Workers’ Compensation in Arizona provides critical benefits to people who are injured or disabled while working. An injury can lead to a partial or full disability that is temporary or permanent. Despite the law that lays out details like the time limits on filing claims and caps on benefits, a variety of work comp claims issues can arise, like miscalculated benefits or denied claims that must be appealed.
No-Fault Workers’ Compensation System
Arizona has a no-fault workers’ compensation system that allows injured workers to receive benefits no matter how the work-related injury or disability was incurred. That makes it sound as if receiving compensation and benefits is a straight-forward process. Unfortunately, it can be a very complicated process, from obtaining claims approvals to appealing denials.
Arizona employees who are approved for claims may be eligible for:
• Payment of a portion of lost wages
• Medical care reimbursement
• Supportive care
• Job retraining
Work comp claims issues can involve something as simple as requesting a change of physician or as complicated as an employee believing unfair claims processing practices are in play. The Claims Division of the Industrial Commission of Arizona says it makes more than 30,000 workers’ compensation claims determinations each year. The odds of a mistake being made or a claim being slow walked through the system are high.
Many Possible Claims Issues
There are many reasons that work comp claims issues develop. They include but are not limited to:
• Employer claims the injuries were caused by disobeying reasonable workplace rules and the employee disagrees
• An injury proves over time that it caused more severe medical problems than previously determined so the claim needs reopening
• A claim is denied because case reviewers decided it was a mental injury only, or some portion of an approved claim is not paid due to a mental health component
• Claimant gets an unfavorable decision from an Administrative Law Judge (ALJ) who has reviewed a denied claim per appeal
• Benefits end before the employee is physically ready to return to work
• A condition due to a workplace incident develops over a period of time, making it more difficult to prove cause-and-effect, i.e. exposure to a chemical
• Disagreement over what should be included in the employee’s earnings amount used for determining the value of the claim
• Questions as to whether the employee was really traveling to a jobsite when an accident occurred
• Employee’s chosen physician does not agree with the physician the employer required the employee to see for the first medical examination
• Insurance company requires an Independent Medical Examination (IME) that appears to be for the purpose of limiting benefit amounts
This is just a short list of the types of work comp claims issues that an employee may experience.
Get Legal Help to Settle Issues
Thousands of work comp claims issues in Arizona lead to the need to consult with an attorney. When temporarily injured or permanently disabled, it is stressful to have to deal with the workers’ compensation claims process. This is especially true when the state or employer creates a risk of being unable to continue paying bills or support a family. For people who are injured on the job, consulting an attorney can mean getting the full benefits allowed by law.
Professional Insurance Strategies
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