An amputation compensation claim is one of the most serious workers’ compensation cases an injured Arizona employee can bring. Whether the loss of limb came from an industrial accident, a construction site incident, or a manufacturing-line injury, an amputation has lifetime consequences for both your ability to work and your daily life.
An amputation compensation claim in Arizona can pay for all medically necessary treatment — including prosthetics — plus scheduled or unscheduled monthly wage benefits and long-term retraining like vocational rehabilitation.
A Matt Fendon Law Group workers’ compensation attorney can help you pursue every category of benefits you are entitled to.
Our workers’ compensation lawyers offer dedicated client service to injured and disabled workers. Founding attorney Matt Fendon is board-certified in workers’ compensation law, giving our firm the knowledge and experience to tackle the most complex cases.
If you are living with a disfiguring work injury, let us help you pursue the full workers’ compensation benefits you are entitled to so you can focus on your recovery and rebuild your life.
Call us at (800) 229-3880 or use our online contact form to schedule a free consultation.
What Workers’ Compensation Benefits Are Available For an Amputation Injury?
If you have an approved claim for a work-related amputation injury, then Arizona workers’ compensation will cover the cost of all your medically necessary treatment. This includes emergency room visits, inpatient hospital stays, surgery, outpatient medical visits, prosthetic limb replacement, and prescribed medications.
Long-term medical care and needed forms of therapy can also be part of your medical expenses, for which workers’ compensation will pay your medical bills.
In addition, when your amputation keeps you from working, you can receive workers’ compensation benefits to compensate you for at least some of your lost earning ability. Arizona workers’ compensation categorizes these benefits as scheduled or unscheduled.
Scheduled Workers’ Compensation Benefits
Arizona Revised Statutes (ARS 23-1044(B)) lists certain body parts like arms, legs, hands, feet, eyes, hearing, fingers, thumbs, and toes as “scheduled” injuries. This means that these injuries are specifically provided for in the statute.
Scheduled awards are straightforward and finite; you get a fixed period of benefits defined by Arizona law. Each scheduled body part has a predetermined value, which is measured in how many months of compensation you can receive for it. For example, losing a major or “dominant” arm is valued at 60 months of benefits, while a leg amputation provides 50 months of benefits.
For a scheduled injury, your monthly payment is calculated as a percentage of your average monthly wage (AMW). The applicable rate depends on the nature of your loss and whether you can return to the work you were performing at the time of the injury:
- 55% of your AMW for a total loss — such as the full amputation of a scheduled body part — paid for the full number of scheduled months.
- 50% of your AMW for a partial loss of use, paid for the proportion of the scheduled months that matches your impairment percentage. For example, a 40% loss of use of a leg pays at 50% of your AMW for 40% of the 50 scheduled leg months (20 months).
- 75% of your AMW if you are unable to return to the work you were performing at the time of injury because of the total or partial loss of use. This higher rate is set out in A.R.S. § 23-1044(B)(21) and recognizes the greater wage impact when the injury prevents a return to your prior job.
Because most workplace amputations are total losses of a scheduled part, the 55% rate is the most common starting point — but if your amputation prevents you from returning to your pre-injury job, you may be entitled to the 75% rate instead.
Unscheduled Injuries
If your injury is not on the statutory schedule, or if you have multiple injuries to more than one scheduled body part, this is classified as an “unscheduled” injury under Arizona law. Amputations can become unscheduled if they are combined with other injuries.
- For example, if you lose a leg and injure your back in the same accident, this would be treated as an unscheduled disability (because back injuries aren’t scheduled).
- Also, having two or more separate scheduled impairments, like an arm and a foot, generally renders the overall disability unscheduled.
Unscheduled awards are more complex to calculate than scheduled injuries. Instead of for a predefined period, your compensation is based on your loss of earning capacity (LEC). This considers how your permanent injuries affect your long-term ability to earn a living.
For unscheduled injuries, the Arizona Industrial Commission (the ICA) may examine factors like your age, education, work history, and the job market to decide if you can earn wages after your amputation. If you lose earning capacity because of the injury, you can receive monthly benefits equal to 55% of the difference between your pre-injury wages and what you can now earn.
Unscheduled benefits have no fixed end date. Your unscheduled compensation can continue for the rest of your life, subject to periodic reviews, as long as your earning capacity remains reduced.
If, however, you fully recover your earning ability in an unscheduled case or otherwise can earn the same as you did before your injury, then no ongoing permanent compensation is paid.
Amputation and Permanent Impairment Ratings
A permanent impairment rating is the centerpiece of any amputation compensation claim. After you complete your active medical treatment and reach maximum medical improvement (MMI), your doctor will evaluate any lasting loss of function from your injury.
A permanent impairment rating is a percentage that represents how much permanent damage or loss of use of a body part, or of your whole person, is because of your work injury.
- For example, a 100% impairment of an arm because of an amputation means no use of that arm.
- A 50% impairment means half your normal function is lost. This rating does not directly measure how the injury affects your job; it relates to your medical loss of function.
In Arizona, doctors use the American Medical Association (AMA) “Guides to the Evaluation of Permanent Impairment” to assess and assign your impairment percentage. The AMA Guides provide a consistent method for measuring impairment for each body part and, if needed, converting it to a whole-person impairment.
Your treating physician must issue a final report detailing your rating and how it was calculated, then provide this to your employer’s workers’ compensation insurance carrier and the ICA. In some cases, the insurer can require you to see another doctor in an independent medical examination to obtain a second opinion on the rating.
Your impairment rating is a key factor in calculating your permanent disability benefits.
- For scheduled injuries, your rating determines what fraction of the scheduled award you receive. For example, if your leg is 50% impaired, you get half of the full leg award (half of 50 months = 25 months of benefits).
- If you receive a 100% impairment from an amputated leg, then you get the full scheduled award for that leg (50 months).
- For unscheduled injuries, any non-zero impairment rating qualifies you to be evaluated for ongoing disability benefits based on your earning capacity. The exact percentage depends on how the impairment translates into work restrictions and wage loss.
Prosthetic Coverage Under Arizona Workers’ Compensation
When you suffer a work-related amputation, workers’ compensation insurance must pay for your initial artificial limb as part of your medical benefits. You pay no deductibles or co-pays for this device. Arizona workers’ compensation also covers prosthetic repairs, maintenance, and replacements when medically necessary.
Upgraded prosthetics, like a microprocessor-controlled knee or a more advanced prosthetic hand, may be covered if they are reasonably required to improve your ability to function.
Beyond the prosthetic device itself, workers’ compensation will cover maintenance and training related to prosthetics. This can include physical therapy or occupational therapy to learn how to use the prosthetic, follow-up appointments for prosthetic adjustments, and replacement of liners, straps, or other components as they wear out.
Lifetime Workers’ Compensation Medical Benefits for Amputees
In Arizona, an accepted workers’ compensation claim provides lifetime medical benefits for all reasonable and necessary care related to your work injury. Arizona provides lifetime medical benefits as long as the treatment remains reasonably required under ARS 23‑1062(A).
Lifetime benefits include ongoing needs such as prosthetic replacements, treatment for complications that may arise (e.g., infections in the residual limb), physical therapy or rehabilitation, pain management, and any future surgeries that might be required. All such care is covered at 100%, so you have no co-pays or shared costs for approved medical care.
Supportive Care
Generally, once you reach maximum medical improvement and your condition is not expected to improve further, your claim might be closed for active treatment with a finding of permanent disability. If this happens, then in Arizona, doctors can request supportive medical care for serious injuries like amputations.
Supportive care is a maintenance regimen. It can include yearly specialist evaluations, ongoing pain or phantom limb medications, periodic physical therapy to maintain function, and device replacements. This kind of necessary care can continue throughout your life.
How to File For Amputation Claim Benefits Through Arizona Workers’ Compensation
Here are the steps necessary to get started with your Arizona workers’ compensation benefits claim.
- Notify your employer. In the case of amputations, your health should be your top priority. Next, you must notify your employer as soon as possible about the accident. Your employer should, in turn, inform their insurance carrier and the Industrial Commission of Arizona (ICA).
- Seek medical help. In addition to emergency first aid, you will need to see a doctor regularly. Be sure to attend all medical appointments and follow the doctor’s recommendations. Your doctor will write up a medical report of the incident. This document will be useful in case of disputes.
- Fill out and file claim forms with the ICA. To formally launch your claim, you must fill out two forms. The first one is the Worker’s and Physician’s Report of Injury, which you can usually find at your doctor’s office. The second form is the Worker’s Report of Injury. Both these forms must be filled out accurately and adequately. Don’t forget to file them with the ICA.
What if Your Amputation Injury Claim Gets Denied?
Not all initial workers’ compensation benefit claims are approved. Amputation claims often require extensive and expensive long-term treatment, which can incentivize an insurance company to look for ways to minimize or even deny your workers’ compensation claim.
- For example, the insurance carrier might argue that some treatments, such as therapy or a subsequent surgical procedure, are not medically necessary.
- Or, the insurer might propose a cheaper prosthetic model than the one your doctor recommends, or argue that a requested replacement is too soon.
- The insurer may also periodically send you for an independent medical exam to see if it can declare that you no longer need certain treatments.
If this happens, then you have the right to challenge the denial.
Sometimes your attorney can negotiate with the insurance company to resolve the denial. If negotiation fails, you can request a hearing before the Industrial Commission of Arizona, where an Administrative Law Judge will decide whether the prosthetic or upgrade is medically justified.
If you are not satisfied with the results of your ICA hearing, you can also appeal to the Arizona Court of Appeals.
Get Help From Matt Fendon Law Group
If you suffered a work-related amputation, you may be entitled to substantial benefits through the Arizona workers’ compensation system. But pursuing an amputation compensation claim can be frustrating, time-intensive, and full of red tape.
Working with a knowledgeable Arizona workers’ compensation attorney is one of the best ways to make sure the insurance company treats your claim fairly.
The attorneys at Matt Fendon Law Group can help you pursue the benefits you need to take care of yourself and plan for the future.
Call us at (800) 229-3880 or contact us online today for a free consultation with an experienced workers’ compensation lawyer.
