If you are injured while on the job or you become ill with an occupational disease due to toxins or other conditions at your job, you have the right to have your medical bills paid and to receive cash benefits through Arizona's workers' compensation program. The Industrial Commission of Arizona (ICA) oversees the workers' compensation program.
All employers in Arizona that employ one or more people, either full or part-time, are required to provide workers' compensation coverage. Employees do not have to pay anything toward this coverage. Employers typically pay premiums to an insurance company, which pays out accepted workers’ comp claims. The ICA also has a special fund to give benefits to workers when their employers have failed to secure coverage.
Most workers are eligible for benefits. In general, it doesn’t matter how you got hurt or if it was your fault. As long as your injury was caused by your work activities, you will still be eligible for benefits. (For more information, see What Injuries Aren’t Covered by Workers’ Comp?)
As soon as you get hurt on the job or become sick due to your workplace, let your employer know. Your employer will then be required to report your injury or illness to its insurance company and to the Industrial Commission of Arizona.
You also need to file a claim with the ICA by completing and submitting a claim form (Worker’s Report of Injury). Or, when you are at the doctor’s office getting treatment, you and your physician may complete a Worker’s and Physician’s Report of Injury. Your doctor’s office will typically submit this form to the ICA for you. Either way, you must make sure your claim is filed within one year of your injury.
After your claim is submitted, you will receive an acknowledgement of receipt letter from the ICA. If you don’t receive this letter within two weeks of filing your claim, you should call the Commission to make sure they received your claim. Your employer’s insurance company will make a decision about whether to grant or deny your claim for workers’ compensation benefits within about three weeks.
For your first medical visit, your employer gets to choose the doctor you see. After that, you are allowed to choose your own doctor. An exception to this is when your employer is self-insured, in which case your employer could have the right to direct which doctor you see on a continual basis. To be self-insured, your employer must meet certain financial criteria and obtain approval from the ICA.
Workers' compensation covers all reasonable and necessary medical treatment related to your work injury or illness. Your doctor will bill your workers' comp insurance company directly, so you shouldn’t have to pay out of pocket for medical care.
In addition to medical coverage, injured workers can receive benefit payments for lost wages and for permanent disabilities.
If you are unable to work for longer than a week due to your injury, you are eligible to receive compensation for the wages you have lost. These are called time lost benefits. Your doctor must certify that you are unable to work due to your injury.
Time lost benefits are two-thirds of your average monthly earnings, based on your 30 days of work before the injury. However, Arizona law establishes a maximum monthly benefit. For 2017, the most you can receive is $4,521.92 per month. This is considered temporary compensation, to last only while your doctor is actively treating your injury.
Once your doctor says you can work, you’ll get a letter from the insurance company, called a Notice of Claim Status, telling you the date your doctor said you can return to work. If you return to light duty or other modified work, and you are earning less than you normally do, you can continue to receive time lost benefits. They will be two-thirds of the difference in your earnings, subject to the same maximum mentioned above.
Once your doctor finds that your condition is stationary—in other words, it is not expected to improve any further—your doctor will assess you to see if you have a permanent disability. If you do, your doctor will assign a percentage of disability. Along with your age, work and education history, and earning capacity, this percentage will typically determine the rate of your compensation. Certain injuries, such as facial scarring, loss of teeth, or loss of a limb, will be paid at rates determined by law (as opposed to your doctor’s determination). For the details on what type of permanent compensation will be paid in your case, see our article on permanent disability payments for Arizona workers' comp claims.
If your claim is denied or if you disagree with the amount of compensation awarded, you have 90 days to file a request for a hearing. To do so, you must complete and submit a hearing request form to the ICA. You can also simply write a letter to the ICA requesting a hearing and stating the reason for your request.
After you file a request for a hearing, you will receive a letter from the ICA with the date and time of your hearing. You will normally wait about three months to have a hearing before a workers’ comp judge. This is so you and your employer can gather evidence and prepare your case. In some cases, there may be more than one hearing held before a decision is issued.
Sometimes the administrative law judge (ALJ) will arrange a prehearing conference before the hearing itself. Normally a prehearing conference takes place over the phone. The purpose is to talk about issues in the case, who may testify, and other required procedure. If you fail to participate in this call, your request for a hearing may get dismissed.
Your hearing will be held in a room at the ICA offices or another government building. In addition to you and the judge, the following people will be present: your employer’s lawyer, a court reporter, and sometimes a representative of the insurance company. Witnesses usually have to wait outside the room until it is their turn to testify.
After introductions the judge will let you speak and might ask you some questions. The employer’s lawyer might cross-examine you as well as your witnesses. Usually any doctors who testify do so by telephone. Sometimes you might be allowed to participate by phone, too, but you have to check with the judge’s office beforehand to find out if this is possible. Your employer’s lawyer will also talk and ask questions of witnesses, and you will have the chance to cross-examine those witnesses.
You can expect to receive a written decision from the judge within a month or two after the last hearing is held in your case and the last papers are filed by you or your employer.
If you are unhappy with the judge’s decision, you have 30 days from the date the decision was mailed to you to appeal the decision. You will need to file a Request for Review with the judge’s office. The judge’s original decision will include details on how and when to file your request. If you don’t file a Request for Review, the decision becomes final.
The judge will reconsider his or her decision and either affirm the decision or issue a new decision. If you are not satisfied with the judge’s final decision, you may file an appeal with the Arizona Court of Appeals. You must file a Petition for Special Action with the court within 30 days.
You are not required to hire a lawyer, but you may want one. Your employer will have an attorney, and it can be difficult to understand the complex laws and procedures you will have to follow. You can fill out an evaluation form on our website to find a local workers’ compensation attorney. (For more information, see Do I Need a Lawyer to Get Workers’ Compensation Benefits?)
If you decide to represent yourself, call ICA and ask for a copy of the hearing procedure rules. The ICA also has an Ombudsman Office that is available to assist you with any questions you may have. You can reach the Ombudsman’s Office at (602) 542-4538 or (800)544-6488.