Yes, Arizona workers’ compensation generally pays for medical bills.
The Arizona workers’ compensation system covers two main areas: partial wage replacement for lost wages when you have been injured on the job and coverage of medical bills connected with reasonable medical treatment for the injury or illness that you have experienced at work.
In this article, our workers’ compensation attorneys at Matt Fendon Law Group focus on the second of these two workers’ compensation benefits: how your workers’ compensation claim pays for your medical expenses.
We will take a detailed look at:
- Which medical treatments workers’ compensation provides coverage for
- Considerations that go into your choice of a treating medical professional
- How Arizona workers’ compensation decides what medical treatments are reasonably required
- How your medical bills are processed under workers’ compensation
- What to do if your medical bill is delayed, disputed, or denied
How Matt Fendon Law Group Can Help With Your Workers’ Compensation Medical Bills
Matt Fendon Law Group provides workers’ compensation advocacy services to injured employees in Phoenix, Prescott, Scottsdale, Flagstaff, and Tucson, Arizona. Since 2008, our attorneys have fought for workers in tough situations due to injuries on the job. We provide comprehensive legal representation for those who need aid from workers’ compensation.
The Arizona Board of Legal Specialization has certified our founding attorney Matt Fendon as a specialist in workers’ compensation law. This certification process is rigorous and requires special knowledge, skill, and proficiency. Our legal team has extensive experience handling workers’ compensation cases, including problems with medical treatment billings.
With five offices across the state, one of our workers’ comp attorneys can work with you regardless of where you are in Arizona.
Contact our law firm toll-free at (800) 229-3880 or fill out our online contact form.
Who Chooses Your Doctor in an Arizona Workers’ Compensation Claim?
Most Arizona injured workers may choose their medical provider. But your employer may designate an employer-approved doctor to conduct one examination of you to determine the nature and extent of your injury.
According to the ICA, after that one employer-designated visit, you generally may select another provider. If you voluntarily return to the employer’s doctor a second time, then doing so can make that doctor your attending physician.
Certain private employers, whether insured or self-insured, operate under ARS 23‑1070, which allows an ICA‑approved directed‑care arrangement. These employers may require you to use contracted medical providers.
If you are unsure whether your employer is authorized to direct care, contact the ICA Claims Division for verification.
Once you have selected your attending physician, you should stay with that doctor. Under ARS 23-1071(B), changing your attending physician generally requires a referral from your current attending physician, written approval from the carrier, or approval from the ICA after a written application.
The ICA may authorize a change from your attending physician when:
- Your current care endangers or impairs your health or recovery
- The physician agrees or is unavailable
- The existing relationship makes progress unlikely
- Your recovery may be expedited
- The workers’ compensation insurance carrier agrees
If you are under directed care, then ARS 23-1070 permits the ICA to order a physician or treatment change when there is reasonable ground to believe your employer-provided care is endangering or impairing your health, life, or recovery.
What Medical Treatments Does Workers’ Compensation Cover?
For workers’ compensation to cover medical costs, they must be reasonably required at the time of your injury and during your disability. After you provide notice to your employer of a workplace accident or injury, under Arizona Revised Statutes (ARS) Section 23-1062(A), you are entitled to receive medical, surgical, and hospital benefits and other reasonably required treatment.
Workers’ compensation insurance carriers and self-insured employers must provide these benefits without waiting for a separate award from the Industrial Commission of Arizona (the ICA).
What Does “Reasonably Required” Mean in Arizona?
Arizona also uses evidence-based treatment guidelines to evaluate medical necessity for workers’ compensation medical treatment. The ICA has adopted the Official Disability Guidelines—Treatment in Workers Compensation (ODG) as its standard reference for accepted body parts and conditions. Care the ODG recommends is generally presumed to be reasonable, but your employer or its workers’ compensation insurer can challenge this presumption.
The ODG does not create an absolute treatment ceiling. Furthermore, if the ODG does not cover a particular medical treatment, the absence of coverage does not by itself mean that a workers’ compensation insurance company can deny payment for it.
A health care provider may support departure from the ODG by producing documentation and justification that shows, by a preponderance of credible medical evidence, including clinical expertise and judgement, that a medical basis for the different treatment exists.
When the ODG supports a requested service, the insurance company generally may deny it only by rebutting the presumption with a medical or psychological opinion or another significant medical or psychological reason.
Under ARS 23-1062(A), Arizona’s statutory definition of what constitutes medical, surgical, and hospital benefits includes:
- doctor visits
- nursing care
- medicines like prescription medications
- surgical supplies
- crutches
- prosthetic devices
- any other apparatus or treatment reasonably required because of your industrial injury, like physical therapy or other rehabilitation services
Necessary translation services are also included in what workers’ compensation covers, and reasonable travel expenses are reimbursable when you must travel more than 25 miles from home to obtain injury-related care.
Depending on your work-related injuries and supporting medical evidence, covered treatment services may include:
- Emergency-room care, hospital services, physician visits, prescriptions, braces, crutches, and splints.
- Diagnostic testing, specialist evaluations, surgery, physical or occupational therapy, medications, durable medical equipment, and follow-up treatment when reasonably required.
- Supportive medical maintenance after your condition becomes medically stationary, and when continuing care is authorized to maintain that condition.
- Reasonable and necessary diagnostic testing associated with a petition to reopen a previously accepted claim, subject to Arizona’s reopening rules.
Do I Need to Miss Work for Workers’ Compensation to Cover Medical Bills?
You do not need to miss work to qualify for payment of necessary medical treatment. The ICA distinguishes a medical-only claim, in which medical expenses are paid but temporary disability compensation is not owed, from a time-loss claim, in which you may receive medical benefits and disability payments.
Arizona law requires you to report the accident and injury to the employer “forthwith,” meaning promptly under the circumstances. Employers cannot refuse to report a valid workplace injury or illness to the ICA.
Once notified, your employer must provide the name and address of its workers’ compensation carrier, policy number, and expiration date and must report the accident to the carrier and ICA within 10 days.
After the ICA notifies the carrier, the carrier ordinarily has 21 days to accept or deny your workers’ comp claim, although this rule does not apply if you miss seven or fewer days from work.
If the carrier fails to issue a denial within the 21-day period, then ARS 23-1061(M) requires immediate payment as though the claim were accepted, including medical benefits, until a denial is issued.
On an accepted medical-only claim, your medical bills continue to be paid until your treating doctor determines that further treatment is no longer needed or your claim is otherwise lawfully closed.
Is Prior Authorization Required to Pay Medical Bills?
Preauthorization is not required to ensure workers’ compensation coverage for your reasonably required medical treatment or services, although a medical provider may still use the ICA Medical Treatment Preauthorization Form to obtain a decision on whether treatment is reasonably necessary before delivering a disputed or costly service.
The insurance company generally must respond in writing within seven business days by approving, partially denying, denying, identifying an incomplete request, or notifying the provider that an independent medical examination (IME) has been requested.
If the workers’ compensatrion insurer timely requests an IME, then the decision period is suspended until the IME report is received, after which the insurer generally has seven business days to decide.
If the insurance company does not respond on time or denies ODG-supported treatment without an IME, then the treatment provider or you may be able to proceed directly to ICA administrative peer review.
Emergency Medical Treatment After an Arizona Workplace Injury or Illness
Emergency care often occurs before the insurance carrier has accepted your claim.
You should not postpone an emergency room visit or urgent care initial treatment while waiting for a claim decision. At the emergency room, urgent-care facility, or doctor’s office, you should state clearly that the injury happened at work and provide the employer’s information. This includes the worker’s portion of the Worker’s and Physician’s Report of Injury, commonly called Form 102 or the “pink form,” or separately filing a Worker’s Report of Injury, Form 407.
Because the statutory rule protecting you from responsibility for a medical bill expressly applies to an accepted claim, you should not ignore invoices received while the claim is pending. Provide the medical service provider with the insurance company name, claim number if available, adjuster contact information, and a copy of the claim-acceptance notice when issued. Ask the provider to submit or resubmit the emergency bill to the workers’ compensation insurer.
For a previously closed claim, Arizona’s emergency rule applies only when a true medical emergency prevents filing a petition to reopen before surgery, and it covers the surgery performed within seven days before filing.
If your claim is reopened, then you may receive payment for other reopening-related medical, hospital, or laboratory expenses incurred within 15 days before filing.
Future Medical Care and Arizona Workers’ Compensation Settlements
When you become medically stationary, you may still receive authorized supportive care. You can reopen a previously accepted claim for a new or undiscovered condition with a physician’s report, unless you waived your reopening rights in a qualifying settlement.
What Goes Into Settling Your Workers’ Compensation Claim?
Under ARS 23-941.01, parties may settle all or part of an accepted claim. You can generally negotiate a full-and-final settlement after a temporary disability has ended through a final Notice of Claim Status, ICA award, or stipulation.
- The settlement agreement must be a signed document that outlines the medical conditions, anticipated future medical care, projected costs, calculation method, and allocation for future medical benefits.
- Your settlement must also address known medical liens and unpaid charges and reasonable protection of Medicare, Medicaid, Indian Health Service, and U.S. Department of Veterans Affairs interests. You must acknowledge that money allocated to future industrial treatment should be set aside to pay these costs.
If you have legal representation and satisfy the statutory requirements, the administrative law judge (ALJ) will approve the agreement. An unrepresented worker must appear for a hearing at which the ALJ conducts a detailed inquiry into the released rights, calculations, and responsibility for future treatment costs.
A qualifying full-and-final settlement can waive future benefits and the right to reopen, so projected surgeries, medications, supportive care, equipment, and Medicare considerations should be evaluated carefully before signing.
Who Pays for Workers’ Compensation Medical Bills in Arizona?
The treating provider generally bills the insurance carrier, self-insured employer, or claims-processing representative instead of you. There are typically no deductibles or co-pays for authorized medical bills.
ARS 23-1062.01(D) states that as an injured worker, you are not responsible for any portion of a medical bill for services rendered on an accepted claim, nor for any disputed amount between the healthcare provider and the insurance carrier.
On an accepted claim, the insurance company must decide whether to pay or deny the bill, in whole or in part, within 30 days after acceptance if the bill arrived before acceptance, or within 30 days after receiving a later bill. The approved portion must then be paid within 30 days after the payment determination.
According to the ICA’s annual fee schedule update (effective May 1, 2026), maximum reimbursement values apply unless a separate contract governs the charge. Provider coding, fee-schedule reductions, and contractual-rate disputes are ordinarily matters between the provider and the insurer.
If your employer is uninsured for workers’ compensation, you may file a workers’ compensation claim with the ICA, and the ICA Special Fund may provide medical and indemnity benefits after investigating and accepting the claim. Arizona also permits you, in appropriate circumstances, to pursue a civil action instead of Special Fund benefits.
What Should You Do If You Receive a Bill That Workers’ Compensation Should Have Paid?
Occasionally, a treatment provider will send you a medical bill that your employer’s insurer should have received. If such an event happens, here are the steps to take:
- Confirm whether the claim and relevant body part have been accepted. Review the Notice of Claim Status and any later closure, supportive-care, or body-part notices. A bill may remain unpaid because the entire claim, a particular diagnosis, or the requested treatment is disputed.
- Contact the treatment provider’s billing office and the insurance claim adjuster. Provide the ICA claim number, carrier claim number, employer information, date of injury, and adjuster contact details. Ask the provider to stop billing you and submit the bill to the correct payer.
- Send the bill to the carrier in writing, and also request the reason for nonpayment. Keep the invoice, medical report, explanation of review, correspondence, and proof of delivery. If you already paid an accepted injury-related expense, the ICA advises sending the receipt to the insurance carrier for reimbursement.
- Use the appropriate ICA procedure if the problem continues. The Medical Resource Office offers an informal payment-dispute process, although this program does not apply to hospital or ambulatory-surgical-center fee disputes.
- Assume that a billing complaint means you must still meet any separate protest deadline. If the underlying claim or treatment was denied by a Notice of Claim Status, then you should use the Request for Hearing process and comply with the stated deadline.
An experienced workers’ compensation attorney, such as one from Matt Fendon Law Group, can help you handle a situation when you receive a treatment bill.
What Are Insurance Company Grounds to Deny a Medical Disability Benefits Claim?
Treatment directed mainly to an unrelated condition may be denied. Disputes commonly arise over whether your diagnosis is part of the accepted claim, whether continued treatment remains reasonably required, whether a procedure is medically appropriate, or whether your claim has been closed.
A denial must have reasonable justification.
To reduce the risk of denial, your medical provider’s records should explain the industrial diagnosis, objective findings, requested treatment, expected benefit, and relationship between the treatment and the accepted work injury.
Options When Treatment Is Denied, Delayed, or Disputed
The table below summarizes some procedures that may be available to you if your treatment claim is not approved.
| Arizona procedure | When it may apply |
|---|---|
| Request for Hearing | This procedure is used to protest a Notice of Claim Status, an award, an order, a claim denial, or another formal determination.A request challenging a qualifying notice generally must be in the ICA’s possession within 90 days. |
| ARS 23-1061(J) Request for Investigation | Use this procedure when you have been denied a benefit like medical treatment or disability payments but are not protesting a formal notice, award, or order.The ICA reviews the claim and may refer the matter for an Administrative Law Judge (ALJ) hearing. |
| Treatment-guideline reconsideration or administrative peer review | Use this procedure for eligible disputes involving preauthorization, ODG, payer nonresponse, or denied treatment for an accepted condition.A party who is dissatisfied with an administrative peer-review determination generally has 10 business days to request referral to the ALJ Division. |
| Bad-faith or unfair-claims-processing complaint | The ICA provides a signed complaint form for allegations such as unreasonable delay in authorizing or providing medical treatment.ARS 23-930 authorizes benefit penalties when the ICA finds bad faith or unfair processing. |
At an ICA hearing, medical evidence is often decisive. You may need to provide treatment records, diagnostic reports, testimony or opinions from treating and examining doctors, and evidence connecting the requested care to the accepted industrial injury.
The ICA advises that defendants ordinarily have counsel and that your attorney can address evidence, witnesses, applicable rules, and settlement considerations.
Contact Matt Fendon Law Group About an Arizona Medical-Benefit Dispute
Arizona law gives strong protection for your medical treatment after you file a claim for a work injury or work-related illness, but payment disputes can get complicated when issues like claim acceptance, medical necessity, provider choice, an IME, claim closure, or future care are contested.
Timing also matters: for example, missing a 90-day protest period or using the wrong ICA process can allow a determination to become final.
Legal assistance from an experienced Arizona workers’ compensation lawyer may make all the difference for you when:
- The carrier denies your claim or refuses to accept an injured body part.
- Emergency-room or specialist bills are being sent to collections.
- Surgery, therapy, imaging, medication, or a referral is delayed or denied.
- The employer claims it can direct your care or refuses a change of doctor.
- An IME conflicts with your treating physician.
- Your claim is being closed despite continuing treatment needs.
- You must choose among reconsideration, peer review, an ARS 23-1061(J) investigation, or a formal hearing.
- A proposed settlement would terminate your future medical or reopening rights.
If workers’ compensation is not paying your medical bills for ongoing care after an on-the-job injury, or if your treatment has been delayed, or if you are considering a settlement that affects future care, then contact Matt Fendon Law Group to speak with a Scottsdale workers’ compensation attorney. In a free consultation, a member of our legal team can evaluate your claim, explain the available Arizona procedures, and pursue the medical benefits supported by the law and evidence.
A Matt Fendon Law Group workers’ compensation attorney can review the notices and medical record, identify the correct ICA procedure, preserve your protest deadlines, obtain supporting medical opinions, communicate with the adjuster and providers, prepare the case for hearing, and analyze whether a settlement adequately accounts for anticipated future care you may rightfully deserve.
To speak with one of our Arizona workers’ compensation attorneys, call us at any time at (800) 229-3880, or visit one of our offices.
If you prefer, you can also reach us online to speak with a quality workers’ comp lawyer and to set up a free consultation with us.
