THE FOLLOWING ANSWERS TO FREQUENTLY ASKED QUESTIONS
ARE INTENDED TO PROVIDE GENERAL INFORMATION ABOUT IDAHO LAW AND ARE NOT A SUBSTITUTE FOR LEGAL COUNSEL
HOW DID WORKERS’ COMPENSATION START?
Workers’ compensation laws had their beginning in Germany during the late 1800s. Most states in our
country enacted these laws at the beginning of the 1900s. Workers’ compensation has been a part of Idaho law since 1917.
Before workers’ compensation, injured workers were frequently left to fend for themselves. Workers could sue employers
in court, but they had to prove that the employer was at fault and the worker not at fault at all. It was very difficult,
and at that time there were few safety precautions. As injuries and horror stories of destitute injured workers increased,
unions and other sympathetic groups began to seek solutions. Employers were also being sued more as courts began to be used
more to force changes. These competing interests resulted in the creation of workers’ compensation laws. A compelling
literary description of life without workers' compensation is Upton Sinclair's novel, "The Jungle."
WHAT IS WORKERS’ COMPENSATION?
Workers’ compensation is designed to be a no-fault system of limited benefits to assist
workers injured on the job. It involves a legislated compromise between employers and workers. Under the compromise, employers
are responsible for payment of benefits regardless of the fault of the employee or others. Workers do not have to prove that
the employer was at fault. Employers are required to pay a set level of benefits. Workers give up their right to sue the employer
for certain types of damages such as "pain and suffering." In most states including Idaho, the employer and worker do not
have a choice to agree or not with the compromise. It is the law. In Idaho and most states, employers are required to carry
insurance. If they do not there are penalties. In Idaho the penalty includes payment to the injured worker of an additional
10%, plus attorney fees and costs of the lawsuit.
WHAT INJURIES ARE COVERED?
To be covered, an injury must be caused by an accident at work, or be classified as an occupational
disease. An accident is an unexpected event which can be reasonably located by time and place. Lifting boxes for an
hour could be an accident if it causes an injury. Lifting boxes over a week would probably not be an accident, because it
is not reasonably located in time, unless the specific time of injury during the week could be identified. An occupational
disease is a condition caused by exposure to a hazard at the employment usually over a period of time, and may involve
delayed symptoms. This could include asbestos and radiation injuries, chemical poisonings, and repetitive use injuries such
as carpal tunnel syndrome.
ARE THERE TIME LIMITS FOR MAKING CLAIMS?
Yes, there are a number of time limits, some of them complicated. In Idaho, an injured worker
must report an accident caused injury to the employer as soon as practicable, but not later than 60 days. Notice should be
in writing, but may be verbal if you can prove it was given. A written claim for benefits must be made within one year, but
is not required if benefits are paid during the year. A notice and claim can be combined in one writing. An employer must
be notified of an occupational disease within 60 days of when a physician informs the employee that he has an occupational
disease. If no benefits are paid, a lawsuit must be filed within one year of when the written claim was filed. If a dispute
arises over an accepted claim, a lawsuit must usually be filed within 5 years of the accident or disease diagnosis date. The
time may be longer for medical benefits or for cases where disability benefits are still being paid 4 years after the accident
or disease diagnosis.
WHAT BENEFITS ARE AVAILABLE?
Each state varies in the specific benefits available. Generally in Idaho there are five types:
(1) Medical, (2) Temporary disability, (3) Retraining, (4) Permanent disability, and (5) Death benefits. Medical benefits
are to pay for the expense of medical treatment and rehabilitation. This benefit includes payment for hospitals, various types
of physicians, therapy, prescriptions, tests, mileage if over 15 miles, and in serious cases, even home care. Temporary
disability benefits provide income payments during the recovery period. The amount of payment is generally 67%
of the worker's wage; however, there are maximums, minimums and other special rules. Retraining benefits may be available
if a worker is unable to return to the former type of employment and there are not adequate alternatives available. This benefit
pays a maximum of two years extended temporary disability, plus reasonable costs of retraining. Permanent disability benefits
are paid if the worker suffers a permanent physical or, in limited cases, mental impairment after the period of recovery.
Payment is based upon a rating of between 0 and 100 percent, and a set scale of benefit payments depending on the rating.
Physicians give a medical impairment rating, but the disability rating may be more, depending upon how the physical impairment
affects the ability to be gainfully employed. Factors such as age, education, skill levels, and other circumstances are considered.
Permanent disability benefits may last from a few weeks to several years depending on the severity. Serious cases involving
total disability pay a lifetime benefit. Death benefits are income payments made to a surviving spouse, minor children
or certain other dependants. They last a maximum of 500 weeks (9 1/2 years). Remarriage may affect the benefits. A funeral
allowance is also provided.
WHY IS MY CLAIM BEING DISPUTED?
Although workers' compensation is a no-fault system, there are many issues over which employers and their
insurance companies dispute claims. Some of those issues are: (1) Did you give notice and file your claim within the proper
time period? (2) Were you an independent contractor rather than an employee? (This issue frequently arises in the construction
or trucking industries) (3) Were you hurt somewhere else, and not on the job? (4) Was your injury or disease a pre-existing
condition not caused by employment? (5) Are you are as disabled as you feel that you are? There is also one area of fault
that can be a reason for limitation of benefts -- That is if the injury is shown to be substantially caused by intoxication.
These and other issues are often technical, and should be evaluated with the assistance of legal counsel.
HOW ARE WORKERS' COMPENSATION DISPUTES DECIDED?
The workers' compensation claim process is overseen by a state agency known in Idaho as the Industrial Commission.
The Commission is made up of three Commissioners: one from Labor, one from Business, and one who is an Attorney. Disputed
claims are usually resolved through negotiation, mediation or litigation. Some cases involve all of these. Negotiation requires recognition of the issues in the case, the potential value of the claim, as well as the
potential risk of losing. This applies to all parties to a dispute. Compromise is required in order to reach a negotiated
settlement. The law requires that all settlements be approved through the Industrial Commission. Mediation involves a neutral third party who is trained in helping the parties come to an agreement.
It is a form of assisted negotiation. The mediator usually meets with the parties together, and then meets with each side
separately, clarifying issues, and helping the parties communicate. Since a mediator does not provide legal advice, or evaluate
the case for the parties, it is advisable for the parties to have legal counsel in the process, so that the issues can be
properly evaluated. Litigation is going through a lawsuit,
including a trial, and having the Industrial Commission decide the case for better or for worse. Referees usually hear disputed
cases as a judge would, and then recommend a decision to the Commissioners. Referees are attorneys who are employed by the
Industrial Commission. There is no jury, but cases are otherwise presented in a trial setting, with witnesses and exhibits.