Idaho's system of workers' compensation is compulsory, meaning that employers are required to provide workers' compensation insurance to their employees. Workers' compensation insurance may be provided through private insurance carriers, a competitive state fund, or self-insurance. Waivers are not permitted.
Exemptions from coverage may apply to certain employees, including domestic workers, casual workers and professional athletes.
Medical Benefits are provided to employees entitled to workers' compensation benefits, with no limits on necessary medical care.
An employer may make the initial choice of treating physician. If the employer does not designate a care provider the employee may obtain reasonable care at the employer's expense. The employee may change treating physicians with the employer or insurance company's consent, following a referral by the treating physician, or upon successfully petitioning the workers' compensation commission for a change of doctor.
Indemnity benefits are payable to injured workers to help make up for lost income. There is a waiting period of 5 days before a worker is eligible for indemnity benefits, but if the worker's disability lasts more than 14 days indemnity benefits become retroactive to the date of the injury. The waiting period may be waived if the injury requires inpatient hospitalization.
Benefits available to injured workers include the following:
Temporary Total Disability (TTD)
Temporary total disability (TTD) benefits are paid to workers who are unable to work due to injury, but who are expected to make full or partial recovery such that they may return to work. Benefits are based upon 67z% of the worker's average pre-injury weekly wage, subject to a cap, and continue for the duration of the temporary disability.
Permanent Total Disability (PTD)
When a worker is not expected to recover from a total disability caused by a work-related injury, and as a result suffers a total loss of earning capacity, the worker becomes eligible for permanent total disability (PTD) benefits. In Idaho PTD benefits are calculated based upon 67% of the worker's average weekly wage. Benefits are periodically adjusted for inflation.
Permanent Partial Disability (PPD)
Once an injured worker has recovered to the maximum possible extent, the worker may be able to return to employment but nonetheless remain partially disabled, and may potentially qualify for permanent partial disability (PPD) benefits. In Idaho PPD benefits are determined based on a statutory schedule and 55% of the state average weekly wage for the year the injury occurred. For unscheduled injuries, persona partial impairment benefits are based on a functional impairment rating, and factors including the worker's age, occupation and education, and are payable for a maximum of 500 weeks.
Temporary Partial Disability (TPD)
When a worker suffers an injury that limits his ability to return to work, resulting in a reduction of income as a result of reduced hours or wages, the injured worker may be eligible to receive a benefit based on the difference between the worker's pre-injury earnings and their reduced, post-injury earnings. In Idaho, TPD benefits are paid based upon 67% of the difference between the injured worker's pre-injury and post-injury wage, subject to a cap.
For some, more serious injuries, workers' compensation indemnity benefits may be paid according to a statutory schedule, instead of following the standard model of the weekly benefit based on the duration of the disability. Scheduled injuries include such injuries as the amputation of an arm, the loss of a dominant hand, the loss of a leg, the loss of a foot, the loss of an eye, or loss of hearing in both ears.
Coverage may be available for cumulative trauma, disfigurement, and occupational hearing loss.
When a worker dies as the result of a work-related injury, workers' compensation pays additional benefits, including a burial allowance, and benefits for a surviving spouse and dependents. Survivor benefits are calculated based on 50% of the state average weekly wage, subject to a cap in duration. Benefits may continue for minors until the age of 18, the age of 23 if the dependent is a student, or indefinitely in the event of disability subject to the cap. Spousal benefits end upon remarriage.
Attorney fees are limited to 20% of benefits secured by the attorney if the matter is resolved without a hearing, or 30% of the matter goes to hearing. Attorney fees are normally paid from the award to the injured worker, subject to approval by the workers' compensation commission.
This article provides a quick overview of the benefits available to injured workers, but the full formulas used for assessment of benefits, coordination of different types of benefits, and assessment of injuries and disability ratings can quickly complicate the determination of benefits. Also, states frequently revise their workers' compensation laws. Most workers who suffer a significant injury or wage loss as the result of a workplace injury will benefit from consulting a workers' compensation lawyer.
The state agency responsible for workers' compensation is:
Idaho Industrial Commission
700 South Clearwater Lane
P. O. Box 83720
Boise, ID 83720-0041