Once your doctor closes your case (at the point where your condition is no longer improving) they should assess whether or not you have made a full recovery.  If you have fully recovered, you will not be eligible for any type of monetary award at the closure of your case.  However if not, the doctor should “rate” your disability in the form of a percentage.  Based on this number, you may be eligible for one of two types of post-closure monetary benefits called “awards”. Your doctor can also recommend post-closure medical benefits as well:

“Scheduled” Award:  This type of award is usually the result of a permanent injury to the extremities, eye or ear.  The percentage of disability given by your doctor is plugged into a formula used to calculate this type of award.  These awards are only paid out over a set number of months indicated in the formula, and then end.  Pay careful attention to these awards, because they are commonly miscalculated in favor of the insurance carrier .  You may also be eligible to receive vocational training from the state if you are unable to continue your prior job.

 

“Unscheduled” Award:  This type of award is usually the result of a permanent injury to the back, neck, shoulders, or two “scheduled” injuries.  The existence of a previous workers’ compensation claim, even in another state could make you eligible for this type of award.  Unlike a “scheduled” award, this award is based on your general reduction in ability to earn, not just your percentage of disability.  That means that it is possible to receive nothing if the insurance makes a case that you have no diminished earning ability, even with a disability!  Insurance carriers will often contract doctors and labor market experts to prove you have no diminished earning capacity.  This type of benefit has to be reaffirmed every year, can go up or down, and can be fervently contested by the insurance carrier.   The assistance of an can often be the difference between receiving nothing and significant monthly award.

 

Supportive Medical Benefits: Even if your doctor has to close your case because your condition cannot be improved, your doctor could recommend some continuing basic medical benefits to maintain your condition.  Medications, office visits, therapy and braces are common types of post-closure medical benefits.  Your doctor can indicate the need for such treatment in his final evaluation before closing your case.  The insurance carrier then has to issue a “notice” explaining what benefits you will receive.  Usually the doctor recommends that benefits be issued for a year, and may be renewed at the end of this period.  However if you fail to use these benefits, you will lose them!

Sometime a case has to be reopened several months or years after it is closed.  While certain treatments can be performed to maintain your condition while your case is closed, more serious treatments like surgery require your case to be reopened.  The possible need to reopen a case is an excellent reason to take advantage of supportive medical benefits.  Reopening a case requires medical proof, usually in the form of a doctor’s report.  Reopenings are often denied, and your time to fight the denial is limited.  If your case is successfully reopened, you will be eligible for the same benefits as a new case.

The Arizona workers’ compensation system is a serious legal process.  As any legal process, you have rights, as well as some responsibilities.  Your knowledge of your rights, as well as your compliance with legal your responsibilities are essential to the survival or your Arizona workers’ compensation claim.  There are three basic principles that will help you properly exercise your rights and get you what you are entitled to:

  1. NEVER Make Assumptions.  Never assume your boss or manager knows that you are hurt unless you tell them.  Never assume that your doctors are aware of every part of your injury unless you tell them.  And above all, never assume you know the law unless you have been informed by an Arizona workers’ compensation attorney that specializes in workers’ compensation.  NEVER assume anything.
  2. Don’t Let Time Pass By!  Do not wait to tell your boss or supervisor that you are hurt.  Do not wait to file your claim.  Do not wait to go to a doctor if you believe you are injured.  Do not hesitate to contact an attorney with questions.  Acting quickly is one of the best ways to ensure that the process works, because time is one of the most valuable resources in law and medicine.

Listen Carefully To Advice.  This process will usually try hard to be frustrating and insulting, but effectively utilizing competent, professional advice from your doctor or attorney is often essential to the general process, and certainly indispensable in the most complex medical and legal situations.  Being injured and out of work can be a lonely and freighting place to be, but if you tap into the knowledge and experience of professionals that have seen many situations like yours, it’s not an unfamiliar place.  Don’t let a giant insurance company intimidate you.  You have access to an attorney with more knowledge and experience than any insurance adjuster.


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