by John Pace
Workplace accidents can happen whether you work in an office or on a construction site. Depending on your injury, you could face expensive medical bills, loss of income, or even permanent disability. It’s beneficial to know what to expect when falling victim to a workplace accident, so you can avoid losing out on any compensation to which you may be entitled.
The laws and processes can differ depending on your state, so how does workers’ comp work in Arizona?
Arizona employers with one or more employees must have workers’ compensation insurance to cover accidents and injuries that happen on the job. When you claim workers’ comp, your employer’s insurance provider has to pay your medical expenses and compensate certain damages, such as a loss of earning capacity due to a permanent injury.
Those are the basics of workers’ comp, but if you keep reading, you’ll learn the details of the complicated process of claiming workers’ comp benefits in Arizona.
What Does Workers’ Comp Cover in Arizona?
Before we get into the essential details, let’s look at what workers’ comp covers in Arizona to give you an idea of the types of compensation you can expect.
Arizona has a no-fault workers’ comp system, meaning any employee covered by their employer’s workers’ comp insurance can receive benefits regardless of who caused the work accident. Workers’ comp benefits cover damages related to your work injury, including:
How the Arizona Workers’ Comp Process Works
The process of filing a workers’ comp claim can be very complicated. While you don’t legally need an attorney to file a claim, it helps to have a knowledgeable representative backing you, especially since your employer no doubt has their own workers’ comp lawyer on hand.
Below, we’ll describe the major steps of the Arizona workers’ comp claim process, including reporting your injury, filing a claim, understanding compensation amounts, and receiving ongoing support.
Reporting the Injury and Filing a Claim
If you want to ensure a workers’ comp claim progresses smoothly and quickly through the system, you should report the job-related injury to your employer as soon as it happens. Failure to do so in a timely manner could result in an automatic denial of your claim.
Your employer will have 10 days from the notice of your injury to fill out the Employer’s Report of Injury, which they will send to their workers’ comp insurance provider and the Industrial Commission of Arizona (ICA) for verification, assessment, and approval.
After notifying your employer, you need to file your claim within a year of the date of your injury or when you learned about it.
You should visit a doctor about your work-related injury to file a workers’ comp claim. Let them know you got your injury on the job so they can help you fill out a Worker’s and Physician’s Report of Injury. The doctor’s office will send your report to the ICA and give copies to your employer and their insurance carrier.
If you don’t fill out the worker’s comp form at the doctor’s office, you can get the Worker’s Report of Injury form from the ICA website and submit it yourself to get the ball rolling.
After filing your claim, you should receive a letter from the ICA within 14 days containing information about your employer’s insurance carrier. The ICA will notify the insurance provider, giving them 21 days to deny or accept your workers’ comp claim.
Receiving Notice of a Denied Claim
If your employer’s insurance company denies your workers’ comp claim, you’ll receive a Notice of Claim Status informing you of the denial, and you’ll have 90 days to protest the decision.
Using the Request for Hearing form on the ICA website, you can petition the ICA’s Administrative Law Judge division to organize a hearing for your case. After filing the request, a notice with the date, location, and time of the hearing will arrive in the mail.
Receiving Notice of an Accepted Claim
If your workers’ comp claim receives approval from the insurance provider, the following notice will inform you of your benefits, depending on whether you have a medical-only or time-lost claim.
In a medical-only claim, you’ll receive a Notice of Claim Status that states you’ll receive workers’ comp benefits with no time loss compensation. In that case, the insurance carrier will pay for all medical expenses associated with the injury.
If your injury doesn’t keep you out of work longer than seven consecutive days, the insurance doesn’t have to pay for lost time.
Workers’ comp insurance covers medical expenses such as:
The insurance provider keeps paying the medical bills related to your work injury until your doctor says you no longer need treatment. If you voluntarily stop getting medical treatment, the insurance provider could close the claim, so it’s important to keep receiving care until your doctor discharges you.
If you end up receiving a medical bill for treatment associated with the injury, you should contact the insurance carrier to inquire about the charge and, if you paid the bill, get reimbursement.
For a time-lost claim, your doctor must say you can’t work or can only perform light duty for more than seven days because of your injury. In that case, your employer’s insurance will provide temporary compensation for missed income.
Insurance won’t pay the first seven days after the date of your injury unless you’re out of work for 14 days or longer. For example, if you can’t work for 10 days, you only get paid for the last three days. If you lose more than 14 days, your compensation starts the day after the injury.
If you continue working light duty and receive temporary compensation for loss of income, you’ll have to submit monthly reports on your earnings.
Calculating Compensation
You’ll receive your first temporary compensation check along with the Notice of Claim Status, which will also tell you the monthly wage the insurance provider recommends. The notice will have an attached wage calculation sheet explaining how the provider arrived at the wage, which also goes to the ICA for review.
The wage isn’t officially set until the ICA reviews the insurance carrier’s calculations and sends you a Notice of Average Monthly Wage. If there’s any question about the accuracy of the wage calculation, the ICA might request verification from you.
If you disagree with the established monthly wage, you can contact the ICA’s Claims Division to ask about the accuracy of the calculations or request a hearing to challenge the wage calculation.
When you get paid for lost time, your compensation is 66.6 percent of your average monthly wage, typically based on your earnings during the 30 days before your injury. There’s a maximum monthly wage for calculating compensation, and even if you make more than that amount, you can only receive 66.6 percent of the maximum wage.
Big Choosing a Doctor
In most cases, you can choose your doctor. However, your employer has the right to request that you see a doctor of their choice for one visit. If your employer is self-insured, which only a select few companies in Arizona are, they have the right to direct care to their doctor.
You can’t change to another doctor without the approval of your current doctor, the insurance carrier, or the ICA. You should contact the insurance carrier if your doctor doesn’t authorize the change. If the carrier doesn’t approve, you can apply for approval from the ICA.
The ICA will review your case and contact the carrier or doctor for their opinion on the change, after which they’ll approve or disapprove it. Before requesting a change, you should already have a doctor picked out who has agreed to take you as a patient, and you shouldn’t see a new doctor until the change is approved. You can request a hearing if you disagree with the ICA’s decision.
Closing the Claim With or Without Permanent Impairment
When your doctor discharges you from active care, they must provide the insurance provider with a medical report confirming you’re done with treatment. You’ll receive a Notice of Claim Status saying the insurance carrier is ending your active benefits, with or without permanent impairment.
If you need continuing medical support, your doctor should indicate this in the report, prompting the carrier to issue a Notice of Supportive Medical Maintenance Benefits. If your work injury resulted in permanent impairment, you could receive compensation for one of two permanent injuries: scheduled or unscheduled.
Compensation for scheduled injuries lasts for a limited time. The types of injuries that qualify as scheduled affect a certain part of the body, such as an arm, leg, eye, or hand. The amount of compensation you receive for disability benefits depends on the extent of your injury, as described below:
An injury that doesn’t qualify as a scheduled injury is an unscheduled general disability. Examples of unscheduled injuries include occupational diseases and injuries to your back, shoulder, or hip. The amount you receive for your disability, if any, is up to the ICA. Their decision is based on how the injury affects your ability to work and the wages you can earn compared to your income before the injury. The ICA also considers other factors, such as age, education, and previous occupation (if any). For partial loss of use, you might get 55% of your reduced earning capacity, which is the difference between your previous wage and current earning capacity. As for total loss of earning capacity, you’ll receive 66.6 percent of your average monthly wages.
Can You Still Sue Your Employer After Claiming Workers’ Comp Benefits?
In most cases, you can’t sue your employer if you claim workers’ comp benefits. However, you can file a lawsuit against your employer if they didn’t have workers’ comp insurance on the day of your injury. You can then apply for workers’ comp benefits from the ICA’s Special Fund, which provides medical benefits to injured workers with uninsured employers.
Consult With an Experienced Workers’ Comp Attorney
Hopefully, we’ve answered your question, “How does workers’ comp work in Arizona?”
While you technically don’t have to work with an attorney to file a workers’ comp claim, the laws are complex, and you’ll likely have many questions during the process. At Rios Law Firm PLLC, our founding attorney, Crystal Rios Ramos, has extensive experience guiding injured workers through filing for workers’ comp.
Want to learn more? Call us today at 602-237-6265.
