| WHAT IS WORKER'S COMPENSATION? |
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Workers' Compensation laws are designed to ensure that employees who are injured or disabled on the job are provided with fixed monetary awards, eliminating the need for litigation. These laws also provide benefits for dependents of those workers who are killed because of work-related accidents or illnesses.
Some laws also protect employers and fellow workers by limiting the amount an injured employee can recover from an employer and by eliminating the liability of co-workers in most accidents. State Workers Compensation statutes establish this framework for most employment. Federal statutes are limited to federal employees or those workers employed in some significant aspect of interstate commerce. |
| FILING AN ACCIDENT REPORT |
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| Whenever you have a workplace accident or work-related injury or illness, you need to notify your supervisor and file a claim. Your employer is required to have claim forms at work. It is best if you file a claim the day of the injury. The sooner you fill one out, the better, but you legally have one year from the date of the accident or injury. Do not be talked out of filing a claim or talked into filing it under your health insurance. Even if you think the injury is minor, you need to fill out a claim. Be sure to list any witnesses to an accident. |
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| It is the injured worker’s responsibility to file a claim within one year of the date of injury. The injured worker should also notify the employer as soon as possible that a work-related injury has occurred. A claim is made either by filling out and signing a claim form at the doctor’s office or by obtaining a claim form from the ICA, and filing either form with the ICA. The employer is required to file an Employer’s Report of Injury; however, this is not a claim. It is only a report of the injury. When the claim form is received by the ICA, the employer’s workers’ compensation insurance carrier is notified of the claim. The carrier has 21 days to accept or deny the claim. When the ICA receives a claim, a notification letter containing general information is sent to the injured worker. The letter advises who the insurance carrier is and provides general claim information. If the insurance carrier accepts the claim, it is responsible for payment of compensation and the payment of medical bills in accordance with the Arizona Fee Schedule.
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| GETTING MEDICAL TREATMENT |
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| When an injury occurs, an employer has the right to have an injured worker seen by a doctor of the employer’s choice one time. (If the injured worker returns to that physician a second time, that physician becomes the attending physician.) After the one visit to the employer’s designated physician, the injured worker may report to a physician of his/her choice. Exception: A small number of Arizona employers are self-insured with contracted medical care on file with the ICA. Workers who are injured while in the employ of one of these self-insured employers are required to go to the employers' contracted doctors for all medical care related to the industrial injury. To determine if an employer is self insured, contact the ICA Claims Division at (602) 542-4661. |
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All medical and hospital bills related to your injury claim are paid in full. You may also be eligible for compensation based on how long you are out of work. |
0 - 7 days only:
8 - 13 days only:
14 days or more:
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No compensation
Compensation for those days only
Compensation back to the 1st date |
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Arizona State Law sets the limit at 2/3 of your average monthly wage but the highest average monthly wage you can claim is 2/3 of $4428.91, even if your average monthly earnings are greater. |
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| You may also be eligible for sick pay benefits under your Union contract to make up for any loss in pay. If you are covered under the United Food and Commercial Workers Union and Employers Health Insurance plan and you are out for more than one week, you are eligible for a waiver of premium. This maintains your health insurance coverage for up to six (6) months if you are not working eighty (80) hours a month. However, you can not collect disability pay under the Union's health insurance for a work-related injury. Call the Plan Administrator or your Union office for more details. |
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| The Arizona Industrial Commission notifies your employer's insurance company of your claim. The insurance company has twenty-one (21) days to accept or deny your claim. If your claim is denied, you have ninety (90) days to appeal the decision. While you are appealing the denial, you can have your medical bills paid by your health insurance by filing a claim and attaching the denial form. If you later win your appeal, the Industrial Commission will pay your medical bills and your health insurance company will be reimbursed. |
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| Once an attending physician is selected, there are three ways to change doctors: the attending physician refers the injured worker to another doctor; the insurance carrier approves a change of doctors; or upon written application from the injured worker the ICA approves a change of doctors. |
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| A claim for benefits should be filed as soon as possible. The ICA requires that, in order to process the claim, a specific date of injury must be supplied. The injured worker may want to use the date the condition was first noticed or the date of first treatment, but the ICA requires a Month, Day, and Year in order to notify the insurance carrier of the claim. |
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There are two kinds of permanent impairments, scheduled and unscheduled. Both types are paid on a monthly basis.
- A scheduled injury is to a specific body part and the Arizona Workers’ Compensation Law sets out a schedule indicating the amounts to be paid for these impairments. There is also compensation payable for visible facial scarring and loss of permanent teeth.
- An unscheduled injury is the result of a general impairment, a combination of impairments to different body parts injured in one incident, or a history of other permanent impairments. In these cases, the ICA determines what amount of compensation the injured worker is entitled to based on loss of earning capacity. Many factors are involved in these decisions, such as limitations, education, work experience, etc. In some cases, there is no monetary award as the injured worker has returned to work earning the same or in excess of the established average monthly wage. These awards take approximately 90 days from the issuance of the notices by the insurance carrier. The insurance carrier will review this type of award on a yearly basis, sending the injured worker an Annual Report of Income. Both the injured worker and insurance carrier have the right to file a Petition for Rearrangement. This petition requests the ICA to review the previous award and determine whether the monthly benefits should remain the same, increase, decrease or cease.
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| Many employers have "light duty" programs for workers who are not able to perform their normal duties because of a work-related injury. If your employer puts you on "light duty", don't try to do more than your doctor permits. You could re-injure yourself and further prolong your recovery |
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| The injured worker must apply in writing to the ICA requesting permission to be out of the state of Arizona for any period exceeding fourteen days. The ICA issues an award either approving or disapproving the request. If approved, the claim continues to be processed in accordance with Arizona Workers’ Compensation Law. |
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| If an employer has no workers’ compensation insurance, the injured worker has the right either to file a civil action against the employer in superior court or to file a claim for workers' compensation benefits with the ICA. The ICA has a division called Special Fund which pays benefits identical to those paid by insurance carriers. Penalties may be assessed against the non-insured employer. |
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An injured worker's benefits are subject to unilateral suspension by a carrier or self-insured employer under the following circumstances:
- Leaving the state without the written approval of the Industrial Commission (See Topic No. 4 for information regarding leaving the state).
- Failure to file an annual report of income. An injured worker who is receiving monthly loss of earning capacity award payments is required to annually report the worker's income to the carrier. Failure to do so could result in suspension of benefits until such time as the report is filed.
- When an injured worker refuses to submit to, or obstructs an independent medical examination.
- Compensation benefits are suspended during the time that an injured worker is incarcerated. Medical benefits are continued and any court ordered child support payments are paid.
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| INDEPENDENT MEDICAL EVALUATIONS |
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| The insurance carrier has the right to have an injured worker periodically examined by the doctor of its choice. The carrier may use the doctor’s opinion to change the status on a claim. If the injured worker feels that he or she is being unfairly requested to attend this examination, a Motion for Protective Order may be filed with the ICA and an administrative law judge will decide whether the injured worker must attend the exam. The carrier is required to pay travel expenses (mileage and living expenses) for these types of appointments. |
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| The injured worker can file a petition to reopen a closed claim to secure additional benefits on the basis of new, additional or previously undiscovered conditions. The letter/petition must be accompanied by a current medical report supporting the relationship of the current condition to the industrial injury. When both the petition and the medical report are received, the carrier is notified of the petition and it has 21 days to accept or deny the reopening. |
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| The Industrial Commission is the State Agency responsible for administering workers' compensation. They can be reached at: |
www.ica.state.az.us |
Phoenix
800 W. Washington St
(602) 542-4661 |
Tucson
2675 E. Broadway
(520) 628-5188 |
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