Injured Worker

Sustaining an on-the-job injury or suffering from a work-related illness can impact several aspects of your life. If your employer has a policy with SIF, you can be assured that we will handle your claim with compassion and professionalism. The Workers’ Compensation Law protects employees by guaranteeing medical benefits for a covered injury or illness at no cost to you; it also provides income benefits for those who qualify.

SIF’s 10 Tips for Navigating the Claims Process

I’ve been injured. Now what?

If you are injured at work, notify your employer immediately and seek medical attention if necessary. Unless it’s an emergency, see your employer’s designated provider if they have one.

Work with your employer to complete the First Report of Injury or Illness (FROI). SIF cannot open a claim until we receive this form.

Once SIF receives your FROI, your assigned claims examiner will evaluate your claim. Medical and income benefits may be available based on guidelines established by the Workers’ Compensation Law.

Attend all scheduled medical appointments and follow your doctor’s treatment orders to get the best results possible for your recovery.

If your physician authorizes you to return to work, either on a part- or full-time basis, SIF is here to support and direct you to the resources you need.

Cooperate with return-to-work efforts by your employer and the Industrial Commission Rehabilitation Division when involved. Notify us of any change of employment status.

Effective communication with your claims examiner, employer, and physician is key to a stress-free experience. Have your SIF claim number handy and use the same name when you talk to your examiner or medical providers.

Notify your claims examiner of any change of address. Return all requests for information to SIF. We don’t want to delay important payments or correspondence.

SIF closes a claim when:

  • No further medical treatment is necessary and all benefits have been paid.
  • The injured worker successfully returns to work.
  • A permanent partial impairment is awarded and paid in full.

Most importantly, call your examiner with any questions or concerns you have. We’re here to take the worry out of your workers’ comp claim.

Medical Benefits


Medical Benefits

Workers’ compensation pays medical benefits directly related to your injury or illness based on a fee schedule set by the Idaho Industrial Commission. You are not responsible for any unpaid balance of approved services related to your claim, but you are responsible for any cost of treatment unrelated to your injury or illness.

Medical benefits include, but are not limited to:
  • Treatment and diagnostics such as X-ray, lab test, etc. (Please note: you may need pre-approval for these)
  • Medical, surgical, hospital and nursing care
  • Prescription medications
  • Crutches and apparatuses prescribed by your physician
  • Necessary replacement or repair of appliances or prosthetics under normal wear
  • Replacement of glasses with like kind if they were broken in a work-related accident where an injury also occurred
  • Reasonable travel expenses for medical exams and treatments

Income Benefits


Income Benefits

Time away from work (disability) must be authorized by your treating physician to receive income benefits. If your physician prescribes that you be off of work for more than five days, your approved benefits will begin accruing on the sixth day; however, if you are hospitalized overnight or your disability exceeds fourteen days, benefits are calculated from the first day of disability. Benefits are typically paid every two weeks.

There are several types of benefits to be aware of:
  • Temporary Total Disability (TTD): Income benefits are paid when you are totally unable to work for a temporary period of time.
  • Temporary Partial Disability (TPD): When work restrictions limit your return to work to a part-time basis or at a reduced rate of pay, SIF pays a percentage of the difference between your regular wages and the reduced wages.
  • Permanent Partial Impairment (PPI): Benefits paid following a permanent loss of function of a body part. A doctor’s assessment is required to determine any impairment.
  • Permanent Partial Disability (PPD): If you suffer a permanent impairment and also suffer a decrease in your wage-earning capacity or labor market, you may be entitled to these benefits. The Idaho Industrial Commission evaluates and determines the percentage of disability.
  • Death Benefits (DB): In the event of your death, the law provides weekly income benefits for your spouse and dependents for a specified time. SIF also pays up to $6,000 for burial expenses and transportation of the body.

Forms


Medical Release Authorization Form

Please complete and return this form to allow SIF to access your medical bills and reports so we can help process your claim quickly. Your medical information is and will remain confidential.

Travel Expense Reimbursement Form

You can request reimbursement for travel when seeking reasonable care and treatment for your injury or illness. Travel must exceed 15 miles round trip from your home per visit.

Download Forms

Frequently Asked Questions


Notify your employer immediately if you are injured or develop a work-related illness so they can file the First Report of Injury form for you. Once SIF receives the form, a claims examiner will be assigned to your case and will assist you through the process.
Follow your doctor’s orders and keep your employer and claims examiner informed of your progress and ability to return to work. Be sure to ask your physician questions as it is important to understand your injury and what can be expected. Be careful not to do any activity that will worsen or delay your healing.

Circumstances about your claim may require additional information including:

  • One of our in-house investigators may contact you to take your statement about the incident.
  • We may request your salary history from your employer to better determine your income benefit.
  • A Medical Release Form may be needed from you to allow us to request bills and medical records.
  • We may ask for a police report (for a car accident) or pictures or product information if your accident was caused by another person or faulty machine or product.
  • The Industrial Commission Rehabilitation Division may work with your physician, employer and you to make accommodations to get you back to work.
  • We may ask for you to see an independent medical provider for an evaluation.
You must receive a referral from your treating physician if you wish to change physicians. If you are unable to obtain a referral from your physician, contact SIF to request a change. If SIF does not grant your request, you may file a petition with the Idaho Industrial Commission.
If your claim is registered with SIF, contact the provider and have them send the bill to us. Give them your claim number to expedite the process. If SIF paid the medical provider and you receive a bill for the portion we did not pay, call your claims examiner. By law, you cannot be billed for charges in excess of the allowable amount; however, you are responsible for any charges not related to treatment for your work-related injury or illness.
You have the right to pursue a claim against the party that was at fault. SIF is required by law (Idaho Code 72-223) to provide benefits to the injured worker regardless of who is at fault. SIF has the right to the first recovery of any monies that may be received from a third-party claim. If a claim is caused by a non-company person or a machine or product malfunction, please contact SIF immediately.
Most claims are processed without incident and SIF makes every effort to resolve disputes in a fair and equitable manner. If you disagree with a decision about your claim, contact your examiner first. They will listen to your concern and review your case. Based on the circumstances, it may be best to have mediation, request a hearing before the Industrial Commission, or in the case of benefits, a lump sum settlement may be agreed upon and approved by the Industrial Commission.
Although workers’ compensation is regulated and procedures are in place to help your claim go smoothly, you do have the right to hire an attorney. Generally, the injured worker is responsible for the cost of his or her attorney. Once an attorney is involved, all communications, including benefit payments, must go through the attorney and we can no longer talk directly to the injured worker about the claim.