Who qualifies for permanent total or partial disability benefits after a workplace injury?
Thousands of on-the-job injuries occur each year. Some workplace accidents cause permanent partial or total disability. Anyone who suffers disabling injuries at work may be eligible for Arizona workers’ compensation benefits.
According to the Industrial Commission of Arizona (ICA), calculating disability benefits (partial or permanent) can depend on a number of contributing factors:
Many factors are involved in these decisions, such as limitations, education, work experience, etc. In some cases, there is no monetary award as the injured worker has returned to work earning the same or in excess of the established average monthly wage. These awards take approximately 90 days from the issuance of the notices by the insurance carrier.
Arizona scheduled vs. unscheduled injuries
The state of Arizona classifies injuries as being either scheduled or unscheduled situations.
Scheduled permanent injuries
According to the ICA:
A scheduled injury is to a specific body part and the Arizona Workers’ Compensation Law sets out a schedule indicating the amounts to be paid for these impairments. There is also compensation payable for visible facial scarring and loss of permanent teeth.
Scheduled injuries involve an eye, arm, hand, leg, or foot. In the event that an individual suffers a partial loss of a body part, permanent partial disability calculation in Arizona is commonly half of the employee’s average monthly wages.
In the event that an employee suffers an amputated limb or the total loss of a body part, they may receive 55 percent of their average monthly wage. However, if a physician determines that the individual can’t return to their normal job secondary to the injury, they may receive up to 75 percent of their monthly wage. Employees who suffer permanent facial scarring or tooth loss receive 55 percent of their monthly wages for up to 18 months.
The length of time that the employee receives the compensation depends on the injured area of the body. In the case of a digit loss, the employee may receive benefits for 15 months. Hearing loss in one ear entitles employees to payments for up to 20 months. Payments for vision loss in a single eye extend for 25 months.
Losing the ability to use a dominant hand entitles the individual to payments for up to 50 months. Should an employee lose both arms, hands, legs, feet, or vision in both eyes, secondary to a work-related accident, they are entitled to statutory permanent total disability payments for the remainder of their lives.
Arizona workers’ compensation’s scheduled injury in the event of a partial disability extends for the number of months in proportion to the percentage of the loss. If an employee loses 50 percent of the use in their dominant hand, they may receive payments for up to 25 months, which is calculated as 50 percent of 50 months.
Unscheduled permanent injuries
According to the ICA:
An unscheduled injury is the result of a general impairment, a combination of impairments to different body parts injured in one incident, or a history of other permanent impairments. In these cases, the ICA determines what amount of compensation the injured worker is entitled to based on loss of earning capacity.
Unscheduled injuries are classified as other types of injuries. The injured areas may include the back, a shoulder, or a hip. Occupational diseases are also part of the category. In these cases, the ICA determines if an employee should be awarded compensation for the injury and what amount. Factors that the Commission considers include the likelihood that the employee is able to return to work and the amount of wages they might earn. Age, work history, and education level are also considered.
If an employee is awarded compensation for the unscheduled injury, the compensation is calculated as the difference between the prior wage and the wage the employee is capable of earning in their present condition. However, if the unscheduled injury results in total disability, the individual receives 66 ⅔ percent of their former monthly wage. A partial permanent disability enables the injured worker to receive 55 percent of their monthly wage.
Injured employees may also be eligible to receive up to 25 percent of an attorney’s fees.
Lump-sum compensation for permanent disabilities
Under certain circumstances, ICA may award an injured employee with a lump sum of their disability benefits.
Situations in which total payments occur include a scheduled injury of $25,000 or less, which doesn’t require the insurance company’s approval. An unscheduled injury of $150,000 or less requires the insurance company’s approval.
Lump-sum payments may be approved in the event that the employee has a financial or rehabilitation need. The ICA has the forms that require completing and submitting to determine approval. In the event of a request denial, the individual has up to 10 days to file a hearing request with the ICA.
Changing permanent compensation benefits
Employees awarded unscheduled permanent partial disability benefits may have their payments increased or decreased based on their current earning ability. A petition must be filed with the Commission to determine whether an adjustment in payment is appropriate. Benefits may increase if the injury has progressed or the employee’s earning capacity has decreased. Upon receiving the petition, the Commission sends the individual documentation to verify their current work and health status.
Permanent total and partial disability eligibility
In the majority of cases, employees suffering permanent injuries or illnesses that occurred while performing job-related tasks are eligible to receive disability payments in Arizona.
Questions that are commonly asked to determine eligibility include:
- Does the employee have any degree of physical function?
- What are the individual’s physical or psychological limitations?
- Are there other factors that may cause permanent disability?
Questions and answers about compensation for a job-related accident, injury or illness in Arizona
How to file a permanent disability claim in Arizona
Before filing a claim, the employee must be treated by medical professionals. The physician’s diagnosis, notes, and prognosis must be included in the discharge documents. Depending on the type and extent of the injury, an employee may receive documentation from more than 1 healthcare provider. The paperwork is then filed with the ICA.
If an employer’s insurance company denies the disability claim for any reason, the individual should contact an attorney experienced in dealing with workers’ compensation and disability cases. Sometimes, insurance companies may not make timely payments or attempt to alter the amount.
In these instances, the employee has the advantage of consulting an Arizona lawyer who possesses the knowledge needed to evaluate the case and guide the client through the legal process. For Arizona workers, the team you need is at the Law Offices of Robert E. Wisniewski.