Request Free Consultation

As an employee or employer, workers’ compensation insurance is crucial to your protection and livelihood. That said, it is a complex topic that too many people do not understand. Workers’ compensation in Arizona is a “no-fault” system with many benefits for employees and employers, but you need to understand it to make the most of it. Learn from our Arizona workers’ compensation lawyers the most important things to know.

1. Overview of Workers’ Compensation in Arizona

In the Grand Canyon State, the workers’ compensation program is under the regulatory agency of the Industrial Commission of Arizona. The ICA outlines the rights and responsibilities of injured workers and employers.

Ultimately, workers’ compensation is an insurance program for employees injured on the job. The program pays for medical costs and may also cover lost wages, depending on the injury and recovery.

2. Eligibility Requirements for Workers’ Compensation

Most businesses operating within Arizona must carry workers’ compensation insurance. While some states may not require coverage for part-time employees, Arizona is not one of them.

Some businesses might be exempt from carrying coverage. For example, coverage isn’t required for independent contractors, for casual employment or employment not typically under the business’ purview, or for sole proprietors with employees.

3. Benefits Under Workers’ Compensation in Arizona

Workers’ compensation benefits in Arizona cover everything from medical expenses to lost wages and death benefits for some dependents. Wage loss benefits depend on the severity of the injury and typically fall into one of four categories: temporary partial, temporary total, permanent partial, and permanent full disability.

Temporary disability covers partial and total injuries. Partial injuries refer to people who can still maintain their employment but at a reduced capacity. Temporary total injuries refer to people who can’t return to work until after their recovery.

Permanent disability refers to injuries a worker will never recover from. Partial disability is for people who can still work, but their injury limits their ability to perform usual tasks. Full disability is for workers who can never return to work after sustaining a permanent injury.

Benefit Limitations

Arizona workers’ compensation laws stipulate that wage loss benefits are a portion of a worker’s monthly income. In 2019, the state instituted a maximum wage cap for loss calculations, $4,741.57. Also, workers will not receive the first seven days of losses unless they miss over 14 days after the injury.

Finally, if an employer wants to, they can require injured employees to attend a medical evaluation with a doctor of their choosing. After the one-time evaluation, the employee is free to see whomever they want, in most cases.

4. Claims Process for Workers’ Compensation

If an employee wishes to receive workers’ compensation benefits for an injury, filling out the proper forms within the allotted timeframe is vital. In Arizona, a worker must file a claim within one year of the accident and injury. Still, workers should notify their employers of the injuries as soon as possible.

Once notified of the workplace injury, an employer must inform the insurance carrier and the ICA. They must file an “Employer’s Report of Industrial Injury” form within 10 days of an employee’s notification. Also, according to workers’ compensation in Arizona, employers must provide reporting employees with insurance carrier information, including:

  • Name and address of the carrier
  • Policy number
  • Policy expiration date

Seeing a Doctor

Many employees risk their coverage and benefits because they hesitate to see a doctor. A doctor helps legitimize employee claims and also ensures rapid and correct treatment and therapy. Avoiding medical care makes a claim look suspicious. Also, it puts employees’ health at risk.

Filling Out and Filing Essential Forms

To file a claim, an employee must fill out a Worker’s Report of Injury form or a Worker’s and Physician’s Report of Injury form. The first form is a basic questionnaire for the injured worker. The second includes a section for the injured worker and a section for the health provider.

After filling out the correct form, the employee must file it with the ICA. The Worker’s and Physician’s Report of Injury form must also be sent to the employer and their workers’ compensation carrier.

Once filed, the insurer can take up to 21 days to accept or deny the claim. Workers can appeal or dispute denials.

5. Disputes and Denials of Claims for Workers’ Compensation in Arizona

Unfortunately, insurers may deny claims for many reasons, from inefficient information to improperly completed forms. Thankfully, injured workers can appeal a denial, disputing the decision. The worker must request an appeal by filing a Request for Hearing form within 90 days of the denial letter.

If the appeal fails, upholding the initial decision, an injured worker can request a review of the decision, but they must file the request within 30 days of the hearing. Finally, if the decision stands, the worker can appeal the case to the Arizona Court of Appeals. Workers may want to obtain a lawyer if they haven’t already at this point.

6. Work-Related Injuries and the Right To Return To Work

When placed on disability, you will need to prove your ability to return to work. While an employee has every right to return to work, employers also have the right to limit their liability risks.

Before injured workers can return to the office or facility and resume their duties, they will need a physician to clear them for duty. Employees should also understand that Arizona law does not require employers to reinstate injured individuals within a set timeframe.

7. Insurance Fraud and Workers’ Compensation in Arizona

Some employees might make claims to receive benefits without suffering an injury, which is fraud. Filing false, misleading, or incomplete statements or claims can cause fines of up to $50,000 and jail time.

Honesty is always the best policy when dealing with your employer and their insurance carrier. If you need additional assistance in the claims process, hire a competent and reputable Phoenix injury attorney.

8. Legal Counsel for Workers’ Compensation in Arizona

Were you injured on the job and need help receiving workers’ compensation in Arizona? Stop worrying about the complexities of compensation laws and processes. Contact Sargon Law Group and get the help you deserve.