Idaho Workers’ Compensation Guidance For Employers Idaho Industrial Commission

Employers’ Guide to Workers’ Compensation Industrial Commission Role Principles of Workers Compensation Coverage Requirements Benefits Legal Strategies to Reduce Claims Costs Rehabilitation Services

The Commission Does not write policies Does not pay benefits What Is the Industrial Commission?

What Is The Industrial Commission’s Role? Regulates workers' compensation system Settles disputes Informal – Mediation - Adjudictation Ensures coverage as required by law Provides no-cost rehabilitation services Decides unemployment appeals Administers Crime Victims Compensation Program

What Is Workers’ Compensation? Implemented in all states Limits employers’ liability Provides medical care to injured workers Enhances productivity by returning trained employees to work In Idaho since 1917

Principles of Workers’ Compensation No Fault No Negligence No Pain/suffering Exclusive Remedy

Who Needs Coverage? Coverage is required for all employers with one (1) or more employees, either full- or part-time

Who Is Not Required to have Coverage? Exemptions Family Members Casual Employment Sole Proprietors Partners LLC Members Corporate Officers

Employee vs. Independent Contractor Case-by-case basis Right to control End result vs. the means by which that result is accomplished

Employee vs. Independent Contractor 1) Direct evidence of control 2) Method of payment 3) Furnishing tools necessary for completion 4) Right to terminate the employment relationship at will and w/out liability

Contractors Idaho Code : An employer subject to the provisions of this law shall be liable for compensation to an employee of a contractor or subcontractor under him who has not complied with the provisions of section , in any case where such employer would have been liable for compensation if such employee had been working directly for such employer

Penalties For Failure To Obtain Coverage May be personally liable for all benefits awarded May be liable for a penalty of 10% of all compensation awarded May be ordered to pay the injured worker’s attorney fees and costs CIVIL PENALTIES

Penalties For Failure To Obtain Coverage May be fined $2/day per employee, or $25/day, whichever is greater May be prohibited from operating the business until coverage is obtained May be subject to criminal penalties CRIMINAL PENALITIES

What Is Covered?   "Injury" means a personal injury caused by an accident arising out of and in the course of any employment covered by the worker's compensation law.   "Accident" means an unexpected, undesigned, and unlooked for mishap, or untoward event, connected with the industry in which it occurs, and which can be reasonably located as to time when and place where it occurred, causing an injury.

What Is Covered?   "Occupational disease" means a disease due to the nature of an employment in which the hazards of such disease actually exist, are characteristic of, and peculiar to the trade, occupation, process, or employment…

What Is Not Covered? Psychological Injuries AKA Stress Claims Generally not covered unless associated with a physical injury

Idaho Statistics FY ,991 Medical Only Claims $24,370,315 15,016 Time Loss Claims $81,430,395 Indemnity $125,532,184 Medical 930 Legal Complaints Filed 81 Hearings Held

Workers Compensation Benefits Reasonable medical care Total temporary disability (TTD) Temporary partial disability (TPD) Retraining Permanent partial impairment (PPI) Permanent partial/total disability (PPD/PTD) Death benefits

Statute of Limitations 1) 1) One year from the date of making claim when no compensation paid 2) 2) Five years from the DOI when compensation discontinued 3) 3) One year from date of last payment when income benefits discontinued more than 4 years from the DOI 4) 4) Payment of medical benefits does not extend time 5) 5) Right to medical benefits not affected

Employers’ Role Strive to provide a safe work environment Maintain coverage for workers’ compensation Post notice of coverage Maintain record of injuries Report injuries to insurance provider within 10 days Supplemental report when disability > 60 days Offer light duty when practical

What Can An Employer Do To Control Cost?

Cost Control Methods Report injuries promptly Designate a medical provider Practice good record keeping Training & communication Maintain a light duty return to work (RTW) program Establish a drug-free work place program

When To Report An Injury When the injury   Requires medical treatment from a licensed physician   Results in 1 day or more of work missed   Upon employee’s request Filing is not an admission of liability

Hazards of Delayed Reporting STATUTE OF LIMITATIONS Failure to report tolls employee limitations DIRECT BILLING REQUESTS May extend Statute of Limitations from one (1) to five (5) years

Timeliness Counts Engleman, Anne and Vice Patrick, (2001). “First Report Of Injury: Impact On Claims Costs”

Timeliness Counts Early reporting: Allows the claims adjuster to monitor the doctor’s work release Allows witness statements to be taken while memories are fresh Allows physical evidence to be gathered for investigation Defuses tension with the injured worker Reduces the likelihood that the employee will hire an attorney

Designated Medical Provider Employer shall provide reasonable medical treatment If the employer fails to provide reasonable medical care, the injured employee may do so at the expense of the employer

Designated Medical Provider No reimbursement for care obtained outside the designated chain of referral Employee not responsible for charges of physicians to whom he/she has been referred for treatment of injury

Benefits of a Designated Provider Enhances communication Allows for some level of control over referrals Facilitates light duty work release

Record Keeping Prompt documentation of accident and statements of witnesses may provide a better defense Separation of Overtime from regular pay in payroll records reduces Average Weekly Wage (AWW)

Training Employees should know who to report an injury to Designate a position responsible for reporting injuries to the insurance provider Inform staff of a designated provider and post the information prominently Employees should know to keep in touch with the employer regarding work status

Light Duty Program Keeps premiums down by reducing claim cost Keeps the employee in a more controlled environment Keeps the work routine intact Makes the employee feel valued

Temporary Partial Disability Light Duty may be offered At reduced hours At a reduced wage Temporary Partial Disability Comp benefit 67% of reduction

Drug-Free Work Place Program Insurance companies may grant a premium credit to employers who have a qualifying alcohol and drug-free program

Industrial Commission Rehabilitation Division No cost to employers Determine physical requirements of job duties Help to develop job modifications to accommodate restrictions Work with employers to develop alternative work opportunities Working with provider to assess ability to RTW

Further Information Further Information Idaho Industrial Commission   (208)   (800)  

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