Idaho Required Postings and Forms
The adjusting of the claims in this state are handled by Intermountain Claims. Once a claim is reported to EMPLOYERS, the claim will be assigned to Intermountain Claims. The contact information for Intermountain Claims is:
P.O. Box 4367
Boise, ID 83711
Please print and post the following notices, both in English and Spanish, in a conspicuous location frequented by employees, such as the break room, lunch room or time clock. If you have multiple business locations, be sure to post the notices at each location.
The following forms need to be completed and submitted to EMPLOYERS when a work-related injury occurs:
- I-A-1 Worker’s Compensation Employer’s First Report Injury or Illness. As soon as you have been notified of a work-related injury, please fill out this form and submit it to EMPLOYERS. You must complete this form when an injury results in medical treatment by a physician or lost time from work. EMPLOYERS will forward this form to the Idaho Industrial Commission.
- IC Form 14 Employer’s Supplemental Report. You will need to complete this form when the employee returns to work. You are required to complete this form for all lost time claims. This form can be completed and submitted to EMPLOYERS by mail or e-mail. Please see below for mailing/e-mailing instructions.
You will need to fill out this form in duplicate and mail...
- The original to: Intermountain Claims, Inc at P.O. Box 4367 Boise, ID 83711
- A copy to: Industrial Commission at: P.O. Box 83720, Boise, Idaho 83720-0041
The form must be completed and sent to the organizations above, in the following instances:
- Upon termination of disability (regardless of length of time disabled for work).
- At the end of 60 days from the date disability began, if the employee is disabled that long.
Please complete this form and e-mail it to us at firstname.lastname@example.org. In addition, please print out a copy of this form, sign it and save it in your files. Do not e-mail this form to the Industrial Commission.
- Wage Statement. This form enables us to calculate the correct compensation that may be owed to an injured employee. Please complete the form and submit it to EMPLOYERS within five days after your knowledge of any accident that has caused your employee to be disabled for more than seven scheduled calendar work days.
- First Fill Form. This form provides your employees with basic information about our Pharmacy Benefit Program, including such things as the phone number to call to locate a First Fill participating pharmacy. When your employee becomes injured, please print and complete this form and provide it to your injured employee. Your employee will need to provide this completed form along with the prescription for his/her work-related injury or illness to the pharmacist. Using this form will help enable quick authorization for your employee’s initial medication and ensure that the initial prescription is provided at no cost to the injured employee.
- Accident Investigation Report. This basic accident form should be completed by the employee’s supervisor/manager as soon after the accident as possible. Please send the report to the following EMPLOYERS address as soon as it has been completed by the supervisor/manager: EMPLOYERS Claim Department, P.O. Box 32036, Lakeland, FL 33802-2036. You should keep a copy on file for your records.
- Off-Site Transitional Duty Program - Helping Your Injured Employees Get Back to Work
A successful transition back to work relies on the collaborative efforts of the manager/supervisor, the injured employee and their adjuster. As a manager/supervisor, learn what you can do to help facilitate a successful return to work.