Northwest Specialty Hospital : Employee Accidents

1593 E. Polston Avenue · Post Falls, ID 83854 · ph: (208) 262-2300 · fax: (208) 262-2390

Ear, Nose and Throat department at Northwest Specialty Hospital

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Medical Benefits:

Workers compensation benefits include reasonable and necessary medical treatment as prescribed by a treating physician. This section contains information about medical benefits and other aspects of medical care.


Covered Items: Diagnostic Testing Physician Reporting Requirements Medical Payments Medical Release Choosing a Physician Tell Your Employer About the Injury or Illness as Soon as Possible Have Your Employer Fill Out a First Report of Injury or Illness Form as Soon as Possible Communicate with Your Employer, the Surety and Your Physician
Covered Items: The following benefits are covered: All medical, surgical, hospital and nursing care reasonably necessary for treatment and rehabilitation, including prescribed medications. Crutches and apparatus prescribed by the attending physician that may be needed for a reasonable time. Necessary replacement or repair of appliances or prosthesis unless the need is due to lack of proper care by the injured worker. Reimbursement for reasonable travel expenses for medical examination or treatment. Replacement of glasses with like kind and quality when broken in a work-related accident resulting in an injury. It is not necessary that the injury require medical attention by a physician. Injuries such as abrasions, bruises, etc., may be sufficient to allow for replacement of broken glasses.

Diagnostic Testing:

In non-emergency cases, the Surety requests providers notify the Fund prior to proceeding with testing such as MRI, CT scan, nerve conduction studies(NVC/EMG), myelograms and discograms.The physician will contact the Surety for authorization and then will notify the patient.

Physician Reporting Requirements:

In order to receive payment, the physician or hospital must provide the Surety with a medical report and billing. If a report is not received, there may be a delay in the payment of the bill. The injured worker should notify the physician of the claim number assigned to ensure any information sent to the Surety is routed to the appropriate claims file.

Medical Payments:

Medical charges are paid based on the Idaho Code and the fee scheduled administered by the Industrial Commission. If a bill is reduced to comply with the usual and customary rates, the injured worker or employer is not responsible for the balance of the charges. An injured worker will be responsible, however, for non-covered expenses or charges unrelated to a work-related injury.

Medical Release:

At times, pre-injury medical information is needed to determine benefits for the current injury. A medical release, along with a request for a list of physicians the claimant has seen in the past, may be sent to the claimant.

Choosing a Physician:

In the state of Idaho the Employer can designate a WC medical provider. People are generally encouraged not to go to their family physician. This is really an advantage to the Injured worker, as designated providers are fully versed in WC laws and regulations.

Tell Your Employer About the Injury or Illness as Soon as Possible:

Prompt and accurate reporting is crucial in processing your claim. Your employer should be notified as soon as possible that you have suffered an industrial accident or illness. Be aware of your employer's policy on the use of a designated physician. Be sure to report your accident or illness to your supervisor even if no medical treatment is received.

You should notify a physician as soon as possible if you feel your injury is work-related. Medical documentation of your injury will be needed in order to pay benefits on your claim.
Reporting a claim to your co-worker is not considered reporting a claim to your employer. You must notify an employee in a supervisory position.

Have Your Employer Fill Out a First Report of Injury or Illness Form as Soon as Possible:

If you need to seek medical treatment or miss one day or more from work, your employer must complete a First Report of Injury or Illness form and send it to the Surety.

A claim cannot be opened and a claim number assigned by the Surety until the first report of injury or illness for is received.

Communicate with Your Employer, the Surety and Your Physician:

Good communication helps avoid problems with your claim. Keep your employer and the Surety informed of your status, including when you can be expected to return to work. Don't be afraid to ask your physician questions. It is important that you understand your injury and what can be expected.

The Surety's largest department, claims, is made up of professionals who make decisions concerning medical and compensation benefits for injured workers. As an injured worker, you will be assigned a claims examiner who will keep you informed by phone and mail about the status of your claim. You are encouraged to make this a two-way communication.

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