Current through September 2, 2024
Section 17.10.01.013 - COMPENSATION01.Disbursements of Compensation. Eligible payments shall be made directly to the provider of the service unless the claimant has already paid the provider. If the claimant has already paid the provider, payment shall be made to the claimant.02.Allowable Payments for Medical Services. Pursuant to Section 72-1026, Idaho Code, the Commission adopts a medical fee schedule that is posted on the agency's website and will pay providers for medical services in accordance with said schedule. The conversion factors set out in the medical fee schedule may be adjusted once a year in conjunction with the annual adjustment of the Resource-Based Relative Value Scale (RBRVS), published by the Centers for Medicare and Medicaid Services of the U.S. Department of Health and Human Services.03.Wage Loss Benefits. "Wages received at the time of the criminally injurious conduct" shall be the claimant's gross weekly wage; which shall be determined under Section 72-419(1) -(3), Idaho Code, if applicable, and if not, as follows: a. If the Wages were fixed by the hour, and the claimant worked or was scheduled to work the same number of hours each week, the weekly wage shall be the hourly rate times the number of hours that the claimant worked or was scheduled to work each week.b. If the Wages were fixed by the hour and the claimant did not work the same number of hours each week, or if the claimant was paid on a piecework or commission basis, the weekly wage shall be computed by averaging the amounts that the claimant was paid during his last four completed pay periods prior to the criminally injurious conduct and converting that amount to a weekly basis using a method consistent with 72-419(1)-(3); provided that, if the claimant was employed for less than four (4) pay periods before the criminally injurious conduct, the average shall be computed based upon the time period that they worked.c. If none of the above methods are applicable, the weekly wage shall be computed in a manner consistent with the above methods.04.Weekly Compensation Benefits If Claimant Employable But Not Employed. If a claimant qualifies under Section 72-1019(7)(a), Idaho Code, the following provisions apply:a. If at the time of the criminally injurious conduct the claimant was receiving unemployment benefits and as a result of that conduct the claimant becomes ineligible for those benefits, the claimant's weekly benefits under the Crime Victim's Compensation Act shall be the lesser of one hundred fifty dollars ($150) or their weekly benefit amount under the Employment Security Law.b. If at the time of the criminally injurious conduct the claimant was unemployed, but scheduled to begin employment on a date certain and if they were unable to work for one (1) week as a result of that conduct, weekly benefits under the Crime Victim's Compensation Act shall be the lesser of one hundred fifty dollars ($150) or two-thirds (2/3) of the amount that they would have earned at their scheduled employment, and those benefits shall be payable beginning on the date that their employment was scheduled to begin.c. If prior to the criminally injurious conduct the claimant was performing necessary household duties which they are disabled from performing as a result of that conduct and it is necessary to employ a person who does not reside in the claimant's house to perform those duties, the claimant shall receive weekly benefits under the Crime Victim's Compensation Act equal to the amount paid to the person so employed, but not exceeding one hundred fifty dollars ($150) per week.d. In other circumstances, the Commission may award an amount it deems appropriate.05.Treating Physician. A claimant may choose their own treating physician.06.Overpayment. The Commission may reduce future payments by an amount equal to the overpayment or request a refund when overpayments are made to either the claimant or the provider.07.Reimbursement for Transportation Expenses. If the claimant utilizes a private vehicle, reimbursement shall be at the mileage rate allowed by the State Board of Examiners for state employees. Reimbursement is limited to one (1) round trip per day. The claimant shall not be reimbursed for the first fifteen (15) miles of any round trip, nor for traveling any round trip of fifteen (15) miles or less. Such distance shall be calculated by the shortest practical route of travel. The mileage reimbursement amount shall be credited to the medical benefit.08.Payment of Bills.a. Bills for treatment and sexual assault forensic examinations must be submitted within three (3) years from the date of treatment or the date of eligibility, whichever is later, to be compensable. The time for submission may be extended upon Commission approval.b. For the purpose of dispersing payment, the claimant may be required to provide certain documentation, including a W-9 form.09.Right to Recover. a. The Commission's right to recover its full economic loss under a restitution order as a victim under Section 19-5304, Idaho Code, is independent from any other legal remedy it may have, including its statutory right to subrogation under Section 72-1023, Idaho Code, and is not barred by civil settlements entered into by other victims.b. The Commission may reduce or waive its subrogated interest in a settlement or civil action.Idaho Admin. Code r. 17.10.01.013