23 Aug Processing a Worker’s Compensation Injury Case
Sustaining an Injury and Diagnosis
If you are injured in a workplace accident, you must fill out a Worker’s compensation injury claim at once. You can do this electronically online at azica.gov here or you can print the form off from your printer and send it in by the postal service. If you do send it by mail, be sure to use either a certified process or by registered mail.
If your injuries were severe enough to go to the hospital emergency center, then you will be evaluated, get x-rays if a bone is broken or suspected to be broken, or if you injured your head, possibly fracturing your skull. In cases of severe injury with medical attention received shortly thereafter, your claim is most likely to go through immediately.
With lesser injuries, you may be seen by a doctor who could evaluate your injuries and fill out the doctor’s Report of Injury form from the same website above. While you may endure great pain, your injuries may not be as visible as a broken bone, lost hand or finger, or leg and foot.
You may be called in for an appointment with the employer’s insurance doctor which you must attend, short of being on your deathbed. Answer any questions asked by the doctor but do not offer more information not asked for, like announcing you had a similar injury 10 years before. Once this insurer doctor has made the medical evaluation and used the body part value chart for calculating your benefit amount, you will get a notice of whether your claim is accepted or denied.
Obtaining the Required Paperwork
All claims related to filing and processing your workers’ compensation claim are found at the Industrial Commission of Arizona (ICA) workers’ compensation website. If your claim is denied, go to the website, and find the Request for Hearing which you can also file online. At the same time, contact an Arizona workers’ compensation attorney to get help with your claim and to go with you to the hearing, once the appointment is made.
The Request for Hearing puts you in front of a judge who hears your case. If you have more supporting evidence to include in your case, such as copies of your employer’s CCTV video of your accident, you can present this at the hearing. Do make sure you acquired the CCTV video copies legally.
You can also provide witness statements from other workers who were present at the time of the accident. Sometimes, after an accident, further injuries may manifest but you should have your doctor review them, officially, before bringing that information in front of the judge. Your case may also require a settlement which we discuss in the last section here.
Determining the costs: How Do They Compute It?
Every year, a maximum amount for monthly benefits is provided, based on the Bureau of Labor Statistics (BLS) from the Employment Cost Index (ECI) and is supported by A.R.S. § 23-1041(D)(8) in Arizona state law. For 2022, the highest amount that can be paid in monthly benefits, based on the employee’s salary, is $5,161.12, a 2.6 percent increase from 2021, at $130.79 higher than the benefits paid in 2021.
When it comes to injured body parts, the insurance medical doctor uses the AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition, although some still use the Fifth Edition. The guide is used by the doctor to determine a percentage of an injured body part and for how long this will be paid for. One example for calculating a permanent award is provided below. You can also find a sample body part value chart here in an earlier post.
An injured worker’s monthly salary was $3,100.00 and he could not return to work for some time after the injury. He had severely injured his foot in the accident and would be unlikely to ever return to his previous job. Therefore, the doctor makes a .75 percent calculation of the salary first.
- $3,100.00 x .75 = $2,325.00 (75 percent of salary paid out)
- Injured foot at 8%, over 40 months = 3.2 months (permanent foot injury = 8%)
- 2 months x $2,325 = $7,440.00 (the award paid for the foot)
Your monthly benefits which you continue to receive, either for a recovery period until you return to work, or if it is a permanent monthly payment, are calculated in a different way. First, during recovery, you receive 662/3 percent of your working monthly salary. Therefore, if you made $3,100.00 monthly, you would receive $2,068.00 to pay rent or mortgage, utilities, food, car payment, and so on. Medical bills would be paid directly from the insurance company under workers’ compensation.
If you are not a fan of data calculations, your workers’ compensation attorney can help with determining the benefits and award amounts if your claim goes through. You may also have severe injuries that you might want to look at getting a settlement.
It is important to understand that if you wish to pursue a settlement, it will be final, and the case can never be opened again further on down the road. Therefore, when choosing to go with a settlement, the agreement looks at the current medical condition of the claimant and projects future medical treatments. If you have been offered a settlement by an insurance company for a work-related injury, consult first with an Arizona Workers’ compensation attorney to ensure you will receive the best outcome possible for your future needs.
Arizona Injury Law Group offers experienced and Certified workers’ compensation lawyers and legal services for injured workers. Call for your free consultation! 602-346-9009.