If your employer is insured through Workers Compensation Exchange and your claim has been denied, your benefits have been delayed, or you are having trouble getting the medical care your doctor has recommended, Goicoechea Law can help. We represent injured workers in claims against Workers Compensation Exchange throughout Idaho — from initial claims to settlements, through Idaho Industrial Commission hearings and appeals.

Your initial consultation is completely free. There is no attorney fee unless we win your case.

Call 208.743.2313 for a free, confidential case review.

Workers Compensation Exchange in Idaho

Workers Compensation Exchange is one of the Idaho Industrial Commission-authorized carriers writing workers’ compensation insurance for Idaho employers. Like all workers’ compensation insurance carriers operating in Idaho, Workers Compensation Exchange is required to comply with Idaho’s workers’ compensation statutes and the rules of the Idaho Industrial Commission — including the obligation to pay valid claims promptly and fairly.

When a carrier fails to meet those obligations — by denying valid claims, delaying medical care, cutting off benefits prematurely, or using IMEs to minimize legitimate injuries — injured workers have the right to challenge those decisions before the Idaho Industrial Commission.

What Benefits Are You Entitled To?

If you have been injured at work and your employer is insured through Workers Compensation Exchange, you may be entitled to the same benefits available under Idaho workers’ compensation law regardless of which carrier insures your employer:

Medical Benefits. All reasonable and necessary medical treatment related to your work injury must be paid by the carrier — including emergency care, surgery, specialist visits, physical therapy, prescriptions, and medical equipment.

Temporary Total Disability (TTD). If your injury prevents you from working while you recover, you are entitled to wage replacement benefits equal to 67% of your average weekly wage. These benefits continue as long as your doctor certifies you cannot work and you remain under active medical care.

Permanent Partial Impairment (PPI). When your injury results in a permanent physical impairment, your treating physician assigns an impairment rating. That rating determines the starting point for your disability compensation.

Permanent Disability Benefits. Beyond your impairment rating, a full disability evaluation considers your age, education, work history, and the labor market to determine the total disability benefits you are owed.

Retraining Benefits. If your injury prevents you from returning to your previous occupation, you may be entitled to vocational rehabilitation and retraining benefits.

Attorney Fees for Unreasonable Denials. Under Idaho Code, the Idaho Industrial Commission may award attorney fees against a carrier that unreasonably denies or delays valid workers’ compensation benefits.

Common Reasons Workers’ Comp Claims Get Denied

Workers’ compensation insurance carriers — including Workers Compensation Exchange — deny valid claims for many reasons. Common grounds for denial include:

  • Disputing that the injury occurred in the course of employment
  • Claiming the injury was caused by a pre-existing condition
  • Arguing the injury resulted from the worker’s own misconduct or safety violation
  • Claiming the injury was not reported to the employer within the required timeframe
  • Disputing the medical necessity of recommended treatment
  • Using an Independent Medical Examination (IME) to challenge your treating physician’s findings
  • Declaring you at Maximum Medical Improvement (MMI) before you have fully recovered

A denial is not the final word. You have the right to challenge any denial before the Idaho Industrial Commission, and many denied claims are reversed when properly presented by an experienced attorney.

The IME Problem

One of the most powerful tools workers’ compensation carriers use to reduce or eliminate benefits is the Independent Medical Examination. Despite the word “independent,” IMEs are conducted by physicians selected and paid by the insurance carrier — physicians who understand what opinions benefit the carrier.

An unfavorable IME report can be used to:

  • Cut off your medical benefits
  • Challenge your treating physician’s work restrictions
  • Declare you at MMI before your recovery is complete
  • Reduce your permanent impairment rating
  • Deny authorization for recommended surgery or treatment

If an IME has been scheduled or an unfavorable IME report has been used against you, contact Goicoechea Law before taking any further steps. We know how to challenge biased IME reports and present credible medical evidence effectively before the Idaho Industrial Commission.

Don’t Give a Recorded Statement Without an Attorney

Shortly after a workers’ compensation claim is filed, an adjuster may contact you and request a recorded statement. You are not legally required to give a recorded statement to the insurance carrier, and doing so without legal counsel can seriously harm your claim.

Adjusters are trained interviewers. The questions they ask are carefully designed to establish facts that can be used to minimize or deny your claim — including questions about your activities before and after the accident, prior injuries or medical conditions, and the exact circumstances of the injury.

If Workers Compensation Exchange or any adjuster contacts you requesting a recorded statement, tell them you will have your attorney contact them and call us immediately.

We Represent Injured Workers Statewide

Goicoechea Law represents injured workers in claims against Workers Compensation Exchange and all other Idaho workers’ compensation carriers throughout Idaho including:

  • Lewiston and the Lewis-Clark Valley
  • Coeur d’Alene, Post Falls, and Kootenai County
  • Moscow and Latah County
  • Sandpoint and Bonner County
  • Orofino and Clearwater County
  • Grangeville and Idaho County
  • All of North, Central, and Southern Idaho

Free Case Review — No Fee Unless We Win

If you have been injured at work and your employer is insured through Workers Compensation Exchange, contact Goicoechea Law today for a free, confidential case review.

Call 208.743.2313 or fill out our online contact form.

There is no attorney fee unless we win your case.