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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 pink
form 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.
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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.
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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.
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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.
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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.
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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.
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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.
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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’
compensation lawyer, or a lawyer who specializes in both before
making this decision.
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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.
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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.
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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.
How can I afford an attorney?
Attorneys representing injured workers are paid on a contingency
basis. This means that they will receive an agreed upon percentage,
usually 25%, of your monthly benefits if they are successful.
If they are not successful, then they do not receive a fee. You
need to talk over the costs with your attorney.
Is there a certain type of attorney
that I should hire?
Yes, it is recommended that you consult with an attorney who
is a specialist in Workers’ Compensation. You can contact
the Arizona State Bar Association for a list of qualified attorneys.
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