17 Nov 50 Ways for Your Arizona Workers’ Compensation Claim to Be Denied (and what to do about it).
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)
- Off site injury
- Pre-existing condition
- Independent Contractor
- Failure to Forthwith Report
- Late Reporting
- Un-witnessed event
- Late Filing
- Domestic servant
- Motion picture employee covered by 23-909 exemption
- Real Estate licensee covered by 23-910 exemption
- Out of state worker covered by 23-904(C)
- Employer does not regularly employ anyone
- Opted out of comp system
- Self inflicted injury
- Violation of Rule
- Misconduct interrupting course of employment
- Wrong employer
- Idiopathic condition
- Not an unusual, extraordinary, unexpected stressor for mental condition
- Stressor not a substantial contributing factor to mental condition
- Stress or exertion not a substantial contributing cause to heart injury
- Hernia fails 23-1043 test
- Abandonment of work by intoxication
- Going/coming to work
- Illegal Conduct
- Valley Fever
- Failure to report significant exposure (to body fluids)
- Not dependent on decedent (death benefits)
- Election of remedy – tort lawsuit
- Failure to notify carrier of employment: Not covered by policy (PEO)
- No coverage (policy lapse, etc.)
- Improper Jurisdiction
- No contract for hire
- Personal Assault (no work friction involved)
- Deviation from business trip
- Personal comfort by unreasonable method or great deviation
- Horseplay
- Off premises recreational/social activity not sponsored or encouraged by employer
- HIV fails 23-1043.02 test
- Hepatitis C fails 23-1043.03 test
- MRSA fails 23-1043.04 test
- Bad Faith
- Unexplained injury at time/place outside course of expected work duties
- Lent employee
- Volunteer worker
- Refusal to attend a medical evaluation
- Claim not filed until after being terminated
- Refusal to grant a “recorded” statement
- Refusal to sign a “medical release” to access medical records
- 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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