What is workers’ compensation?
All Arizona employers are required to carry workers’ compensation insurance. Since 1925, Arizona injured workers have been insured by their employers in the event of an on-the-job injury for both medical and lost wage benefits. Workers’ compensation is a no-fault system. It is governed in Arizona by the Industrial Commission of Arizona (ICA).
What type of injury qualifies for these benefits?
A compensable injury is one that BOTH arises out of the employment AND occurs in the course of employment. There are additional conditions that apply to hernias, HIV, MRSA, and heart and mental conditions. NOTE: Mental industrial injuries are very difficult to prove.
Can I sue my employer for getting hurt at work?
Since workers’ compensation is an exclusive remedy, no, unless one of these four conditions apply:
– Your employer had no insurance. You have the choice to either file a claim with the No Insurance Section of the ICA or to sue the employer directly.
– You rejected workers’ compensation insurance before your injury. Arizona law permits you (unless you are a public employee) to reject workers’ compensation insurance through a written rejection form.
– Your employer failed to post a notice telling you about your right to reject, AND you can prove that there was no notice you did not know about rejecting workers’ compensation before your injury.
– Your employer deliberately and knowingly caused you to suffer your particular injury. This is very difficult to prove.
Can I sue someone else for getting hurt at work?
If your injury was caused by a third party (not your employer or co-worker), during the first year after your injury, you can sue the third party. During the second year, your employer’s workers’ compensation insurance carrier (Carrier) can sue the third party. However, if you sue the third party, the Carrier will claim a lien against any recovery you receive from the third party for all the money the Carrier has already spent on your workers’ compensation claim AND a credit for all the money the Carrier expects to spend in the future on your workers’ compensation claim.
What do I have to do if I get hurt at work?
Immediately tell your boss or Human Resources or someone in Management. Follow up by seeing your doctor and filing a workers’ compensation claim. Your employee handbook probably requires you to immediately report the injury. While your employer cannot fire you for filing the claim (as that would be a tort under the Arizona Employment Protection Act), it can fire you for failure to report the injury or even having the injury if you acted in an unsafe manner. Also, the Carrier can deny your claim based on your failure to “forthwith report” your industrial injury as required by law.
How do I file a workers’ compensation claim?
Either you or your doctor need to file the claim with the ICA. If you don’t sign the Worker and Physician Claim at your doctor’s office (and remind them to file it!), you can file in person or online at www.azica.gov/forms/claims0407. Remember that your employer cannot file the claim for you – you or your doctor must do so. Just because your employer has you complete a form does not mean that a claim has been filed.
How do I know if my claim has been filed?
Call the ICA Claims Division at 602-542-4661 and ask.
Can I see my own doctor?
Yes, unless your employer is self-insured. The self-insured employer has the right to “direct care.” If you see your own doctor, it will be at your own expense. NOTE: Larger employers tend to be self-insured.
Do I have to see my employer’s doctor?
If your employer is not self-insured for workers’ compensation, it has the right to send you to its doctor to determine the nature and extent of the injury. If you want care with your own physician and your employer is not self-insured, do not go a second time to your employer’s doctor, or you have chosen that doctor as your own. You can petition the ICA to change doctors. See www.azica.gov/forms/claims0121.
What kind of medical benefits can I receive?
Two kinds:
– Active medical care. This includes surgery, physical therapy, and other treatments that are designed to improve your health condition caused by the injury (your “industrial condition”).
– Supportive medical care. This includes medication and other treatments that are designed to maintain your industrial condition now that you have reached a medically stationary point. See below.
What kinds of cash benefits can I receive:
Two kinds – temporary and permanent:
– Temporary benefits fall into two categories – total and partial.
a) If you can return to full duty, you will receive no cash benefits.
b) If you cannot work at all, every 14 days, you will receive temporary total benefits, which are calculated as two-thirds of your average monthly wage. The ICA annually caps the average monthly wage. Please be aware that 90% of all workers’ compensation claims are “no time lost” because you are not entitled to cash benefits unless you have lost seven (7) days from work. You must lose 14 days from work in order for your temporary benefits to be retroactive to your date of injury.
c) If you can return to light duty and your employer puts you back to work at your date of injury wage, then you will receive no cash benefits. However, if your employer does not return you to work or reduces your wages, then you will receive two-thirds of the difference between your average monthly wage and what you are earning on light duty. These benefits are payable every 30 days.
– Permanent benefits are only payable once your claim is closed and you are “rated” by a physician.
a) If the injury is to certain parts of the body (legs, arms, hands, feet, eyes) and there is a permanent impairment of function in that part of the body due to the industrial episode (what caused the injury to occur), then the law provides a certain dollar amount of permanent benefits in a formula determined by the average monthly wage times whether you can return to your date of injury job times the number of months assigned to that body part by the law times the percentage of permanent impairment. This is called a “scheduled permanent disability.” It usually is a one-time payment.
b) If the injury is to the whole person (shoulder, back, neck, hip) and there is a permanent impairment of function to the whole person due to the industrial episode, then benefits are based upon loss of earning capacity. If your employer returns you to work at your date of injury wage, there is no loss and no cash benefits. However, if you cannot return to work at your date of injury wage, permanent unscheduled disability benefits can be payable over your lifetime based upon a formula where your earning capacity in dollars is subtracted from your average monthly wage and then multiplied by 55% to arrive at a monthly benefit. Both you and the Carrier have the right during your lifetime to petition the ICA to rearrange those benefits based upon any changes in your earning capacity due to the industrial injury.
c) Permanent total disability benefits are also available at two-thirds of the average monthly wage in rare circumstances.
Who processes my claim?
The Carrier issues Notices of Claim Status. The ICA sets your average monthly wage – which is the basis for all cash benefits in the claim. You have the responsibility to react to these Carrier and ICA notices. If you disagree, you must timely file a Request for Hearing at the ICA – www.azica.gov/forms/claims0446.
When does my claim end?
The Carrier will close your claim when your doctor – or the Carrier’s doctor – finds that your medical condition is neither any better nor any worse. In other words, your industrial condition is medically stationary. However, you have a lifetime right to reopen your claim if you can prove by objective medical evidence (X-ray, MRI) that something different (new, additional, previously undiscovered) has happened to your industrial condition and that this difference is related to the original injury.
I am receiving active medical care and want to see my sister in Seattle. Do I need to do something?
Yes! You need the ICA’s permission to leave the state if you will be gone for 14 days. See
www.azica.gov/forms/claims0122 to request permission. If you don’t get permission, your benefits can be suspended.
I just got something in the mail that says my claim has been denied. What do I do?
You only have 90 days from the date on that Notice of Claim Status denying your claim to file a Request for Hearing at the ICA, www.azica.gov/forms/claims0446, or the denial becomes final, and your claim is dead.
Can I get an attorney to help me?
A: Yes. The State Bar of Arizona certifies certain attorneys as specialists in workers’ compensation. Go to Workers Compensation Law at www.azbar.org/for-lawyers/career-advancement/legal-specialization/find-a-board-certified-specialist. Please note that most attorneys handle cases on contingency, which means that you need to have cash benefits at stake in your claim.
What is involved in the hearing process at the ICA?
Lots! Please see the video guide at www.azica.gov/alj-video-guide-page and the ICA’s excellent new (December 2022) book for injured workers at www.azica.gov.
Is vocational rehabilitation available?
Yes, under limited circumstances. Call the ICA Special Fund at 602-542-3294.
What about a “settlement?”
Seek help from an attorney.
Help! I need more information!
The ICA has a superb Ombudsman’s Office – see www.azica.gov/ombudsman or call 602-542-4538 and get all your questions answered.