_____________________Workers' Compensation Information
What is Workers’ Compensation?
Workers' Compensation is a “no-fault” system in which the injured worker receives medical and compensation benefits no matter who caused the job-related accident. Lawsuits against the employer, except under very limited circumstances, are not permitted.
If the injury or illness is job related, the injured worker receives medical benefits and, if eligible, temporary compensation. In some cases, the injured worker may also receive permanent compensation and “job retraining.”
The Industrial Commission of Arizona and the insurance carrier are not identical. The Industrial Commission is a state agency that is responsible for deciding disputes and monitoring the activities of the State Compensation Fund, private carriers and self-insured employers, referred to as insurance companies. The Industrial Commission of Arizona has produced a video containing valuable information to help you understand the worker's compensation process. Check the website below to view the free informational videos.
http://www.ica.state.az.us/Divisions/administrativeLaw
You cannot sue your employer, but if anyone other than your employer and/or co-worker is partly or wholly at fault for your injury you may have a 3rd party claim against that person or company.
- top of page -
How do I File?
When you were treated for your injury at either your doctor's office or an emergency room and you told them you were injured on the job, you should have been given a form (usually 'pink') to complete and sign. The pink form is a combination form entitled Worker’s and Physician’s Report of Injury. By signing that form, you were applying for Workers' Compensation benefits.
The hospital or doctor sends the original form to the Industrial Commission (ICA), a copy to your employer and a copy to the insurance company that wrote the policy for your employer. If you did not complete this pink form at the doctor's office or at the hospital, another form, entitled Worker’s Report of Injury, can be completed and filed with the Industrial Commission. This form will be sent to you by the ICA upon request.
- top of page -
Notifying Employer and Filing
An injury is covered under Workers’ Compensation if it is job related. It is the injured worker’s responsibility to make sure the injury is reported to the supervisor/employer as soon as possible. If the injury comes on gradually, it is important to report it as soon as you suspect that it may be work related.
Your claim is offically filed when a proper form is received by the Industrial Commission. If you are not notified of the receipt of your claim within a reasonable time, which is usually about two weeks, please contact the Industrial Commission of Arizona.
All claims must be filed within one year of the date of the injury.
- top of page -
Important Time Limits
You need to notify your supervisor/employer of any work injury as soon as possible. If the injury came on gradually you must tell your supervisor/employer as soon as you suspect that it is work related. It is best to report to your supervisor/employer any problems or pains that seem to get worse as you work.
You must file your claim within one year from the date of the injury.
In addition to the above, there are many other time limits. You need to carefully read all documents you receive since many of them will tell you that if you do not agree with it’s contents, then you must protest within a certain period of time.
The best way to handle time limits is to call a lawyer immediately when anything happens that you do not completely understand.
- top of page -
Benefits if Not Working
If you are taken off work by your doctor, your first 7 days off work are not paid for unless you are off per your doctor for at least 14 days.
Compensation is paid at 66 2/3% of your average monthly wage. The Maximum Average Monthly Wage is presently set at $2,400.00. This is set by law. The compensation is paid every fourteen (14) days while the doctor has you on a no-work status.
If you are released to light duty, the insurance company will review your case to decide if your benefits will be continued. If you want your compensation benefits to continue, you must take light duty if offered by your employer and, if not offered, you must diligently seek work. On light duty you are paid every thirty (30) days.
- top of page -
Types of Benefits
Benefits under workers’ compensation include medical benefits and loss of wages. The medical benefits are paid even if you do not lose any time from work. For more information on compensation benefits see sections on Benefits if Not Working, Scheduled and Unscheduled Injuries and Permanent Benefits.
Your benefits begin as of the date you are injured. They continue until you are stationary or cured. Even after your case is closed, you may be able to reopen your case for additional benefits, which may include further medical treatment and further compensation.
- top of page -
Scheduled and Unscheduled Injuries
There are two types of permanent injuries: Scheduled and Unscheduled. There is also death, which is a separate category.
Scheduled injuries are permanent injuries to a certain part of the body, such as an eye, a hand, an arm, etc. Compensation for Scheduled injuries depends on a formula which is spelled out in the workers’ compensation law. The benefits are a fixed amount of money for a fixed period of time.
Unscheduled injuries are injuries that are not Scheduled. For example, backs, necks, shoulders, etc. Unscheduled injuries may also be based on other considerations such as previous injuries and disabilities. A lawyer is recommended to sort these considerations out. Compensation for an Unscheduled injury is based on the effect the injury has on your ability to return to work and the wages you are able to earn compared to your average monthly wage.
- top of page -
Permanent Benefits
Permanent benefits depend upon whether the injury is scheduled or unscheduled. If scheduled, the benefits are spelled out in the Statue on workers' compensation.
If the injury is unscheduled, the benefits depend on the effect, if any, the injury has on your earning capacity. Proof of your earning capacity, if you have not returned to your regular job and/or are not making as much money as you did before the injury, usually requires experts in both the medical field and the labor market field.
The determination takes many factors into consideration, such as age, education, previous occupations, physical limitations, and wages after the injury.
The calculation of benefits if you have an unscheduled injury, is 55% of the difference between your average monthly wage and the amount of money you should be able to earn with your injury on the open and competative labor market. It also considers your labor market, which is where you live, and the area surrounding where you lived or worked at the time of injury.
- top of page -
Uninsured Employers
If your employer had no workers’ compensation insurance on the date of your injury, you may either file a civil action (lawsuit) against your employer in Superior Court, or file a claim for workers’ compensation benefits with the Industrial Commission.
The Industrial Commission has a trust fund called the Special Fund, which was set up to pay the medical and/or compensation benefits to workers injured during the course of their employment with uninsured employers. The Industrial Commission's Special Fund Division will process your claim and conduct an investigation to determine if you were an employee or an independent contractor and, whether the injury arose during the course and scope of your employment.
The decision whether to file a civil action or proceed with the Special Fund can be a very complicated issue. It is recommended that you contact both a personal injury lawyer and a worker’s compensation lawyer, or a lawyer who specializes in both before making this decision.
- top of page -
Issues Surrounding Doctors
Do I have the right to select my own doctor?
You have the right to select the doctor of your choice unless your employer is self-insured.
What happens if my employer (not self-insured) wants me to see it’s doctor?
It is okay to see your employer’s doctor. In fact, it is mandatory under certain circumstances. Keep in mind,however,that if you voluntarily visit a doctor more than once, it is interpreted that you have officially chosen that doctor to be your doctor.
- top of page -
Leaving The State
Are there restrictions to leaving the State while under the workers' compensation system?
Yes there are restrictions. You may not leave the State for more than two (2) weeks while under active medical treatment without prior approval. If you are planning to be outside the State for more than two weeks, you must have written approval from the Industrial Commission before you leave the State. Requests to leave the State must be sent to the Claims Division of the Industrial Commission of Arizona. The request should include the reasons that you need to or want to leave the State, the date you plan on leaving and the date of return. Obviously, moving out of State creates problems which need to be considered.
What problems can I expect if I leave the State for more than 2 weeks without prior approval?
If you fail to get approval, prior to leaving the State, the insurance company may suspend your benefits.
- top of page -
Do I Need a Lawyer?
Do I have to have an attorney, or can I represent myself?
You can represent yourself. Keep in mind however, that the Workers’ Compensation Law is very complex and the insurance company or self-insured employer will be represented by attorneys who specialize in Workers’ Compensation Law at the hearing. If you choose to represent yourself, you will have to follow the Rules of Procedure for hearings before the Industrial Commission of Arizona. A copy of the rules can
be obtained from the Industrial Commission of Arizona’s Administrative Law Judge Division.
- top of page -
How Can I Afford an Attorney?
Attorneys representing injured workers are paid on a percentage basis. This means that they will receive an agreed upon percentage, usually 25%, of your monthly benefits, fees and if your case does not generate benefits, then those receive no fee. You need to talk over the costs with your attorney.
- top of page -