FAQ: Filing a Claim

Who Files the Workers’ Comp Claim?

The injured worker or the doctor, not the boss or the employer.

My boss hasn’t filed or won’t file a claim. What do I do?

Doctors will often file the claim if they know your injury should be under workers’ compensation insurance. However, if your doctor fails to file the claim, you can file the claim yourself by filling out “worker’s report of injury” form that you can get from the Industrial Commission of Arizona or our office.

I don’t get along well with my doctor, and I don’t think I’m getting good treatment. Can I change doctors?

Often, yes, if your employer is not self-insured. You have to apply to and be approved by the Industrial Commission to change to a new doctor. Frequently the relationship between a doctor and patient can break down. We can recommend a doctor that has a good professional relationship with our office in case you experience such an issue.

My claim was denied. Now what?

You have to file a “protest” with Industrial Commission of Arizona. If you don’t have an attorney, don’t wait! You only have 90 days to request a hearing date with a judge to protest the denial, because a hearing is the ONLY way to guarantee yourself a chance to get the insurance carrier’s decision reversed. If you fail to file a protest in time, your claim is OVER. It is highly recommended that you contact an attorney if your claim is denied. Your attorney can file a protest for you and may be able to negotiate the acceptance of your claim without going to court. Most importantly, your attorney knows which particular facts prompt insurance companies into action and compel judges to rule in your favor.

I have been out of work for more than a month. Why haven’t I received any money?

There could be several reasons why you have not received a check. The claim may have been denied, filed late, never filed or accepted without notification as a “no time lost” claim. You may be on “light duty” status per your doctor, but have not filled out the insurance carrier’s monthly status form. Sometimes the carrier lacks wage information to calculate benefits. It is also not uncommon for insurance carriers to act slowly for various reasons, often blaming doctors and employers for failing to send requested information. A good attorney will figure out what the problem is and keep the pressure on the insurance company to issue timely benefits.

Can I be fired while on workers’ compensation? What will happen to my claim?

In Arizona, injured status does not protect your job, even if your employer is at fault for your injury. Fault generally does not matter in the system, and workers’ compensation does not alter your employer’s right to fire employees for almost any reason. However, your employer cannot prevent you from filing a claim by firing you. Sometimes employees are even forced to quit their jobs because they become permanently unable to perform the job. Regardless of your current relationship to your employer, you are entitled to file a claim. Remember, your claim is processed and paid by the insurance carrier, not your employer.

Can I sue my employer?

The answer is usually no. Employers may often be at fault for injuries, but employees eligible for workers’ compensation are barred from filing lawsuits against their employers. However, the trade off in this “no fault” system is that employees can collect benefits even when the employee is at fault for their own injury. The most notable exception to this is when another company or “third party” is responsible for your injury. In this case you can collect benefits under your employer’s workers’ compensation insurance to treat your injury while your third-party lawsuit is pending. However, the insurance carrier will have a lien against all benefits paid in your claim.

Will the insurance carrier reimburse my travel mileage?

If you have to travel more than 35 miles to see a doctor because there are no specialists near you, you can be reimbursed.

I need to move out of state while I’m in the middle of my case. Can I move without losing my benefits?

Yes. You need to file a change of address, as well as find a new doctor in near your new area. Your attorney may be able to help find a new doctor if finding one proves difficult. However, you will have to make the trip back to Arizona if there is a need for a hearing.

The insurance is demanding that I go to medical exam with some doctor I’ve never seen. Do I have to go?

Insurance carriers will often use these exams, known as “independent medical exams,” to build evidence for various reasons or to double check your doctor’s assessment. An unfavorable opinion from any doctor can be used to limit your benefits, close your case or deny it completely. It is essential to have the best medical and legal specialists on your side, in case you have to fight for you right to treatment and benefits.

I was hired and usually work in Arizona, but I was injured in another state. Where do I file my claim?

You can file the claim in either the state where you were hired or the state in which you were injured. If you live and work mostly in Arizona, it may be the easiest place to file your claim. Since workers’ compensation laws vary from state to state, your lawyer and court hearings will both be in the state in which the claim is filed.