Benefits Administration serves to ensure the timely and accurate payment of benefits to injured workers, the timely payment of medical bills, and that insurance companies follow Idaho Code, Title 72, when managing claims. The section works with claimants, employers, insurance companies, and attorneys to meet this obligation.

Last year, Idaho’s workforce grew by more than 50,000 employees, an increase of 7.5%. Yet, the rapid escalation in Idaho’s population and workforce did not lead to an increase in the relative number of workers’ compensation claims filed. In fact, the number of claims per 100 employees dropped to 6.19, down by more than 15% over the last ten years.

Even though the relative number of claims has decreased, Benefits Administration processed 2,277 more claims in Fiscal Year 2006 than it did in 2005. The increase represents hundreds of additional claims processed per person by the department staff.

Administration of the claims process is divided between Compensation Consultants, administration support staff, and records / reception staff. The Compensation Consultants answer questions about the claims process and educate claimants, employers, medical providers, insurance adjusters, and attorneys about workers’ compensation laws and procedures. Consultants also audit insurance companies to ensure compliance with Idaho’s Workers’ Compensation Law.

The claims administrative support staff enter manually submitted First Report of Injury forms (IC-1) and check electronically received claims for accuracy. Claims staff are also responsible for reviewing medical records and other pertinent documents in order to audit and approve Summaries of Payment (SOP) submitted by the claims administrator when disability ends for each time loss claim.

Benefits staff also conduct extensive outreach programs for adjusters, employers, medical providers and others with a stake in the workers’ compensation system. The department offers several education and training opportunities such as the Certified Idaho Workers’ Compensation Specialist (CIWCS) course, Medical Provider Workshops, and the Employer Education and Evaluation (EEE) program.