Arizona Workers’ Compensation Law – Disputed insurance claims harm workers. Montrose Chua, workers’ comp attorneys, explain 5 top reasons for claim disputes.
If you have an Arizona workers’ compensation insurance claim that has been disputed, rejected, and/or appealed, then you know firsthand how frustrating this can be. Even though you have suffered an injury and are in need of benefits, you’ve found that the insurance company and perhaps even the Industrial Commission of Arizona consider your claim to be unsubstantiated.
There are various reasons as to why this happens and many of them are related to how the injured party has proceeded in pursuing their claim. Others are connected to the injury itself and circumstances relating to it. Here are five reasons as to why your Arizona workers’ compensation insurance claim may be disputed.
In Arizona, you have one year from the onset of a work-related accident or illness to make an insurance claim. If you miss this window of opportunity, you are out of luck. It is not only important to file a claim before the deadline, but it is essential that you submit your paperwork earlier rather than later. Late claims raise suspicions regarding the seriousness of any injury or illness.
In addition, it’s very important that your workers’ insurance paperwork is properly filled out and your form is signed. If you have concerns regarding how to fill out a form, you may contact the ICA for guidance. However, the ICA cannot give legal advice. For that you would need to contact an Arizona workers’ compensation lawyer.
Your Arizona workers’ compensation claim may be disputed if you are injured off-site. There are times when workers are covered for off-site injuries. Such as if you are in transit from the office to a meeting at another location and are injured then chances are you’ll be covered under workers’ comp. However, an injury from an accident that occurs when you are commuting to or from work would not be covered. Likewise, if you are at home doing some paperwork related to your work and you suffer some sort of mishap, it’s a good chance that injury does not come under workers’ compensation.
Although Arizona is a no-fault workers’ compensation state that does not mean that someone can automatically qualify for benefits if they have had a work-related accident. As an example, if in some manner a worker engages in misconduct, which would include injuring themselves purposefully, engaging in obviously dangerous behavior not related to their job duties, or working while under the influence, then workers’ compensation insurance benefits would be disputed and, in most cases, not allowed.
If you are injured but already have a preexisting injury to that part of the body, then you’d probably have a hard time proving that your injury was caused by an accident related to your job. A previous injury, which may flair up due to work being performed, may also be called into question. It’s standard procedure for a workers’ compensation insurance provider to check past medical records, and if there is evidence that your injury actually occurred at an earlier time or that it was not job-related, then they will dispute your claim.
One of the reasons that workers are cautioned to have their injury attended to as soon as possible has to do with the perception by insurance providers that those who delay seeking medical advice don’t have serious injuries. This may not be true, as some people will try to ride out an injury even if it is fairly serious. This is never a good idea when it comes to Arizona workers’ compensation insurance claims. It is always advisable to get medical attention as soon as possible. If your symptoms worsen, then the doctor has a baseline from which to judge your condition and make recommendations regarding compensation.
In terms of being completely healed, a worker may request that benefits be extended, however after being seen by a doctor who deems those injuries to be completely healed, that worker may see their request turned down. This decision, as might all others, can be appealed. In filing such an appeal, the worker will need to have substantial evidence to overturn the insurance provider’s decision.
Arizona workers’ compensation law is quite complex and when it comes to a disputed claim the stakes can be quite high. If you are dealing with a claim that is being questioned or has been rejected, please contact the Arizona workers’ compensation professionals at Montrose Chua, Attorneys at Law, PLLC, by calling 602-346-9009 for a free, no-obligation consultation.
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