Get Id Ic-211 2015-2026

Filling out the ID IC-211 form online is essential for self-insured employers to report total unpaid liabilities accurately. This form must be submitted semi-annually to comply with Idaho Workers' Compensation Law, ensuring that all claims are properly accounted for.

Follow the steps to complete the ID IC-211 online effectively.

1. Press the ‘Get Form’ button to access the ID IC-211 form and open it in your preferred editor.
2. In the heading section, enter the name of the self-insured employer, the calendar year, and select the applicable semi-annual date.
3. In Column 1, input the total number of open claims as of the reporting date.
4. In Column 2, report the total incurred medical only liability for all medical claims, including both paid and anticipated unpaid amounts.
5. Enter in Column 3 the total dollar amount that has been paid on medical only claims reported in Column 2.
6. In Column 4, calculate the unpaid medical only amount by subtracting the total paid (Column 3) from the total incurred (Column 2).
7. Move to Column 5 and enter the total incurred liability on all indemnity claims, covering both payments made and expected unpaid amounts.
8. Fill in Column 6 with the total dollar amount paid on all indemnity claims reported in Column 5.
9. In Column 7, calculate the unpaid indemnity amount by subtracting the total paid (Column 6) from the total incurred (Column 5).
10. Column 8 should reflect the total unpaid liability for all medical only and indemnity claims (adding Column 4 and Column 7).
11. Below Column 8, enter the calculated total unpaid liability from Column 8.
12. If applicable, provide the expected compensation from the excess insurance carrier in the designated section.
13. Complete Net Remaining Unpaid Liability by taking the difference between unpaid liability and excess carrier reimbursement expected.
14. Input detailed information on excess carrier reimbursement for each claimant in the excess insurance carrier reimbursement detail section.
15. Ensure that the form is signed and certified by a corporate officer, confirming the accuracy of the information provided.
16. Once you have filled out all required fields, you may save your changes, download, print, or share the completed form as necessary.

Begin completing the ID IC-211 form online to ensure compliance with reporting requirements.