Workers’ Compensation is a system of insurance that pays an employee that cannot work because he or she has been injured while working. Workers’ Compensation can have very complicated medical and legal issues depending on the severity of the workers’ injuries and other factors. Although some cases can get complicated, every case follows the same general pattern. Knowledge of this pattern will help you to understand what stage of the claim process you have reached. After you get hurt on the job and can't work, the workers compensation insurance company owes you total temporary disability benefits or TTD benefits. These benefits replace your wages.
Your DoctorYour doctor has to support your off-work status by sending the adjuster an off-work note. After your doctor has taken you off work for 2 weeks, the workers compensation insurance company is required to pay you wage replacement benefits that are called Total Temporary Disability benefits or TTD benefits. You are paid these TTD benefits until you reach what is called maximum medical improvement. You need to have your doctor support you with his opinion that you cannot work during the period that you receive the TTD benefits. These TTD benefits are paid under Idaho Code § 72-408.
How the TTD Benefits Are CalculatedThese TTD benefits are calculated based upon your average weekly wage. Under Idaho Code § 72-419, the adjuster takes the four quarters prior to your accident and calculates what your average weekly wage is for the highest quarter. Then he/she multiplies that average weekly wage by 67% to arrive at the amount that you will receive in these TTD benefits every 2 weeks. However, the most you can receive is 90% of the average state weekly wage which is currently at $786. Therefore, you can receive no more than $707.40 per week in TTD benefits. When the adjuster is calculating these benefits, they do not have to take overtime or bonus pay into consideration under Idaho Code § 72-419(4).
I know all this sounds confusing. I have been around the Idaho workers compensation industry for the last 32 years both as an insurance defense lawyer in the 90s and for the last 20 years exclusively representing injured Idaho workers just like you. I can audit the TTD benefits that you are currently receiving and make sure that you are being paid what you legally deserve. Not a penny more and not a penny less. Sometimes the adjusters can make mistakes. It is always good to have an experienced Idaho workers compensation lawyer look over your TTD benefits and make sure that you are being paid properly.
Why Did My TTD Benefits Get Cut Off?Idaho insurance adjusters are paid to look out for the insurance companies’ assets. They will want to cut you off from these TTD benefits or wage replacement benefits as soon as they can. They have an entire group of insurance company doctors who they send injured Idaho workers just like you, so that they can get a medical opinion to support them cutting off your TTD benefits. An experienced Idaho workers compensation attorney can put this issue in front of the Idaho industrial Commission at a hearing. If the Idaho workers compensation insurance company is found to have acted unreasonably, then the Idaho Industrial Commission can award attorney fees to you under Idaho Code § 72-804. This happened in our recent case of Hackman v. CHS Inc. decided on August 13, 2018. In that case, the Idaho Industrial Commission unanimously decided:
“The sequence of events, as described above, demonstrated arbitrary and dilatory behavior on the part of Surety in adjusting this claim, beginning with the decision to obtain a second IME from a physician who was not appropriately credentialed to render an informed opinion. Defendants thus unreasonably delayed Claimant’s surgical treatment, prolonging his suffering due to the pain associated with his condition. Defendants initially relied upon a questionable causation opinion authored by Dr. Drake in August 2017 to deny further treatment. Once that became untenable, they appeared to enter into a good faith settlement of the matter by agreeing to cover the additional medical treatment, including doctor visits, a new MRI, and the surgeries. Regardless of whether this stipulation accurately represented Surety’s intentions towards adjusting the claim, the commitment made by Defendants’ counsel should have been honored, as it induced Claimant to rely upon it to his detriment by abandoning his first request for an emergency hearing on November 30, 2017. The Defendants then surfaced the smoking issue in December 2017 to provide a new basis for denial, knowing full well how Dr. Drake would respond because they had already asked him this question as part of his original IME. Again, Defendants undertook this new smoking endeavor without even bothering to wait for Dr. Hansen’s opinion on it.
For the foregoing reasons, Claimant is entitled to recover attorney fees pursuant to Idaho Code § 72-804.”
Call us at 208-232-6101, and we can help you go after your Idaho workers compensation insurance company to make sure they pay you all the TTD benefits that you legally deserve and if they resist us you too could have attorney fees awarded.