No one needs the complications and stress of being injured on the job. However work related injuries are far too common. Accidents, repetitive motions, over exertion, illnesses and even stress regularly cause injuries in the workplace. Most people including lawyers outside the area of workers’ compensation have little experience with the Arizona workers’ compensation system. Sustaining a physical or mental injury on the job that affects your ability to work can be financially and emotionally devastating to those fail to understand the workers’ compensation laws and procedures. What should you do if you are injured in the course of your work? Below is a basic guide to help you understand and prepare for an on-the-job injury claim under the Arizona workers’ compensation system. To begin, there are five basic steps to follow to begin your claim properly:
- In an emergency, seek immediate medical attention as you would in any emergency situation.
- Inform your employer through your boss or supervisor that you have been injured first in non-emergency situations.
- Get to a doctor as soon as possible.
- Make sure the claim has been filed.
- Inform your employer of any limitations the doctor has placed on your work activity.
- Seek advice from an attorney if you have any doubts.
Once your claim has been filed, you should receive a letter from the Industrial Commission of Arizona, which is the state agency charged with adjudicating and administering the Arizona workers’ compensation system. The letter will indicate that the workers’ compensation insurance carrier for your employer has been contacted about your injury. The insurance carrier has 21 days by law to decide to accept or deny your claim. If you do not receive the Industrial Commission letter, response from the insurance carrier or your claim is denied by the insurance carrier, contact our office immediately as your time is very limited to protest the decision. If your claim is accepted, there are two basic types of benefits paid under workers’ compensation: monetary and medical.
Workers’ compensation insurance pays 100% of all your medical bills. You should NEVER receive a bill from a medical provider for any service or medication necessary to treat your work related injury. If you do receive a bill, contact our office. You are eligible to receive “active” medical benefits until the doctor believes your condition cannot improve any further, or is “stable.” That does not necessarily mean that you are physically 100%. It means the doctor has run out of treatment options. If you have a permanent disability as a result of your injury, you may be eligible for both long term medical and monetary benefits for certain types of injuries.
You can receive up 66 2/3% of your average monthly wage while your doctor says you are unable to work. The average monthly wage is not necessarily your salary. It is typically the wage you earn 30 days before you were hurt. So, if you had a light month of work before, it wouldn’t be the average of your last year’s earnings. In addition, depending upon your date of injury, the average monthly wage has a cap. If you earn more than the cap in your salary, you will not receive 2/3 of your salary but only 2/3 of the maximum average monthly wage. The average monthly wage can be a complicated calculation. The insurance carrier should issue a “notice” shortly after the acceptance of your claim indicating what they believe is your “average monthly wage.” If the insurance estimates your earnings to be too low, it could significantly affect the amount of money you will receive throughout your entire case, which could seriously impact long term monetary benefits. That could mean thousands of dollars lost due to failure to protest the insurance carrier’s calculations. Getting the insurance to accept a higher wage may require court action. Do not hesitate to contact our office as soon as you receive this notice.
Monetary benefits are paid every 14 days while you are completely unable to work. However if your doctor allows you to work but with some type of restriction(s) on your work activity, the insurance will send payment every 30 days, and only after you have filled out an monthly status request form. Always keep your employer informed of your work status. If you can work in a limited capacity but your employer will not offer you work, you may be required to look for limited work. Once your doctor releases you to work without restrictions or closes your case, regardless of whether or not you are working, you will no longer be eligible for payments to cover lost salary.
Your medical benefits continue until a doctor closes your case, and your monetary benefits continue until any of the following occur: you are earning your full salary, your doctor releases you to full work status or closes your case. Sometimes the insurance company will hire a doctor who’s opinion contradicts your doctor’s opinion. If one doctor believes that your condition is stable and that your case can be closed, the insurance carrier will close your case. However if you and your doctor disagree, you can protest. Contact our office immediately if your case is closed by a doctor hired by the insurance company, as your time to fight the decision is limited.