Workers Comp in Arizona

You shouldn’t need a dictionary to file a workers compensation claim in Arizona, but it might come in handy to know the definition of “forthwith.”

Arizona law says you have to notify your employer “forthwith” when you get injured at work. The dictionary says forthwith means “immediately … at once … without delay.”

Arizona law also says you have one year to file a workers compensation claim. Waiting 12 months would seem to be anything but forthwith.

So, which is it: One year? Or forthwith?

“Nobody knows what forthwith means, but I give it about two weeks,” said Bob Wisniewski, whose been practicing workers compensation law in Phoenix for 45 years. “Your employer has a right to know when you’ve been hurt on the job., but one of the minefield’s we have in Arizona is a lot of workers count on somebody else to report their accident or their injury. The longer you wait, the more complicated things become. It’s a big problem.”

The somebody else reporting that Wisniewski is referring to, is often an employee’s supervisor or the business owner, it’s not their job to file your claim. The only two parties that can file a claim are the injured worker or the healthcare provider that treated the injury.

It’s important because reporting an accident forthwith, immediately or without delay to your employer is the first step in any successful workers compensation case. Waiting a year or a month or even a week to tell an employer you got hurt at work, opens the door for a lot of problems, especially in a state with a transient population like Arizona.

There could be problems remembering witnesses; locating them, if you did remember; documenting any medical treatment received and from whom. All sides in the matter – employer, insurance carrier, lawyers and judges – say the sooner it’s reported, the better.

Wisniewski’s best advice when you get hurt on the job is to:

• Tell your boss and/or business owner immediately you got hurt
• Get medical care right away and make sure you tell the medical provider this accident happened at work
• Call a lawyer to represent you

“We have injured workers come in here and tell us they got hurt a month ago, but they can’t remember the doctor’s name they saw or the day the accident happened or if any of the witnesses are still on the job,” Wisniewski said. “It’s really just a mess sometimes.”

So, if you get hurt on the job in Arizona and want all the benefits you’re due under the law, report your accident to your employer – forthwith!

How to File a Workers Compensation Claim in Arizona

Workers are only covered by workers compensation insurance if the injury or illness occurred on the job. Waiting to report an injury raises the question of whether you actually got hurt at work, or somewhere else.

If you were injured on the job, go to the Industrial Commission of Arizona (ICA) website and you will find Form 407 – Workers Report of Injury –  waiting to be filled out and filed online. You answer the questions, which are simple, but plentiful, check the box at the end for electronic signature, hit send and you’re done.

If you prefer creating a paper trail, print out form 407, fill it out, make a copy for yourself, mail it to the ICA offices in Phoenix and you’re done.

If you receive treatment for the injury, advise the medical provider that this was an on-the-job injury and they will file a Physician’s Report of Injury with the ICA.

When the ICA receives the Workers Report of Injury and the Physicians Report of Injury, it will notify the insurance carrier. It’s a simple, efficient way to start the wheels turning on getting necessary medical treatment paid for and compensation for lost wages.

The problem is convincing injured workers to take that first step.

Employer’s Responsibility for Workers Compensation Claim

Every employer who has one or more employees, must have workers compensation insurance. The employer must pay for the insurance and is forbidden to deduct any portion of an employee’s wages to pay any portion of the insurance premium.

When an employer has been notified that a worker sustained an injury on the job, the employer has 10 days to file form 101 – Employers Report of Injury — with their insurance carrier and with the ICA.

If the employer is self-insured, the employer may have the right to direct the injured worker’s medical care to a doctor of their choosing. If the employer is not self-insured, the employer can direct the injured worker’s care for one doctor visit. After that, the injured worker can then see a doctor of his/her own choice.

Employers must post notice of workers compensation insurance in the workplace. They must cooperate with investigations of your injury. They must offer the employee the right to reject their insurance plan.

The employer can dispute a workers compensation claim within 14 days by submitting evidence that proves the claim is false.

Deadlines for Arizona Workers Compensation Claims

There are several deadlines involved in the workers compensation system and it makes sense to take note of all of these. Failure to adhere to the deadlines could result in a claim being denied, even if the claim has merit.

Here are some deadlines worth noting:

• If your claim is denied for benefits, you will receive a Notice of Claim Status (form 104) from the insurance carrier and have 90 days to appeal to the ICA.
• If you filed a claim and have not received a letter from the ICA within 14 days following the filing, call the ICA offices and ask for an update.
• The insurance carrier has an obligation to accept or deny the claim for benefits by written notice within 21 days from the date of notification.
• Employers are required to report the incident to their insurance carrier and the ICA within 10 days.
• If you lose your case, you have 30 days to ask for another review. If that is denied, you have another 30 days to petition for Special Action from the Arizona Court of Appeals.

What to Do If Your Workers Compensation Claim Is Denied in Arizona

Arizona workers have the right to appeal when their workers compensation claims are denied and that includes having a closed case re-opened.

Arizona law gives workers 90 days from the date of the denial to file a written request for a hearing with the ICA Claims Division.

The reasons for denying a claim are numerous, but most times center around disputes over whether the injury actually took place at a worksite; whether the employer agrees with the facts of the case; whether the employee was guilty of misconduct; or a deadline has passed.

If you file a request for a hearing, your case will be heard by a workers comp judge from the ICA, who can uphold the denied claim or reverse it. If the administrative law judge upholds the denial, the final appeal can be made to the Arizona Court of Appeals within 30 days.

Filing a request for a hearing to re-open a closed case is a separate matter. This is done when you believe you are due added benefits to address a previously undiscovered condition. Some reasons for re-opening a case include:

• Your injury has worsened and you need additional treatment or compensation
• The light duty job you were doing was eliminated
• You have evidence that shows you were not fairly compensated for the injury the first time

In addition to filing for a request for a hearing, you must include a medical report that proves there is new evidence available. The insurance company has 21 days to respond to the petition for re-opening.

Eligibility for Workers Compensation in Arizona

Employers are required to carry workers compensation insurance in Arizona if they have one or more employees. It does not matter if the employees are full or part-time workers, the employer still must have workers comp insurance.

Any employer that does not have workers compensation insurance can have the business shut down and be subject to a civil suit. The workers also can file a worker comp claim with the ICA and receive compensation from the Special Fund Division/No Insurance Section. The Special Fund will seek reimbursement from the employer for any benefits paid, including a penalty.

The exceptions to the rule are if the worker is an independent contract employee; a worker is casual and not in the usual business of the employer; or the worker is a domestic servant in a home.

Benefits: What Does Worker Compensation Cover in Arizona?

The laws in Arizona allow for benefit payments to injured workers in two areas: medical and wage compensation. Workers may be entitled to one or both areas of coverage, depending on the injury and the amount of time missed while recovering.

Medical Benefits

Many of the workers compensation claims are to pay for medical treatment for the injury suffered on the job site. If the claim only represents medical expenses, the insurance carrier handles all those bills. That could include:

• Doctor’s fees
• Emergency room care
• Prescriptions
• Follow up visits to doctors
• Rehabilitation treatment
• Medical appliances such wheelchairs; walkers; crutches and splints

If your claim is accepted, your medical bills will be paid under a fee schedule, until the doctor says no further medical treatment is required. If you paid for any of your medical treatment while waiting for the decision, the insurance company will reimburse your expenses. If you decided to stop medical treatment, the insurance carrier may close the claim without a doctor’s discharge.

If you file a request for a hearing, your case will be heard by a workers comp judge from the ICA, who can uphold the denied claim or reverse it

Lost Wage Benefits

If the injury you sustained on the job causes you to sustain a loss of earnings for more than seven consecutive calendar days, you are eligible for temporary compensation. The key number there is seven.

If a worker misses seven calendar days or less of work, they will not be compensated for the lost wages. If the worker misses between seven and 14 days, they are paid for days eight through 14, but not the first seven days. If a worker misses more than 14 days, they are paid for all missed days, including the first seven.

Wage compensation is usually calculated at 66 2/3 of the worker’s average monthly earnings. The average monthly earnings are from the previous 30 days of pay. The maximum wage compensation for 2021 was $5,030.33 in a month.

The temporary compensation is equal to 66.6 of your established average monthly wage which is calculated by how much you earned over the 30 days prior to the accident.

Generally, you should receive notice that your claim for compensation benefits was accepted when the insurance carrier mails you your first temporary compensation check. The notice should include a page that shows how the calculations were made to come up with your average monthly wage.

Compensation for Scheduled and Unscheduled Injuries

There are other ways to be compensated for work-related injuries, including permanent scheduled and unscheduled injuries.

Permanent scheduled injuries pertain to an impairment on a certain part of the body such as the hands, legs, arms, eyes, etc. Workers may get paid a certain amount each month for a set number of months. That is amount and time are based on statutes and court decisions. The compensation is calculated in three ways:

• Partial loss where you receive 50% of the average monthly wage
• You receive 55% for losses resulting from amputation or total loss of use of the body part
• If a doctor says the injury prevents you from returning to the essential duties of your regular work, you will receive 75% of the average monthly wage

You also could receive compensation for facial scarring or loss of teeth at 55% of average monthly wage with an 18-month maximum allowable time.

Back injuries, shoulders and hips fall in the category of unscheduled injuries. The ICA determines how much compensation, if any, you will receive based on the effect the injury has on your ability to return to work and earn your average monthly wage on the date of your injury.

That’s a mouthful and it’s meant to be. The decision is very subjective, taking into account education, previous occupations, physical limitations and wages earned after the injury. There is no guarantee you will receive an award, even if you are judged to have a permanent impairment. If you successfully return to work and earn the same or more than you did previously, you could receive no compensation for the unscheduled injury.

Death Benefits for Deceased Injured Workers in Arizona

If an injured worker dies at the result of a work-related accident, their dependents are entitled to compensation in the following manner:

• The family of the deceased worker can receive up to $5,000 for funeral arrangements.
• If there are no children involved, a surviving spouse receives 66.7% of the workers average monthly earnings until death or remarriage. If there are children, the surviving spouse receives 35% compensation.
• Children or stepchildren under the age of 18 receive benefits of 31.3% of the workers’ average monthly wage. If they continue their education, they can receive benefits until the age of 22. If they are incapable of supporting themselves, they can receive benefits until they are capable of supporting themselves. If there is no surviving spouse, the children receive 66.6% of the deceased worker’s income.
• If the worker’s parents are wholly dependent on the employee, they receive 40% of the average monthly wage as compensation.
• If there is no surviving spouse, children or parents, siblings of the deceased worker who are wholly dependent, receive 25%. If there are more than one sibling wholly dependent, they must split 35% of the average monthly earnings.

What Is the Industrial Commission of Arizona (ICA)?

The Industrial Commission of Arizona is the governing body for workers compensation in the state. It was created in 1925 to establish workers compensation system in Arizona and is responsible for enforcing all laws and regulations for workers comp.

The Ombudsman’s office in the ICA offers assistance to injured workers in understanding the workers compensation laws in Arizona. It is not a legal advocate for workers, but will make referrals to other agencies for help.

The ICA manages the “Special Fund” that provides medical and wage loss benefits to injured workers whose employers do not have workers compensation insurance coverage. It also may provide vocational rehabilitation benefits, supportive care and apportionment benefits.