of athletic contests in secondary schools (grades 7-12 only)
• casual employees – for work which occurs occasionally or at irregular times and which is not related to the type of business normally conducted
• employment as an outworker - a person who works on materials at a location not under the control of the employer, and
• family members of a sole proprietor who do not live in the proprietor's household.

For more information on who is eligible to receive workers' comp benefits, see our article on who's eligible for workers' compensation.

Filing a Workers' Compensation Claim in Idaho

You should report any workplace accident or potential job-related disease or illness to your employer as soon as possible. To protect your rights, report all injuries, even minor ones. If you wait longer than 60 days, you risk losing your right to collect workers' compensation benefits.

Once you report your injury, your employer should provide you with the paperwork necessary to file a workers' compensation claim in Idaho. The "First Report of Injury or Illness" form is also available on the IIC website.

Types of Workers' Compensation Benefits in Idaho

A variety of benefits are available to injured workers under Idaho workers' compensation laws, including payments for medical treatment, lost wages, and permanent disability.

Medical Treatment

If you have suffered a job-related injury or disease, you should immediately seek treatment. For emergency care, you may go to the nearest hospital or doctor's office. However, for all non-emergency care, Idaho has specific rules that you must follow when selecting the doctor from whom you will receive treatment.

In general, your employer has the right to designate which physicians will treat all work-related diseases or injuries (except for emergency care). Ask your employer if it has a designated medical provider before you seek non-emergency medical treatment. If your employer has designated a physician, you must normally obtain your employer's approval before treating with another medical provider.

Your employer's workers' compensation insurance company must pay for all "reasonable and necessary" medical treatment related to your work injury or disease. This usually includes payment for doctors, x-rays, medications, hospital stays, physical therapy, and some transportation.

Workers' compensation will cover your medical expenses. Your health care providers will send the bills directly to your employer's insurance company.

Temporary Total Disability

If you are unable to work for more than five days due to your injury or illness, or if you are hospitalized as an in-patient, you are eligible for temporary total disability (TTD) payments for lost wages while you are out of work and receiving treatment.

The weekly amount you will receive, called an "income benefit allowance," is typically 67% of your average weekly wage, subject to a maximum of $817.20 (in 2022). You can expect your first payment to be made 28 days after the date of your injury or illness.

Temporary Partial Disability

Your doctor may allow you to return to work while you are still recovering. Your doctor may limit the type of work, or the amount of work, that you are able to perform in light of your injuries. If your doctor allows you to return to part-time or modified work, you may be able to recover temporary partial disability (TPD) benefits.

If your pay is less than your usual earnings, you may be entitled to receive temporary partial disability (TPD) benefits from the workers' compensation insurer. The weekly amount is typically two-thirds of the difference in your earnings, but it cannot be more than the amount of your TTD benefits.

Permanent Impairment and Disability Benefits

If you are permanently disabled, either partially or totally, as a result of your workplace injury or occupational disease, you are entitled to permanent disability benefits. The amount in benefits you receive and how long you will receive them depends on the nature and severity of your permanent disability.

Your doctor will determine the level of your permanent impairment and assign a percentage to your disability. This percentage is then multiplied by 500 weeks (which is how long someone with a 100% permanent impairment would receive benefits for). The product is the number of weeks that you are entitled to receive permanent partial impairment (PPI) benefits for, at a rate of 55% of the state average weekly wage. In 2022, the state average weekly wage is $908.

For example, suppose you receive a 25% impairment rating. You are entitled to benefits for a total of 125 weeks (25% × 500) at a rate of $499.40 (55%× $908), which amounts to a total of $62,425.

Your permanent disability benefits will be paid on a monthly basis, or in some cases, in a lump sum. In addition, if your permanent disability prevents you from returning to your job, you may be eligible for vocational retraining services and additional permanent partial disability benefit (PPD).

When you have reached maximum medical improvement, you and/or your insurance company may want to settle your claim for a lump sum payment. In Idaho, all lump sum settlements must be approved by the Industrial Commission.

Appeal a Workers' Comp Denial in Idaho

Your employer's workers' compensation insurance company will make many decisions about your claim – from allowing or rejecting your claim, to authorizing medical treatment, to many other decisions. If you feel that the insurer is being unreasonable, you can file a formal complaint with the IIC.

On the complaint form, you need to explain when and how the workplace injury happened, what medical treatments you received, what damages you are seeking, and when and how you gave notice to your employer.

You must file your complaint with the IIC and send a copy to your employer and its workers' compensation carrier. The carrier will be required to formally respond to the issues raised in your complaint by filing a legal document called an answer.

Your complaint initiates the formal legal process to bring the dispute to the IIC for a hearing and decision. The IIC will appoint a commissioner to handle your appeal process. The IIC commissioner routinely schedules conferences, usually by telephone, throughout the discovery phase. These conferences monitor the status of the appeal and allow the IIC commissioner to determine if the parties would benefit from settlement discussions. The IIC also offers a voluntary mediation program to help resolve the dispute.

Workers' Comp Mediation in Idaho

In most cases, the assigned IIC commissioner will suggest that you send your claim dispute to mediation, to see if it can be quickly resolved. Mediation is less formal than an appeal hearing, which more closely resembles a civil trial.

The mediator facilitates discussion, and tries to help the parties reach an agreement, by offering an independent professional perspective of the merits of each party's positions. If both you and the insurer reach an agreement on benefits in mediation, that ends your appeal.

Idaho Workers' Comp Hearings

If your attempts to settle the case aren't successful, you must file a formal request with the IIC in order to schedule the actual hearing. The IIC hearing is similar to a civil trial, with the IIC commissioner conducting the hearing instead of a judge. At the hearing, you may represent yourself or you may hire a lawyer to represent you.

Like a civil trial, witnesses may be questioned and cross-examined by the parties or their attorneys. The length of the hearing varies, from a few hours to several days or weeks, depending on the number of witnesses, the scope of the disputes, the volume of evidence, and whether any expert testimony will be allowed (expert witnesses are individuals with specialized knowledge, such as doctors).

Once the parties have presented their cases, the IIC commissioner will review the admissible evidence and will issue a written decision as to whether you are entitled to benefits and in what amount. Typically, the written decision will be issued within 90 days from the last day of the hearing.

Challenging the Written Decision

If you disagree with the decision you can ask the IIC, within 20 days, to reconsider the decision. If you are still dissatisfied, you may file an appeal with the Idaho Supreme Court within 42 days.

A successful appeal to the Idaho Supreme Court, however, requires detailed knowledge of the workers' compensation laws and the court's procedural rules.

You should strongly consider hiring a workers' comp attorney to represent you. An experienced attorney can also provide an estimate of the time and expense involved in this type of appeal.