Idaho Regulations 17.02.07.011

02. Procedure for Submitting Claims. In order to comply with Section 72-602, Idaho Code, Form 1A-1 shall be submitted to the Commission in substantially the same form as set forth below. At such time as the Commission institutes a system for on-line reporting of claims, claims may be submitted electronically. Fields that require clarification are listed below with explanations and/or applicable coding information:

a. Dates: Use MM/DD/YYYY format. (7-1-97)

b. SIC Code: Code that represents the nature of employers business as it is contained in the Standard Industrial Classification Manual published by the Federal Office of Management and Budget.

c. Carrier: The surety issuing a contract of insurance and assuming financial responsibility on behalf of the employer of the claimant. In the case of a self-insured, the self-insureds information should be submitted.

d. Claims Administrator: The name of the surety, adjuster, state fund, or self-insured responsible for administering the claim.

e. Employment status: This is the claimants work status. The valid choices are full-time, not employed, disabled, unknown, part-time apprentice, seasonal, part-time, on strike, retired, full-time apprentice, volunteer, or piece worker.

f. Date disability began: The first day on which the claimant lost time from work due to the injury or disease.

g. Type of injury/illness: Brief description of nature of injury or illness or the appropriate National Council on Compensation Insurance (NCCI) Detailed Claim Information (DCI) code.

h. Part of body affected: Brief description or the appropriate DCI code(s).

i. Department or location where accident or illness exposure occurred: Enter requested information or, if the accident or illness exposure did not occur on the employers premises, enter address or location as specifically as possible.

j. Nature of injury: Brief description or the appropriate DCI code(s).

k. Work process the employee was engaged in when accident or illness exposure occurred: Describe the work process the employee was engaged in when the accident or illness exposure occurred, such as building maintenance. Enter NA for not applicable if employee was not engaged in a work process.

03. Retaining Claims Files. All employers shall maintain their respective claim files in accordance with Section 051. Upon request of the Commission, employers shall provide to the Commission, in whole or in part according to the request, a copy of the claim file at no cost to the Commission.

a. All employers shall retain complete copies of claims files for the life of the claim or a minimum of five (5) years from the date of closure, whichever is shorter.

b. For time-loss claims, closure will be the date upon which the employer files the final summary of payments. The Commission recommends that an employer retain a closed claim file for a minimum of five (5) years.

04. Filing Not an Admission. Filing a claim is not an admission of liability and is not conclusive evidence of any fact stated therein. If a claim is submitted electronically, no signatures are required.

05. Filing Considered Authorization. Filing of a claim shall be considered an authorization for the release of medical records that are relevant to or bearing upon the particular injury or occupational disease for which the claimant is seeking compensation.

06. Report Form and Content.

a. The Notice of Injury and Claim for Benefits required by this rule shall be submitted on eight and one-half by eleven inches (8 1/2 X 11) paper in a format substantially similar to that which follows. If the employer seeks to request additional information, the employer shall submit the proposed changes to the Commission for approval. Changes shall not be implemented prior to the receipt of the Commissions approval. (7-1-97)

b. Employers wishing to report electronically shall sign a written information sharing agreement with the Commission. This agreement will provide the effective date to send and receive electronic reports, the acceptable data to be sent and received, the method of transmission to be used, and other pertinent elements. The agreement must be signed by the employer and approved by the Commission prior to initial data submission. To ensure the accuracy of reported data, the Commission may make periodic audits of employer files.

07. Timely Response Requirement. When the Commission requests additional information in order to process the Claim, the claimant or employer shall provide the requested information promptly. The Commission request may be either in writing or telephonic.