Insurance Information

Benefits Tables

To calculate benefits an injured worker may be entitled to, use the following tables to:

Claims and Benefits Guidance

Reporting Injuries

If a work-related injury or illness results in lost work time or requires medical treatment, that injury or illness must be reported to the Idaho Industrial Commission. This is done with a First Report of Injury or Illness form. Before completing the form, be sure to read the instructions. The form can be filled out and sent as an email attachment.

Surety Audits

The Industrial Commission Claims and Benefits department conducts compliance audits of insurers and their designated in-state adjusters. Periodic audits are performed to ensure insurer and self-insured employers are in compliance with claims adjusting requirements as required by Statute and Rule.

Audit Guidelines

Medical Fee Disputes

NOTICE: Change to Application of 30% Penalty In Medical Fee Disputes

 

For all Motions filed on or after October 1, 2014, unless the payer demonstrates, by timely response to the provider’s Motion, that the payer’s previous payment is adequate, the penalty will now be applied to the underpayment owed at the time the Motion was filed.  Payments issued after the filing of the Motion may be deducted from the ordered amount, but will not reduce the penalty. For more information, click here.

(Added 08/26)

The Commission has prepared some items to help navigate the medical fee dispute process. The Commission has also created a separate page to answer frequently asked questions.

Electronic Data Interchange

EDI (Electronic Data Interchange) is a computer-to-computer exchange of data in a standardized format. Standardized transactions sets allow hundreds of different documents to be electronically exchanged. Each trading partner (parties who exchange data) must use the standardized format and set of rules for the data information transfer. Electronic submissions are a much more efficient method to transmit the legally required information and forms on workers’ compensation claims. EDI will streamline the submission of required documents by eliminating the need for most paper forms.

The Idaho Industrial Commission’s Benefits Department is responsible to code, enter, and digitize or microfilm all documents related to workplace injuries filed with the division by employers, carriers, and physicians. Each year there are approximately 35,000 claims filed in Idaho, representing 136,500 pages of documents to process. Although EDI Claims Release 3.0 has start-up resource costs, the electronic submission of workers’ compensation claim information has many advantages over the submission of paper forms, including:

1) The opportunity for the jurisdiction and insurance carrier to exchange real-time data to ensure accuracy;

2) Elimination of most paper documents and the attendant handling and storage concerns for data exchanged between the jurisdiction and carriers;

3) Digitized data to facilitate long-term record retention; and

4) An electronic audit trail to document timely compliance with filing requirements.

The International Association of Industrial Accident Boards and Commissions (IAIABC) is a private association of workers’ compensation professionals from both the public and private sector working together to improve the administration and application of Workers’ Compensation Laws across the nation. The IAIABC has developed EDI standards for reporting First and Subsequent Reports of Injury, medical and proof of coverage information. Over two thirds of the states have adopted some form of EDI in their workers’ compensation systems. The IAIABC is committed to the EDI process and is constantly evaluating and enhancing the standards for reporting workers’ compensation insurance data.

Additional Resources

EDI Claims resources

IIC contact information: (Business) Patti Vaughn, 208-334-6063

Out-of-State Check Waivers

To apply for an Out-of-State Check-Writing Waiver, submit a completed application and affidavit to the Industrial Commission at PO Box 83720, Boise, ID 83720-0041. Each surety/underwriter must apply for its own waiver. Waivers are not issued to insurance groups, or to third party adjusters.

Upon receipt of the application, we will review and determine whether we will issue the waiver, based upon the information you return to us and independent information available to us regarding your claims management practices.

Filing Calendar

IC-36: Outstanding Awards Report
Due quarterly: January 31, April 30, July 31, October 31

IC-211: Self-Insured Employer Report of Total Unpaid Liability
Due July 31 (Jan – Jun payments), January 31 (Jul – Dec payments)

IC2-327: Workers’ Compensation Payment on Medical-Only Claims or Indemnity Payments
This report is to be submitted annually. It is to be received in this office no later than March 3rd of the subsequent year.

IC-4008LD: Workers’ Compensation Deductible Policy Report
This report is to be submitted annually. It is to be received in this office no later than March 3rd of the subsequent year.

IC-4008: Premium Tax Report Form
Due semi-annually: in this office no later than July 31 (Jan-Jun payments) and in this office no later than March 3 (Jul-Dec payments).

IC-4010: Premium Tax Report Form, Self-Insured
Due semi-annually: in this office no later than July 31 (Jan-Jun payments) and in this office no later than March 3 (Jul-Dec payments). (Also IC-4010a computation form.)

Security for Compensation Guidance

Eligible Securities Allowed for Statutory Deposits (Insurers)

In-State Adjuster Change Form

In-State Adjuster Change Form

Use the In-State Adjuster Change Form to either change your Primary in-state adjusting company designation, or the in-state adjuster for policyholders not handled by the Primary adjusting company.

For questions related to adjusters please visit the Idaho Department of Insurance.

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