Arizona workers’ compensation is a form of employer insurance. This insurance aims to provide employees with benefits when they are hurt on the job and to protect employers from lawsuits by injured employees.
Arizona insurance companies, including those providing workers’ comp insurance, must do business under Arizona state laws that govern how they operate. These laws also establish the framework under which you, as a worker, file a workers’ compensation claim to receive medical benefits and lost wages.
The Matt Fendon Law Group specializes in Arizona workers’ compensation laws and claims. Our experienced workers’ compensation attorneys can help you know if you qualify for workers’ compensation benefits, understand what those benefits are, negotiate a settlement with a workers’ comp insurance company, and resolve any problems that arise during your claim.
To learn more about how we can help you after a workplace injury and arrange a free consultation with one of our Arizona workers’ compensation attorneys, call us at (800) 229-3880.
Here, we cover Arizona’s workers’ comp laws, who administers those laws, and how those laws affect your rights as an injured worker to receive workers’ comp benefits.
What are the Laws that Govern Arizona Workers’ Compensation?
Arizona statutes and regulations control how workers’ compensation works.
Chapter 6 of Title 23, within Article 18, Section 8 of the Arizona Revised Statutes (ARS), is where you can find the state’s workers’ compensation laws. The workers’ compensation rules are in Chapter 5 of Title 20 of the Arizona Administrative Code (AAC), starting at A.A.C. R20-5-101.
Which Employers Must Carry Workers Comp Insurance?
Unless an exception exists, all Arizona employers must carry workers’ comp insurance coverage for their employees. Employers purchase workers’ compensation insurance from insurance companies licensed to issue such policies in the state.
Employers who must have workers’ compensation insurance must provide the insurance company’s name, address, and other relevant information to any employee who informs the employer of an on-the-job injury or work-related medical condition.
Corporations, limited liability companies, partnerships, and even sole proprietors who hire employees must, unless exempted, cover their workers with workers’ compensation insurance even if they hire only one worker.
Similarly, if the employer is required to have a policy in place, part-time workers, minors, non-citizen employees, and family members must all be covered by workers’ compensation.
Does Workers’ Comp Cover Government Employees?
In Arizona, workers’ compensation covers state workers. This includes all state agency employees, including those employed by boards, commissions, and state universities. Employees of all superior courts in the state are also covered.
What are the Exceptions to the Requirement to Carry Workers’ Comp Insurance?
Arizona’s workers’ compensation law recognizes exceptions to the requirement to cover some individuals.
Members or Owners of Certain Business Entities
Members of limited liability companies, or partners in a partnership, or the sole proprietor in a sole proprietorship are not required to be covered by workers’ compensation. These individuals can choose to cover themselves through workers’ compensation. To do so, they must file a Notice of Election or Rejection.
Independent Contractors
A business that hires a worker as an independent contractor instead of as an employee is not required to cover the contractor through its workers’ comp policy.
However, businesses that hire contractors must be careful not to classify employees as contractors, accidentally or otherwise. Disputes can happen when a worker’s duties are such that under Arizona laws and regulations, that person is really an employee, even if the employment contract expressly states that the worker is a contractor.
In such disputes, a court will consider the totality of the circumstances of the worker’s duties and activities on a case-by-case basis to decide whether an employer-employee relationship exists. Several factors the court will consider include how much control the employer has over the worker’s activities, the duration of the employment, whether the worker must supply his or her own tools to do the work, and whether the employer hires people like the alleged contractor in its regular course of business.
Specifically Exempted Workers
The following kinds of workers are not subject to the workers’ comp coverage requirement in Arizona:
- Farm Workers
- Domestic workers in a home with fewer than 2 full-time employees
- Persons eligible for compensation under federal law (e.g., maritime and railroad workers).
- Employees of Tribal Nations are covered by the Tribe’s own insurance and not subject to Arizona Workers’ Compensation laws.
Employers Allowed to Self-Insure
In some situations, the employer can elect to self-insure to cover injured workers instead of having a workers’ compensation insurance policy. These businesses must comply with the following requirements:
- To become certified as self-insured, they must apply to the Industrial Commission of Arizona (the ICA) and have this application approved by the ICA.
- They must make rejection notices stating their decision not to make workers’ compensation insurance available to their workers and provide forms allowing any employee to reject the employer’s self-insured coverage.
Self-insurance is an option usually reserved for employers large enough that they can afford it.
Can a Worker Choose Not to be Covered Under Workers’ Compensation?
Although an employer may not require you to waive your right to workers’ compensation coverage or pay for any part of its insurance policy, you have the right to refuse to be covered.
- If you refuse coverage, you must do so in a signed and dated writing to your employer, and the employer must file this refusal with the insurer.
- This refusal must happen before you suffer an injury on the job or develop a work-related medical condition.
- You can rescind this refusal in writing at any time before you are hurt at work or suffer from a work-related medical condition.
What if an Employer is Required to Have Workers’ Comp Insurance But Does Not Have It?
Employers who must have workers’ compensation insurance but fail to carry a policy are subject to criminal and civil legal actions.
Criminal Liability
Under Arizona law, willfully and knowingly failing to carry workers’ compensation insurance is a Class 6 felony, punishable by fines and up to one year in prison.
Civil Liability
Failure to have a required workers’ compensation insurance policy in place can subject an employer to fines even if no worker makes a claim. The first time this happens, the fine can be $1,000. If it happens again within five years, the fine increases to $5,000 for the second violation and $10,000 if it happens a third time in the same period.
Shut-down of Business Operations
The ICA can seek an injunction through an Arizona Superior Court to require an employer required to have workers’ comp insurance but which has no policy to cease operation until it has the required coverage.
ICA Claims and Lawsuits by Employees
An employee injured at work but whose employer does not have workers’ compensation as required can file a claim with the ICA or file a civil lawsuit against the employer.
Claims with the ICA go through the No Insurance Section of that agency’s Special Fund Division. If the employee’s claim is upheld, the Special Fund Division will pay the employee’s medical bills and compensation benefits and seek compensation for the same from the employer. In addition to the reimbursement sum, the Special Fund Division will pursue an additional $1,000 or 10% of the benefits paid to the worker, plus interest, whichever is more.
Alternatively, the injured employer can file a civil lawsuit against the employer. This is an exception to the general rule that employees cannot sue their employers, who are required to have workers’ compensation insurance in the absence of willful misconduct by the employer.
Under this legal option, the worker would have to show in court that the employer was negligent in causing work-related harm to the employee, but a presumption of negligence will exist against the employer in such a civil claim.
A civil lawsuit by an injured employee can be more time-consuming and complex to pursue than a claim through the ICA. However, the potential rewards of a successful lawsuit can be significantly greater. These can include money damages for medical care expenses, lost wages, pain and suffering, and attorney fees.
What is the Claim Process for Workers’ Compensation?
If you are injured at work, Arizona workers’ compensation laws and rules establish the procedure you and your employer must follow to process the claim. These include filing requirements and deadlines that you and the employer must both observe.
Filing the Claim
You have up to one year after the date of the injury for your claim to be filed with the ICA. However, your claim could be denied if you do not notify your employer within a reasonable period of time. This is called “forthwith reporting.”
Once the employer receives your written notice of the injury, it has 10 days to notify the ICA by filing an Employer’s Report of Industrial Injury. It must also notify you of the worker’s compensation insurer information, including the insurance policy number and its expiration date.
Once the ICA has received your claim, it has 21 days to accept or deny it. If the ICA denies the claim, then you have 90 days to make a written request for an appeal hearing. If you do not meet this deadline, you forfeit your right to appeal the ICA denial.
Assessing Your Injury
Workers’ compensation covers many kinds of work-related injuries, including trauma from falls and other accidents, exposure to toxic substances, repetitive stress injuries, carpal tunnel syndrome, and more.
Arizona workers’ compensation works under a “no-fault” system. This means that you do not have to prove that your employer was negligent to file a claim; the existence of the work-related harm is sufficient to justify receiving benefits.
The employer has a one-time right to have you see a doctor of its choosing to evaluate your work-related injury or medical condition. After that, you can choose to keep seeing that doctor as your treating doctor or choose your own. Please keep in mind that if you work for an employer that is self-insured and is authorized to direct medical care, you cannot pick your doctor and have to treat within the employer’s network.
Processing Your Claim
Once the workers’ compensation insurance provider has received your claim information from the employer and the ICA has not denied your claim, the insurer will assign the claim to an adjuster. The adjuster will investigate your claim to decide whether to accept or deny it, and if accepted, will assess your compensation, and begin the process of paying the financial costs for your medical care.
Resolving Disputes, if Any
In most cases, the ICA and the insurance carrier will accept your claim. If the insurer denies your claim, it must issue a formal Notice of Claim Status denying it.
If a dispute arises about your claim, you should contact Matt Fendon Law Group as soon as possible.
What Kinds of Benefits Are Available Under Arizona Workers’ Compensation?
Depending on the nature of your injury or medical condition, workers’ compensation will pay for your medical treatment and can provide you with temporary or permanent partial or total disability benefits.
Medical Expenses
Workers’ compensation pays for all necessary medical treatment, including hospitalization, surgery, and physical therapy. This includes transportation to healthcare providers, doctor visits, prescription medications, surgeries, physical therapy, vocational therapy, hospital stays, and other medical costs.
Compensation Benefits
You may be eligible to receive benefits to partially offset your lost wages if you cannot return to work.
If, in your treating doctor’s opinion, you cannot return to work and have missed eight or more consecutive calendar days of work, then you can be eligible for lost wages payments. These can be based on:
- Temporary disability benefits. If you cannot return to work for a certain period while recovering, then temporary disability benefits replace part of your average monthly wages before you were injured. You receive these benefits until you can return to work, for a maximum of five years, depending on the severity of your injury.
- Permanent disability benefits. If you cannot return to your previous employment because of a disability, you may be able to receive permanent compensation payments for the rest of your life.
- Vocational rehabilitation benefits. These provide for education or retraining for placement in another kind of work. Please keep in mind that in Arizona, vocational rehabilitation is not mandatory.
- Death benefits. Close family members can receive death benefits if a loved one dies because of a work-related injury.
Wage loss payments will replace up to two-thirds of your average gross monthly wages, up to a maximum amount set by law. Depending on the kind of lost wages benefits you qualify for, you will receive payments every two weeks or every 30 days.
Sometimes, you can also receive $25 monthly if you have one or more dependents.
If you cannot return to work for less than 13 consecutive calendar days, then the first seven days are not compensable. If you intend to leave Arizona for more than 14 days, you must obtain permission from the ICA in advance.
Temporary disability payments do not end until you return to work or you reach your maximum medical improvement. If you are totally and permanently disabled, then you will receive permanent total disability benefits for life at the same rate you received for temporary total disability.
Returning to Work
Before you can return to work, your treating doctor must clear you to do so. Based on the physician’s report, your employer has the right to put you under work limitations, and under Arizona law, your employer does not have to reinstate you within any set time limit.
Your employer cannot fire you in retaliation for filing a workers’ compensation claim, but it can fire an at-will worker for any legal reason, so it is still possible that you can be terminated from employment as long as the reason was not retaliatory.
Talk to an Arizona Workers’ Compensation Lawyer Today
At the Matt Fendon Law Group, our Arizona workers’ comp attorneys are dedicated to giving the best service to clients with workers’ compensation claims. We will do everything we can to see that you receive the workers’ compensation benefits you deserve.
When you call on Matt Fendon Law Group for help, you will speak directly with a workers’ compensation lawyer who fully understands workers’ comp in Arizona. Our skilled and compassionate attorneys will be there for you every step of the way.
If you have been injured on the job and want to know how Arizona’s workers’ compensation laws affect your workers’ compensation claim, call us at (800) 229-3880 or contact us online to schedule a free, no-obligation consultation.
