Unless you are an agricultural or domestic worker in Idaho, there is every likelihood that you will be covered by your employer’s mandatory workers’ compensation insurance. If you become sick at work because of your job or you have a workplace accident and are injured you should be able to file a claim to recover workers’ compensation, which pays for medical costs as well as some, but not all of any lost wages. Not all claims are honored. This does not mean you cannot obtain compensation, but you may need to make an appeal with the help of a workers’ comp. attorney if your claim is denied. Workers' Compensation Law in Idaho In Idaho, the state body that deals with all workers’ compensation claims and appeals is the Idaho Industrial Commission (IIC). Workers’ compensation law in Idaho requires workers who are injured or are sick on the job to report their condition to their employer within 60 days or risk a denial of your claim. You also have 1 year from the date of the accident or onset of the illness to make a claim. Workers’ compensation claims in Idaho should cover most medical treatment, but not necessarily long term complications. Wage loss is compensated at an average of around 55% of the average wage, although the exact amount depends on the severity of the illness or injury. Some mental illnesses, as long as they are work related, are covered in Idaho. Why Your Workers' Comp Claim Could be Denied in Idaho There are several reasons why your claim has been denied. Some of these are relatively easy to correct. In a large workplace, your work schedule may be incorrectly recorded and the insurer may come to the conclusion that you were not present when an accident you said happened. Check with your employer to confirm what they reported to the insurance company. Times for reporting an workers' comp incident to your employer and making a claim are relatively generous in Idaho, a bit if you are late this could be a reason for a denial unless you were so ill that the delay was understandable. If you do not have sufficient documentation to show that you suffered a particular injury and that it cost you money or will cost you money, then your claim could be denied. Make sure that you have all the medical reports and invoices you need if you are planning on an appeal. The insurer may claim that you deliberately caused your own injuries or that you failed to follow established safety guidelines. The Idaho Workers' Comp Appeals Process If your workers’ comp. claim is denied by your employer’s insurance company you should request a hearing with the Idaho Industrial Commission. Although you don’t have to have an attorney represent you at the hearing, remember that the insurance company will and you are strongly advised to have an attorney yourself. The appeal procedure is quite formal and you will need to fill in the various forms and attend hearings and other meetings on time and be well prepared when you do so. The first two forms to complete and send to the IIC are the “Request for Complaint” form and the “Request for Calendaring” form. The IIC will appoint a commissioner to be present at the formal hearing. Before this happens there may be an attempt at mediation between you and the insurer and there may be a “discovery” session where you and the insurer make available any evidence you have to back up your point of view. The important thing is to make sure you have all the documentation you can get as well as witnesses, especially if there is doubt about when your injuries were inflicted or your behavior at the time. Why a Workers' Comp Attorney May be of Help Making an appeal through the IIC’s hearing procedure is not to be taken lightly. You are unlikely to succeed unless you are sufficiently prepared to contest the workers' comp denial. The whole procedure is very formal and requires you to have documentation ready which substantiates your claim. Get a workers’ compensation attorney to give you advice, help prepare for hearings and represent you wherever necessary.
