Arizona Workers Compensation Claims: Eligibility, Filing and Appeals

Arizona law requires employers to purchase workers compensation insurance for all employees. Employers are required to have insurance even if they only have one employee, or if the employees are family members. Sole proprietors are not required to have worker’s compensation insurance but they can purchase an optional plan. Domestic workers, independent contractors and casual employees are not covered. Volunteer police, firemen and health care workers are considered to be employees under workers comp laws and are covered.

Employees can voluntarily opt out of worker’s compensation insurance by making a request in writing, which the employer will then submit to the insurance company. Employers cannot require or otherwise suggest that employees should opt out of the insurance program.

A Special Fund was also created in 1969 to protect workers whose employers did not have adequate insurance. The Special Fund will pay out claims to injured workers and attempt to collect money from employers.

Work Related Injuries in AZ

Workers compensation in Arizona covers accidents arising “out of and in the course of employment.” This includes injuries that occur by accident arising out of the job while working. It also includes injuries caused by willful harm by a third party, if the harm was directed at the employee because of the occupation. Finally, it includes occupational diseases that are caused by a particular trade or job. The disease must be a natural result of the work or exposure to working conditions.

Arizona Workers Compensation Claims Process

To file a claim, you must notify your employer as soon as you are  injured and obtain a referral to a licensed doctor or medical facility approved by the insurer. Once you have arrived at the doctor’s office, you and your doctor should complete the Worker’s and Physician’s Report of Injury as part of your exam.  Your employer can provide you with the form or you can obtain a copy from the Industrial Commission of Arizona. 

Once you and your doctor have filled out the paperwork, it should be mailed immediately to the Industrial Commission of Arizona and to SCF Arizona. They will review your claim, request additional information if necessary, and send you a letter detailing your approved benefits, if any.

Workers Compensation Claim Denials

 Claims may be denied for a number of reasons. The most frequent reasons for denials are improper filing of paperwork, failure to file claims by deadlines, and insufficient proof that the injury arose out of the course of employment.

How to Appeal an Arizona Workers Comp Denial

The claims division of the Industrial Commission of Arizona makes the initial decisions regarding approval or denial of claims. If you wish to appeal a decision made by the Claims Division, you can file an appeal with the Industrial Commission and have your case heard by an Administrative Law judge. You can request a hearing to appeal a decision by filling out a Request for Hearing Form available on the Industrial Commission website or from your employer. Hearings are usually scheduled within 90 days of receiving notice of appeal.

If you disagree with the decision of the administrative law judge, you have 30 days to file a written Request for Review. If you file a written request for review, the Administrative Law Judge division will evaluate your request and either grant or deny the review. If you don’t file a Request for Review within 30 days, you will lose the opportunity to do so and the decision will become final.

Collecting Workers Compensation Benefits

Arizona Workers Compensation benefits include medical costs and expenses. Some medical procedures require pre-approval. You are also entitled to lost wages if you miss more than 8 calendar days of work as a result of your injury. Lost wages are based on a percentage of your average monthly wage and cannot exceed State maximums, which were set at $3000 a month, as of 2008. Temporary disability benefits are fixed at 66 2/3 percent of your average wage. Permanent disability benefits and rehabilitation benefits are also available. Finally, death benefits and burial expenses can be paid to surviving dependents.

You will receive your first benefit check within 21 days of reporting the injury, and checks will be sent every 14 days thereafter. No taxes are charged on workers compensation benefits in most cases.

Hiring an Arizona Workers Compensation Lawyer

The Industrial Commission of Arizona advises injured workers that the employer and insurance company will have lawyers present at workers compensation benefits hearings. An attorney can provide you with guidance at these hearings, and give you legal advice about evidence needed to prove your claim. Your attorney can also advise you whether to settle your case.

Arizona Workers Compensation Office Locations

Industrial Commission of Arizona
800 West Washington St.
P.O. Box 19070
Phoenix, Arizona 85005-9070

Industrial Commission of Arizona
675 East Broadway Blvd.
Tucson, Arizona 85716-5342