Idaho Law Blog
The Idaho Workers’ Compensation Act requires that all Idaho workers’ compensation claims be adjusted by Idaho-based insurance adjusters. This includes all aspects of handling and adjusting the Idaho workers’ compensation claims, including investigation and interviews. The Idaho in-state adjusters must have full decision-making authority, which includes acceptance or denial of the claims, authorization of medical treatment, and the payment of all income benefits.
Idaho workers’ compensation claims also require the management of the injured workers’ medical treatment. This has to be done through the in-state licensed adjuster and not by a case management nurse, whether they are inside or outside the state of Idaho. The Idaho adjusters can consult with doctors or nurse case managers before making their decision but they have to make all final decision in the injured workers’ health care management within the state of Idaho.
All written communications with medical providers and others involved in the claim and all reports required by law or rule must be distributed through the Idaho in-state adjuster.
All benefit checks must be signed and issued by Idaho in-state adjusters unless they have applied for and received an approval or a written waiver from the Idaho Industrial Commission. The waiver only covers the issuing of checks.
The Idaho Industrial Commission does not allow “fronting”. An example of fronting would be maintaining an in-state adjuster who does not have full authority to make decisions regarding acceptance or denial of claims, full authority over medical treatment and payment, and full authority to sign and issue checks, absent an approved waiver.
The requirement of having in-state adjusters guarantees that the Idaho Industrial Commission can effectively manage Idaho workers’ compensation companies and the adjustment of Idaho workers’ compensation claims. It is probably one of the biggest reasons why Idaho has one of the premier workers’ compensation systems in the entire United States.
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