3. The Industrial Commission is the state regulatory agency that administers the workers’ compensation law in Idaho. The Commission has exclusive jurisdiction over claims involving work related injuries. Forms referred to in this presentation can be found on the Commissions website at www.iic.idaho.gov under find a form.www.iic.idaho.gov

4.  Approve carriers & self-insured employers  Ensure adequate security deposits  Enforce coverage requirements  Regulate benefit payments  Resolve disputes  Provide rehabilitation services  Provide compensation to victims of crime

5. Prior to the introduction of workers' compensation, workers injured on the job were compensated under a system of negligence liability. The employer was no longer liable, respectively, if the worker knew of the danger and assumed the risk of the danger when accepting the job, or if a fellow worker caused the accident, or if the worker's own negligence contributed to the accident.

6.  All medical treatment related to an on the job injury is paid in accordance with the Idaho Fee Schedule. The medical provider is prohibited from billing an employee for any balances remaining.

7.  (67%) of the employee’s wages are covered while the employee remains in the period of recovery and has a decrease in wage earning capacity or is totally off work. (Pain and suffering is not covered under workers compensation)

8.  An employer with one or more employees is required to secure workers’ compensation insurance coverage, even if the employee is a part-time worker.

9.  The employee pays no portion of the employer’s workers’ compensation coverage premium  No agreement by an employee to waive his rights to workers’ compensation benefits will be valid. This includes the employee agreeing to use vacation or sick leave pay in lieu of workers’ compensation income benefits.

10.  The employee shall report his injury to the employer within 60 days of the injury.  Delay in giving notice shall not be a bar to proceedings under this law if it is shown that the employer had knowledge of the injury, or that the employer was not prejudiced in their investigation of the claim by the delay in giving notice.

11.  For injuries requiring medical treatment or one or more days from work, the employer must complete and file a First Report of Injury form (IC form 101) within 10 days after the occurrence of an injury.  Filing of a claim by the employer is not admission of liability and is not conclusive evidence of any fact stated therein.  The employer must maintain record of every injury reported to him, either by filing a First Report of Injury, or for minor injury, completing an incident report as a permanent record of the injury.

12.  If the employer has knowledge of an injury, and willfully fails or refuses to file a report of injury, the time limitations that apply to the employee’s filing of a request for hearing within one year will not begin to run until the report of injury is filed.

13.  This doesn’t look safe. Would an electrocution injury be covered or not?

14.  Idaho Workers’ Compensation is a “no fault” system, which means ignorance is covered.

15.  Injuries that occur on the employer’s premises, including the employer’s parking lot are generally covered.  However, there are some exceptions to the premises rule:

16.  Domestic violence  Fights  Horseplay  Assaults

17.  Exceptions (may be covered): › Peculiar risk › Employer’s premises:

18.  Employer provided Transportation:  Ingress and Egress:  Employer requested trip:

19. Repetitive injuries are generally rapidly developing conditions that are compensable, if a physician has deemed them caused by work related activities. They are distinctively separate from occupational diseases due to their rapid and acute development.

20.  Previous findings state that the employer takes the employee as he finds him. The current employer’s responsibility would be to return the injured employee to his pre-injury condition, not to fix the pre-existing condition.

21.  (1) No compensation shall be allowed to an employee for injury proximately caused by the employee's willful intention to injure himself or to injure another.

22.  If intoxication is a reasonable and substantial cause of an injury, no income benefits shall be paid.  Exception: If the intoxicants were furnished by the employer or if the employer permits the employee to remain at work knowing the employee is intoxicated.

23.  If it can be proven that the employees work was a substantial contributing cause of the heart attack, it may be compensable.

24.  72-102 (22) "Occupational diseases." › (a) "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.

25.  72-102 (19) "Manifestation" means the time when an employee knows that he has an occupational disease, or whenever a qualified physician shall inform the injured worker that he has an occupational disease.

26.  (1) The employer is not responsible if the occupational disease was not incurred in the employer’s employment.  (2) Employee must be exposed to the hazard of such disease for a period of 60 days for the same employer in order for that employer to be liable for a non-acute occupational disease.

27.  72-448 (1) › The employee must give written notice to the employer within 60 days of the manifestation date, or to the Industrial Commission within 90 days of the manifestation, if the employer cannot be located. › A claim for workers’ compensation for an occupational disease must be filed within 1 year of its first manifestation, or will forever be barred.

29.  (1) Reasonable medical treatment. › Designated Company Physician  (2) Appliances and prostheses.  (3) Attendant care benefits.

30.  (4) Change of Physician › 1. By treating physician referral › 2. Upon approval by the employer/surety › 3. Approval by Industrial Commission (IC form “Petition for Change of Physician”)

31.  (5) Employee not entitled to reimbursement of medical care if sought in a manner other than listed in #4  (6) No provider shall engage in balance billing.  (7) Employee not responsible for charges from medical providers related to treatment of an industrial injury.  (9) Treatment by an accredited Christian Science practitioner shall be covered.

32.  11) Medical records related to the treatment of an industrial injury shall not be considered confidential, and shall be provided to the employer, surety, their attorneys, ISIF, the claimant, and/or the claimant’s attorney, and the Industrial Commission.  (12) Physicians or others providing services under this section shall assist and cooperate with the Industrial Commission Rehabilitation staff.

33.  (13) Employee shall be reimbursed their expense of necessary travel while obtaining medical care. › Travel is reimbursable at the current state travel reimbursement rate. The first 15 miles is not covered. › Claimant requests travel reimbursement on IC Form 432. Surety pays travel reimbursement every 30 days.

34.  (14) An employee who moves out of the area must give timely notice to the employer and surety of their intent to leave their locality. The employer/surety can request an examination by the treating physician prior to the employee leaving the locality, or if this is not practical, may assist in arranging an evaluation in the new locality.  The employer/surety shall have the same responsibility to furnish care after the employee’s relocation.

35.  Employee shall submit to an Independent Medical Exam (IME) if requested. The employee will be reimbursed for travel expense and current wage rate if working.  The employee has a right to have a physician of his choice present during the IME exam and/or obtain an audio recording of the exam.

36.  Wages are defined as the employee’s money payments for services.  Wages also include board, rent, housing, lodging, fuel, gratuities (tips), and other advantages, which can be estimated in money, received from the employer.  Gross wages are used, for a maximum of 1 year prior to the injury through the day before the injury occurred, including bonuses and fringe benefits.

37.  Bonuses must be an amount the claimant can make demand for payment on, such as commissions, bonuses related to increased physical effort, or bonuses related increased efficiency.  Overtime pay and Premium pay (shift differential) are not included in the gross wages. Overtime hours should be included at straight-time pay.

38.  “Wages” shall not include sums that the employer has paid to the employee to cover any special expenses entailed on him by the nature of his employment. Per Diem would be considered a special expense in most cases.  Compensation benefits are based on the employee’s average weekly wage at the time the injury occurred.

39.  Idaho Code 72-419 sections (1) through (11) provide the method of calculations for establishing the average weekly wage in different wage situations.

40.  72-402 Waiting Period: 5-day waiting period unless disability exceeds 14 days, or the employee is hospitalized as an in- patient.

41.  Per 72-408, income benefits are paid at 67% of the employee’s own average weekly wage, subject to the maximum and minimum limits in 72-409.

42.  The maximum and minimum limits set forth in 72-409 are based on a percentage of the Average Weekly State Wage established by The Department of Labor every January 1st.

43.  For an employee who earns $600 per week, income benefits would be paid at 67% of their own average weekly wage, or $402.00 per week.  For an employee who earns $1,000 per week, income benefits would be paid at 90% of the currently applicable Average State Wage, or a maximum of $572.40 per week in 2009.

44.  An employee earning $50.00 per week would receive the minimum of 15% of the currently applicable Average State Wage, or $95.40 per week for 2009  Income benefit are payable as long as the injured employee is in the period of recovery, and under medical work restrictions.

45.  If on restricted work duties and the employer provides work at pre-injury wages, the employee will not be entitled to income benefits as there is no wage loss. If the employer provides work at a lesser pay or fewer hours, the employee would be entitled to 67% of the difference between his/her pre-injury wages and the wages earned while working light duty, no to exceed off-work income benefits.

46.  If an employee is injured so severely that they cannot return to any type of work on a permanent basis, the employee shall be entitled to lifetime income benefits as described previously under Income Benefits.

47.  An injury, which results in a permanent physical functional loss, may be eligible for a monetary award. The treating physician assigns a percentage of impairment to the injured body part, and the insurance carrier pays a monetary award based on the work comp statutes.

48.  The physician should not address permanent partial impairment until the employee has become medically stationary from the injury. Permanent Partial Disability  A decrease in wage-earning capacity based on medical and non-medical factors related to a work related injury.

49.  If death occurs within 4 years from the date of accident or manifestation of an occupational disease, the employer shall pay weekly death benefits to the employee’s dependents

50.  Death benefits are subject to annual adjustments as the Average State Wage increases or decreases on January 1st of each year.  Percentage of weekly benefits are as follows: 1) Dependent widow, or widower with no dependent children until death or remarriage, but not to exceed 500 weeks: › 45% of the currently applicable average state wage. For the year 2009, 45% of the average state wage is $286.20.

51. 2) A widow with children: › 45% of the currently applicable average state wage with an additional 5% of the currently applicable average state wage per child ($31.80), to a maximum of 3 children, or 60% of the current ASW. For the year 2009 60% of the average state wage is $381.60 per week.

52.  Children are eligible for death benefits until the age of 18 years, or marriage or death if either occurs prior to the age of 18 years.  Children enrolled as a full-time student in any accredited educational institution, or accredited vocational training program, are eligible until the child reaches the age of 23 or ceases to be enrolled.

53. 3) If there is no dependent widow or widower but a dependent child or children: › 30% of the currently applicable average state wage ($190.80) for the first child, plus 10% average state wage for each additional child to a maximum of 60% of the current average state wage. For the year 2009, 60% of the average state wage is $381.60.

54.  In cases where a third party is responsible for the accident causing the employee’s injury, the employee can pursue the third party for recovery of benefits related to the injury, including pain and suffering.

55.  The employee cannot collect and keep both workers’ compensation benefits and a third party settlement. The employer/surety is entitled to reimbursement of the workers’ compensation benefits paid as a result of the accident

56.  Whenever the commission determines that it is for the best interest of all parties, the liability of the employer for compensation may, on application to the commission by any party interested, be discharged in whole or in part by the payment of one or more lump sums to be determined, with the approval of the commission.

57.  Compensation paid or not disputed would not be considered available funds to apply attorney fees against. › It must be shown to the Commission that the services of the attorney operated primarily or substantially to secure the fund out of which the attorney seeks to be paid.

58.  Reasonable attorney fees are consistent with the attorney’s fee agreement with the claimant subject to the element of reasonableness as follows: › 25% of available funds if no hearing is held › 30% of funds awarded after a hearing is held › Permanent total disability: 25% or 30% of weekly benefits for the first 10 years, then 15% thereafter

59.  1 Year if no benefits paid  5 Years from date of injury if benefits paid › 4 Year exception › Payment of medical bills after 5 years-no affect › No limitation on medical benefits