Medical Benefits
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Workers compensation benefits include reasonable and necessary medical treatment as prescribed by a treating physician.
This section contains information about medical benefits and other aspects of medical care.
Medical treatment
The following medical benefits are covered:
- All medical, surgical, hospital and nursing care reasonably necessary for treatment and rehabilitation, including prescribed medications.
- Crutches and apparatus prescribed by the attending physician that may be needed for a reasonable time.
- Necessary replacement or repair of appliances or prosthesis unless the need is due to a lack of proper care by the injured worker.
- Reimbursement for reasonable travel expenses for medical examination or treatment.
- Replacement of glasses with like kind and quality when broken in a work-related accident resulting in an injury. It is not
necessary that the injury require medical attention by a physician. Injuries such as abrasions, bruises, etc., may be sufficient to allow
for replacement of broken glasses.
Diagnostic testing
In non-emergency cases, the State Insurance Fund requests providers notify the Fund prior to proceeding with testing such as MRI,
CT scan, nerve conduction studies (NVC/EMG), myelograms and discograms. The injured worker should ask their physician to contact
the State Insurance Fund if the physician recommends the injured worker undergo diagnostic testing.
Physician reporting requirements
In order to receive payment, the physician or hospital must provide the State Insurance Fund with a medical report and
billing. If a report is not received, there may be a delay in payment of the bill. The injured worker should notify the
physician of the claim number assigned to ensure any information sent to the State Insurance Fund is routed to the appropriate claims file.
Medical payments
Medical charges are paid based on the Idaho Code and the fee scheduled administered by the Industrial Commission. If a bill is reduced
to comply with the usual and customary rates, the injured worker or employer is not responsible for the balance of the charges.
An injured worker will be responsible, however, for non-covered expenses or charges unrelated to a work-related injury.
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If an injured worker receives any statements requesting payment for
the balance of the charges, the injured worker should contact the State Insurance Fund. |
Medical release
At times, pre-injury medical information is needed to determine benefits for the current injury. A medical release, along
with a request for a list of physicians the claimant has seen in the past, may be sent to the claimant.
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All records received are confidential information. |
Choosing a physician
The employer has the responsibility to provide adequate medical care for an injured worker at the time of an accident. If a
company physician has been selected, it is reasonable to send all non-life-threatening injuries to that physician for care.
If no designated physician is assigned, the employee may select the physician of his or her choice for initial treatment.
Changing physicians
If a claimant wishes to change physicians, according to Idaho Code 72-432 (4), he or she can obtain a referral from the treating physician or request a change
of physicians. If the request is denied, the claimant can file a Petition for Change of Physician with the
Industrial Commission.
Idaho Code 72-432
Request A Change Of Physicians Form [PDF]
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The claimant may be responsible for the fees charged by the physician if
pre-authorization is not obtained from the State Insurance Fund or a Petition for Change of Physician is denied by
the Industrial Commission, Idaho Code 72-432 (5). |
Independent medical examinations
If there are questions regarding a medical diagnosis, medical treatment, medical stability, or a permanent partial impairment, an
independent medical evaluation (IME) may be scheduled with a physician or a panel of physicians. The claimant will be given adequate
notice of the appointment, and necessary travel expenses will be covered.
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