50 Ways for Your Arizona Workers’ Compensation Claim to Be Denied (and what to do about it).

17 Nov 50 Ways for Your Arizona Workers’ Compensation Claim to Be Denied (and what to do about it).

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Posted by Weston Montrose

After filing a claim for workers’ compensation benefits with the Industrial Commission of Arizona the employer’s insurance carrier will be “notified” of the claim. The insurance company is supposed to either “accept” or “deny” the claim within 21 days of receiving the ICA’s notification. If they deny the claim, they just have to check a box declaring that the claim is denied, they don’t have to list any explanation for their denial.

 

After receiving a denial without any explanation, an applicant for benefits will often ask “Can they do that?” The obvious answer is yes, that they can do that as evidenced by the fact that they have “done that.” The better question is “why did they do that?” I have compiled the following list of explanations for “why” a claim may have been denied (please note that each of the reasons may not be ultimately justified):

 

(Sung to the tune of 50 Ways to Leave Your Lover by Paul Simon)

 

  1. Off site injury
  2. Pre-existing condition
  3. Independent Contractor
  4. Failure to Forthwith Report
  5. Late Reporting
  6. Un-witnessed event
  7. Late Filing
  8. Domestic servant
  9. Motion picture employee covered by 23-909 exemption
  10. Real Estate licensee covered by 23-910 exemption
  11. Out of state worker covered by 23-904(C)
  12. Employer does not regularly employ anyone
  13. Opted out of comp system
  14. Self inflicted injury
  15. Violation of Rule
  16. Misconduct interrupting course of employment
  17. Wrong employer
  18. Idiopathic condition
  19. Not an unusual, extraordinary, unexpected stressor for mental condition
  20. Stressor not a substantial contributing factor to mental condition
  21. Stress or exertion not a substantial contributing cause to heart injury
  22. Hernia fails 23-1043 test
  23. Abandonment of work by intoxication
  24. Going/coming to work
  25. Illegal Conduct
  26. Valley Fever
  27. Failure to report significant exposure (to body fluids)
  28. Not dependent on decedent (death benefits)
  29. Election of remedy – tort lawsuit
  30. Failure to notify carrier of employment: Not covered by policy (PEO)
  31. No coverage (policy lapse, etc.)
  32. Improper Jurisdiction
  33. No contract for hire
  34. Personal Assault (no work friction involved)
  35. Deviation from business trip
  36. Personal comfort by unreasonable method or great deviation
  37. Horseplay
  38. Off premises recreational/social activity not sponsored or encouraged by employer
  39. HIV fails 23-1043.02 test
  40. Hepatitis C fails 23-1043.03 test
  41. MRSA fails 23-1043.04 test
  42. Bad Faith
  43. Unexplained injury at time/place outside course of expected work duties
  44. Lent employee
  45. Volunteer worker
  46. Refusal to attend a medical evaluation
  47. Claim not filed until after being terminated
  48. Refusal to grant a “recorded” statement
  49. Refusal to sign a “medical release” to access medical records
  50. Claim filed on Monday after weekend (or on day after days off work)

 

It’s extremely important that a claimant file a “protest” or “request for hearing” within 90 days of the date of the denial notice. If the deadline is missed without a legal excuse, it doesn’t matter whether the denial was truly justified or not. The claim will be forever deemed denied regardless of the merits. If you believe a claim is wrongfully denied you should contact a qualified attorney or take action on your own behalf immediately.

 

Here is a link for a Request for Hearing Form:

https://azworkcomplaw.com/wp-content/uploads/2016/06/Request-For-Hearing.pdf

 

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