This page provides answers to the following questions:
- I had an accident at work. How do I file a workers compensation claim in my state?
- Should my employer have workers compensation insurance? How do I know I am covered?
- What are the conditions that enable me or prevent me from claiming benefits under my state's law?
- What benefits might I be eligible to receive?
- How much time do I have to file my claim? What are the stages of the claim process? What should I expect?
- If I'm not happy with the determination, how do I appeal?
1. I had an accident at work. How do I file a workers compensation claim in my state?
If you are injured at work, it is your job to be as prompt as possible in reporting your injury to your supervisor or employer. If your injury or illness is work-related, you are likely to receive some form of compensation. Reporting your injury as soon as possible will help you to avoid any possible delays or denials of any possible benefits.
When you are treated for your injury, make sure to notify the doctor or physician that you were injured at the job. This should prompt your doctor to give you a pink form entitled "Worker's and Physician's Report of Injury." Filling out and signing this form commences your application for Workers' Compensation benefits. Your treating physician sends the form to the Industrial Commission (ICA), a copy to your employer, and a copy to the insurance company that provides workers compensation coverage to your employer.
If you do not fill out the pink form, you may also fill out another form, Worker's Report of Injury that will also begin a workers' compensation claim. It is sent to the ICA upon request.
You must have one of these forms with your signature (or the signature of a legally authorized representative) sent to the ICA to officially file your claim. Without one of these forms, your insurance carrier is not legally required to proceed with your request for injury-related benefits. You may contact the ICA to see if your form(s) have been received.
Again, it is important to file your claim as promptly as possible. You must file your claim within one year of the date of your injury. You are responsible for ensuring your claim is filed.
2. Should my employer have workers compensation insurance? How do I know if I am covered?
Once you file your claim with the Industrial Commission, your employer's insurance company is notified that your have filed a claim. The insurance company will then make a determination of whether to accept or deny your claims. The insurance company must make a decision within twenty-one (21) days of receiving notice of your claim filing from ICA. If the insurance company denies your claim, which you should expect to receive notice of, you have ninety (90) days to protest the determination.
The Industrial Commission entitles certain large employers to act as their own insurance company. These employers are classified as self-insured employers. Most employers who qualify as self-insured will notify their employees of their status as a self-insured company. You should be observant of what kinds of information your employer provides you about the employer's insurance coverage; your employer is required to tell you the name of their insurance company or what kind of coverage the employer provides for employees.
If your employer is not insured, you may file a lawsuit against your employer Superior Court or you can file a workers' compensation benefits claim with the Industrial Commission. The Industrial Commission has set up a Super Fund to pay medical and compensation benefits to workers whose employers do not have insurance coverage at the time of their injury. The Industrial Commission's Special Fund Division will take on your claim and investigate the nature of your injury and how it was related to the scope of your employment. If your employer is found to have had no insurance coverage at the time of your injury, your employer has violated state laws and may be subject to liability.
3. What are the conditions that enable me or prevent me from claiming benefits under my state's law?
In Arizona, Workers' Compensation is a no fault system in which injured workers receive medical and compensation benefits no matter who causes the job-related accident. So long as eligibility requirements are met, a worker suffering from a work-related injury or illness may receive medical benefits, temporary or permanent compensation, and job re-training.
4. What benefits might I be eligible to receive?
There are two types of claims that can be filed under Arizona Workers' Compensation laws: medical only claims and time loss claims.
Medical only claims are the benefits paid by your employer's insurance company for your medical expenses related to treatment for your injury. Medical only claims do not cover compensation benefits related to lost wages. If the insurance provider chooses to accept your claim, the insurance company will continue to pay your medical bills until a doctor states you are no longer in need of treatment. If you willingly choose to stop treatment for your work-related injury, the insurance company may close your claim without notice from the doctor. If your claim is accepted, you are not responsible for paying any of the medical expenses for your treatment. However, you must be aware that the insurance provider can subject you to periodic examination to check on the status of your treatment and the state of your recovery. Such examinations may serve as a basis for updating or changing your claim status.
Time lost claims are benefits for compensation of lost wages if you are unable to work for more than seven calendar days (these do not have to be calculated consecutively, but are considered in the aggregate). You are entitled to lost wages for all days of work missed after the seventh day. The first seven (7) days are not paid unless you are missing from work for fourteen days. Your compensation is paid at two-thirds (66.67%) of your average monthly wage. This is determined by reviewing your monthly earning for the thirty days prior to your injury. Arizona law has established a maximum monthly wage figure that may not be exceeded ($3,920.75). You are only entitled to time lost compensation up to $3,920.75, regardless of whether you earned more than that figure in the thirty (30) days prior to your injury.
The insurance company will provide you with a notice to inform you that your time lost claim has been accepted. This will include your temporary compensation check and a form detailing how your wage was calculated. This calculated is subject to review by the ICA; if it is not calculated correctly, the ICA can disapprove it and mandate a new, correct wage figure.
Temporary compensation claims are typically paid once every two weeks until the insurance provider receives notice from your doctor that you are no longer in need of treatment. Permanent compensation, for permanent injuries, is handled differently. Your doctor must determine the percentage of your impairment, which is then categorized as being either a scheduled or an unscheduled permanent injury. Scheduled permanent injuries are to a certain body part, such as an eye, hand, arm, foot, etc. All other permanent injuries that do not fit a scheduled injury description are considered unscheduled (these are often occupational diseases). To learn more about how these injuries are compensated and how payments are calculated, visit this page.
5. How much time do I have to file my claim? What are the stages of the claims process? What should I expect?
Two divisions within the Arizona Industrial Commission handle the claims process, by monitoring activities of insurance carriers and deciding disputes: the Claims Division and the Administrative Law Judge (ALJ) Division.
The Claims Division is responsible for regulating the insurance carriers and self-insured employers that process claims filed by injured workers. The Claims Division works to guarantee workers' compensation claims are handled in accordance with state laws. Typically, the Claims Division will receive claims from physicians working with injured workers or the injured workers themselves, and then works with the insurance carrier or self-insured employer to process the claim. At this point, the claim is transferred to the insurance carrier or self-insured employer.
The ALJ Division resolves the legal disputes involved with workers' compensation cases. The Hearing Division of the ALJ receives referrals from the Claims Division for hearing requests from parties involved in a workers' compensation claim.
6. If I am not happy with the determination, how do I appeal?
If you are not happy with the determination of your employer's insurance provider in regards to your claim, you have ninety (90) days from the time you receive notice of the determination to file a request for a hearing with the Industrial Commission. You must do this in the form of a letter or via the following form. You or your legally authorized representative must sign your request for a hearing.
The Industrial Commission will send you a notice of when a hearing before an Administrative Law Judge will be set.
Failing to file a request for a hearing within the ninety (90) day period will render the decision of your employer's insurance provider final.