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Workers’ Compensation FAQs

Workers who are injured on the job in Phoenix often have dozens of questions about what the process is, what their rights are, how to file for workers’ compensation, and more. Here is a look into some frequently asked questions about workers’ compensation in Phoenix.

 

  • What If I Was at Fault for My Injury? Under the workers’ compensation insurance system, employees are eligible to file a claim for workers’ compensation benefits regardless of fault. This is true as long as (a) the injury occurred at the employee’s place of employment or while the employee was performing a work-related task and (b) the employee did not cause his or her own injury as a result of intoxication or impairment from the use of an illicit substance. However, this is not to say that an employee who is intoxicated or impaired cannot recover workers’ compensation benefits; rather, it is to say that the injury sustained by the employee must have been incurred regardless of alcohol or/and drug use. For example: (based on the Arizona Supreme Court Case of Komalestewa v. Industrial Commission of Arizona) An employee is in the process of repairing a conveyor belt. During repairs, his arm becomes caught in the belt and he is severely injured. At the time of the accident, the employee had a blood alcohol content level (BAC) of 0.176 percent. However, because the employee was performing a work related task at the time of the accident, his injuries are covered regardless of his intoxication. If the task that the employee is performing has any risk, and an accident related to that risk occurs, then the employee is still eligible to file for workers’ compensation regardless of fault.

 

 

  • Do I Need an Attorney to File a Claim for Workers’ Compensation Insurance? You are not required under law to file a workers’ compensation insurance claim with the help of an attorney. However, in some cases, even claims that appear to be relatively straightforward may benefit from a legal professional. It is recommended that if you have been injured on the job, you have an attorney review your case. Your attorney may be able to demonstrate why you deserve a higher or/and different benefit amount, can help to ensure that your claim is filed in full and on time, can help you understand your rights in regards to your choice of medical care, can assist you in appealing a denied claim, can guide you through the hearing process, and more.

 

 

  • How Much Does a Workers’ Compensation Attorney Cost? Workers’ compensation attorneys charge in a variety of ways. Usually, most good workers’ compensation attorneys will charge based on a contingency fee based system. This means that your attorney will not charge you unless your case is won, making representation possible for all workers in Phoenix, not just those with extra disposable income. In a contingency agreement, you and your attorney will come to an agreement upfront about what percentage of your winnings your attorney will be entitled to when your case is settled. Usually, a claim that is settled before an appeal and a hearing will warrant a smaller percentage fee–say, 10 percent–than does a claim that goes to hearing or that requires additional appeals. An attorney who has to work on your case for multiple months, especially if your case goes to court, may recover around 25 percent of your winnings. This means that if you recover, for example, $6,000 in your workers’ compensation case, your attorney will be entitled to $1,500 of that amount. These fees range depending upon your attorney – some attorneys may charge up to 35 percent.

 

 

  • Can Workers’ Compensation Benefits Be Recovered by My Beneficiaries? If your workplace injury is not fatal, you may be able to recover benefits for your lost wages and medical expenses. While these benefits can be used to help pay for things for your children, your spouse, and other dependents, they cannot be recovered exclusively on their behalf (i.e. your child or spouse can not apply for workers’ compensation benefits on your record). However, if your injury results in death, then your surviving spouse or/and surviving children will be allowed to recover compensation on your behalf in the form of workers’ compensation death benefits. Burial expenses will be allocated in an amount no greater than $5,000, and a surviving spouse will also be entitled to up to two-thirds of your average weekly wage prior to the injury resulting in death. Benefits to a child are dependent upon the situation. For example, a spouse may be able to recover 35 percent of the worker’s lost income, and a child 31.66 percent of the worker’s average weekly wage. Or, if there is no surviving spouse, or the surviving spouse remarries, then the child will be entitled to 66.66 percent of the worker’s average weekly wage. Compensation for a child under workers’ compensation death benefits typically ends when the child reaches age 18, or age 22 if the child is in college. The exception to these rules are in the event that the child marries, benefits will be terminated, and in the event that the child is incapable of self-support, the benefits will be extended.

 

 

  • How Long Does a Workers’ Compensation Claim Take to Process? It is required under law that the Arizona Industrial Commission process a workers’ compensation claim within 21 days of receiving the claim from the employee. However, while 21 days is the amount of time that the Arizona Industrial Commision has to make a decision about the claim, this does not mean that a workers’ compensation claim will necessarily be resolved with the three week period. The resolution process may be extended if an employee delays in filing a claim (an employee has up to one year to file from the date of injury), or if the claim is denied by the Arizona Industrial Commision and the employee decides to appeal the decision. By hiring a Phoenix workers’ compensation attorney, you may be able to reduce the amount of time that your workers’ compensation claim takes to process and for benefits to be paid.

 

 

  • What If I Am Unable to Return to Work? Sometimes, an injury is so severe that it leaves a worker permanently unable to return to work. This can be devastating both for the injured worker and his or her family. However, the good news is that when a worker is injured to the point where he or she is unable to return to work in any capacity, Arizona’s workers’ compensation benefits will pay the injured worker permanent compensation benefits. There are two types of permanent injuries for which permanent payments may be issued: scheduled injuries and unscheduled injuries. The first, scheduled injuries include permanent injuries to certain body parts, such as an arm, leg, eye, foot, or  hand. If you have partially or permanently lost one of these body parts, you will receive compensation at a rate or 55 percent of your average monthly wage. In the event that the harm or loss prevents you from being unable to return to work, the amount recoverable is increased to 75 percent of your average monthly wage. The second type of injury, unscheduled injuries, refers to all other permanent injuries. For example, an occupational disease or a back injury may be considered to be unscheduled injury types. If your unscheduled injury results in total disability, you are eligible to recover compensation at a rate of two-thirds of your average monthly wage; if your unscheduled injury results in a partial disability, then you are eligible to recover compensation at a rate of 55 percent of your average monthly wage. In some cases, you may be able to receive your permanent (or partial) disability benefits in a lump sum payment rather than in monthly checks. Further, you are also eligible to recover compensation for facial scarring and loss of permanent teeth at a rate of 55 percent of your average monthly wage for a maximum recovery period of 18 months.

 

 

  • Do I Have the Right to Choose My Own Doctor? According to Arizona Workers’ Compensation law, and summarized by the Industrial Commission of Arizona, the injured employee’s first consultation with a physician must be a physician who is of the employer’s choice. After the initial consultation, however, the employee has the right to continue medical care with the physician chosen by the employer, or may seek medical care from a new physician of his or her own choosing. If you have been told by your employer that you do not have the right to be treated by a doctor of your choice, this is incorrect; seek legal counsel for help defending your right to choose your own doctor. As a note, if your employer is self-insured, then you are required to see your employer’s doctor. In this case, a change of doctor requested would only be honored in extenuating circumstances.

 

 

  • Are There Penalties for Committing Workers’ Compensation Fraud? It is very important that you tell the full truth about how you sustained your injuries, the extent of your injuries, and the degree of medical care that you require in order to pay for your injuries. In fact, if you inflate the amount of damages that you have suffered, you have committed fraud under Arizona’s laws. A person who submits a false claim or or helps someone to submit a false claim with the intent of deceiving an insurance company is guilty of a felony offense.

 

 

  • What Is the Difference Between a Medical Only vs. a Time Lost Workers’ Compensation Claim? There are two types of workers’ compensation claim in Arizona – medical only workers’ compensation claim and time lost workers’ compensation claims. Both are exactly what they sound like; the former is a claim that is filed to recover compensation for medical expenses, but not lost wages, and the latter is a claim filed to recover compensation for lost wages (although these cannot be collected unless a worker misses more than seven days of work).

 

 

  • Can Changes to My Compensation Amount Be Made at a Later Date? After a determination has been made the Industrial Commission of Arizona about an amount that you are entitled to receive under workers’ compensation insurance, changing that amount can be difficult, but is not impossible to do. You can file a petition for readjustment or petition for rearrangement of compensation. These petiton types are appropriate if the extent of your disability changes over time, and the amount of compensation that you have been allocated is no longer appropriate.

 

The above are just a few of the many questions that you likely have after you have been injured in a  workplace accident. If you have more questions that are not answered in the guide, please call an attorney for a consultation.

 

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