Summit Insurance Advisors
by on Mar 21, 2017
Arizona’s workers’ compensation laws mandate that employers carry workers’ compensation to cover employees who are injured on the job or develop an occupational illness and are unable to work.
Read on for information on eligibility, how to file a claim, how medical treatment works, types of benefits, and how to request a hearing if your claim is denied.
Eligibility for benefits
In Arizona, all employers that employ one or more people, either full-time or part-time, must provide workers’ compensation insurance. Employers usually pay premiums to an insurance company, which then pays out workers’ compensation claims. Employees don’t need to pay anything toward their coverage. If employers have failed to secure coverage, the Industrial Commission of Arizona (ICA) has a special fund to give benefits to workers.
Most workers are eligible for Arizona workers’ compensation insurance, and generally it doesn’t matter how the worker got hurt or if it was the worker’s fault. As long as the employee’s injury was caused by his or her work activities, they will be eligible for benefits.
Filing a claim
First, it’s important to let your employer know as soon as you get sick or injured. The employer is then required to report your injury or illness to the insurance company and to the ICA. You (the employee) also need to file a claim with the ICA by completing and submitting a Worker’s Report of Injury form. Alternatively, when you’re receiving treatment at a doctor’s office, you and your physician can complete a Worker’s and Physician’s Report of Injury. Typically, your doctor’s office will submit this form to the ICA for you. You must file your claim within one year of your injury.
After your claim is submitted, the ICA will send you an acknowledgement of receipt letter. If you don’t receive this letter within two weeks, call the Commission to make sure they received your claim. Your employer’s insurance company will then make a decision about whether to grant or deny you benefits. This usually takes about three weeks.
Your employer gets to choose the doctor you see on your first medical treatment. After this, you are allowed choose your own doctor. (However, if your doctor is self-insured, he or she may have the right to determine which doctor you see on continual basis.)
Workers’ compensation benefits cover all reasonable and necessary medical treatment associated with your injury or illness. Because your doctor bills your workers’ comp insurance company directly, you won’t have to pay out of pocket for medical care.
Workers’ comp benefits
Workers receive both medical coverage and payments for lost wages and permanent disabilities.
If you are unable to work for more than one week, you are able to receive compensation for the lost wages, which are called “lost time benefits.” Your doctor must certify that you are not able to work.
Lost time benefits are two thirds of your monthly income and determined by your earnings the month before you got sick or injured. Arizona has a maximum monthly benefit of $4,521.92 per month. This benefit is considered temporary and only lasts while your doctor is actively treating you. When your doctor determines you’re able to return to work, you’ll receive a letter from the insurance company called a Notice of Claim Status, which tells you the doctor said you can work again. If you can’t return to work full-time or can only do modified work, and a result are earning less than you usually do, you can continue to get time lost benefits, which will be two-thirds of the difference in your earnings.
When your doctor finds that your condition is stationary, or not expected to improve any further, he or she will determine whether you have a permanent disability. If you do, the doctor will give you a percentage of disability. This number, along with your age, education and work history, and earning capacity, determines your rate of compensation.
If your claim is denied or you disagree with the amount of compensation you receive, you have 90 days to request a hearing. You do this by filling out a hearing request form from the ICA. Alternatively, you can write a letter to the ICA requesting a hearing and explaining why you are requesting one.
You will then receive a letter from the ICA informing you of the date and time of your hearing. Typically, you have to wait about three months before your hearing.
For more information on workers’ compensation in Scottsdale, Arizona and the state of Arizona as a whole, visit the Industrial Commission of Arizona.
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