Frequently asked questions answered What is a classification rate and how is it determined? The National Council on Compensation Insurance (NCCI) is a third-party rating authority that gathers statistics from all workers compensation insurers on all policies written in Idaho. NCCI breaks the statistics down by business classification, comparing the gross payroll versus the dollar value of claims paid for each classification. Thus, the losses within your industry set the rates. NCCI submits those rates to the Department of Insurance for approval and use in Idaho. How is my premium determined? What we call standard premium is determined by multiplying your classification rate times your gross payroll. However, that premium can be modified based upon your own individual claims experience, if you average $3,000 or more in premium per year. How do my claims
modify premiums? Do I have to call you when I hire or fire an employee? No, however, you should keep your claims examiner informed about the employment status of any employee who is receiving workers comp benefits. If I report an employee in the wrong class code and the employee gets hurt on the job, is the injured worker covered by workers compensation? Yes. Complete the First Report of Injury, and if you know the correct class code, provide it. If you don’t know the code, submit the claim form without the code and we will apply the appropriate code. To correct the reported payroll, contact the Audit Department at 208-332-2150 and Fund personnel will assist you. After the correction is made, a revised statement will be sent to you. What is a FROI? A FROI is a First Report of Injury or Illness form, which is used to report a workplace-related injury or occupational disease. (Earlier versions were labeled Notice of Injury and Claim for Benefits. If you have copies of this obsolete form, please destroy them.) A FROI must be filed as soon as practicable but not later than 10 days after the occurrence of an injury or occupational disease. A First Report of Injury must be filed if the injured worker:
The filing of a First Report of Injury is not an admission of liability. If an employer has concerns regarding the injury, a letter should be attached to the First Report of Injury outlining any concerns. The FROI should be completed by the employer, not the employee or medical provider. How do I obtain a First Report of Injury? A printed version is provided to each new policyholder and additional copies can be obtained from your underwriter or insurance agent. The Fund also has an electronic version available at our website (www2.state.id.us/isif). Go to our home page and click on the “File a claim” link. You will find instructions on how to complete and submit the form to the Fund. The electronic form is a Microsoft Word file, and you will need MS Word 97 or a more recent version. Where do I e-mail my First Report of Injury? Send it to reportclaim@idahosif.org as an attached file, not embedded in the e-mail message. If you have questions or need assistance with the form, send an e-mail to forms@idahosif.org. Who is responsible for requesting pre-authorization for medical procedures requiring pre-authorization? The medical provider requesting the service, or performing the service, should contact the Fund to request pre-authorization. Do I have to pay my injured employee for the five-day waiting period? It is up to the individual employer as to whether they pay the employee for the five-day waiting period. If the injured worker is hospitalized or the time loss extends beyond 14 days, compensation will begin on the first day of disability. How is the weekly benefit amount determined for compensation benefits? The income benefit level paid depends on the injured worker’s average weekly wage. Most injured workers will be paid 67% of their gross wage, subject to maximum and minimum values determined by the Average State Weekly Wage (ASWW). The Average State Weekly Wage is an amount determined each year by the Industrial Commission based on data provided by the state Department of Commerce and Labor. The ASWW used for workers compensation benefits purposes is a byproduct of Idaho’s Unemployment Insurance (UI) program. Commerce and Labor research staff calculate the ASWW each year using monthly employment and wage information reported by Idaho employers each quarter in order to collect unemployment taxes. It includes the wages of all employees covered under the state’s unemployment program, including local and state government workers. The ASWW for Benefit Rate Year 2004 is $534. The ASWW for 2005 has already been determined — $543. It was based on the calendar year 2003’s average annual wage of $28,244 per year divided by 52, then rounded to the nearest dollar amount. It is necessary to use the calendar year 2003 wages for the 2005 ASWW because there is a five-month lag after the end of the year before employers submit their reports and Idaho Commerce and Labor staff can collect and compile the data. If I have elected to be covered as a sole proprietor, the law requires me to pay premium based upon $13,000 in salary each year. If I get hurt, will you pay me based on that amount? Benefits would be based on your average weekly wage as determined by law, Idaho Code 72-419. Is severance pay included as payroll? No, severance pay is
excluded from reportable payroll. Tips also are excluded as gross payroll. Return to compUpdate Idaho State Insurance Fund |