The Workers’ Compensation system was developed to provide you with quick and adequate coverage for illness, or injuries sustained at your place of work. Under common law, workers could only claim compensation by filing a lawsuit against their employers. This was a lengthy and often expensive process and the employer had many defenses against such claims.
The system was set up to protect the worker, but you have to take responsibility to protect your rights to benefits. You cannot rely on your employer to protect your rights. Failure to meet your responsibilities could result in loss of your workers’ compensation benefits.
It is your (the injured employee’s) responsibility to make sure that the injury is reported to your supervisor/employer as soon as the incident occurs, or as soon as you become aware of the condition. Even if you think it is a minor injury, report it. Failure to notify your employer promptly may be used as a defense against your claim, if your failure negatively affected your employer’s ability to provide you with appropriate medical care, or to investigate the circumstances surrounding the incident.
Your employer should provide you with the insurance details immediately after being notified of the injury.
If your employer has a “drug or alcohol” test that you are required to take, make sure that you take the test as soon as possible, either before or immediately after emergency medical treatment. Failure to take the test might be a possible defense against your claim later on in the process. Protect your rights and ask to take the test.
See a doctor for a medical examination and treatment – you can either choose your own doctor or see a doctor recommended by the employer/carrier. Inform the doctor that this is a work-related injury.
In most cases, the doctor will be in direct contact with the ICA to get approval for your treatment, but it remains the employee’s responsibility to notify the carrier/employer and get approval for treatment and procedures. A medical emergency situation is obviously an exception. Take note: Failure to notify your employer/carrier could result in you having to pay for the treatment yourself. However, in Lasiter v Industrial Commission (1992) the court held that unless the employer has been prejudiced, the employee is entitled to compensation for all treatment that is reasonably required.
It is your responsibility to file a claim with the Arizona Industrial Commission within one year from the date of injury, or when you become aware of the condition related to the injury. Once you have filed the claim your rights are protected – even if you have no immediate problems, you will be covered should you develop any problems in the future that relates to this injury.
In the event of an accident and the injury is clear, you will know to file the claim right away. Gradual injuries develop over time and the “date of injury” is not exact. A claim for gradual injuries, such as hearing loss due to prolonged exposure to loud noise, must be filed within one year from becoming aware of the condition or being told by your doctor that your injury resulted from the condition at work.
After you have filed your claim, pay attention to any documents you receive from the ICA or from your employer or insurance carrier. It is your responsibility to ensure that you understand all the notices and documents that allows you to request a hearing for disagreements/disputes and that you adhere to the time limits set for filing such requests. Failing to note a dispute within the specified time limit will render the decision final, even if the decision was wrong. For example, failing to protest a Notice of Claim Status, denying your claim, within ninety days, will prevent you from pursuing your claim any further.
Change of address – it is the injured employee’s responsibility to inform the ICA of any change in address to which notices should be sent.
If your claim is approved, the ICA will make an “average monthly wage” (AMW) determination. This will form the basis on which your claim amount will be calculated. It is the employee’s responsibility to evaluate the accuracy of the AMW determination. If you dispute the accuracy of the AMW you have ninety days to file a written request to the Wage Section of the ICA. If you do not file a dispute, the AMW will be considered final and all your future benefits will be based on that amount.
Under the workers’ compensation system you can represent yourself, and you are not required to have a lawyer. However, you are likely to face an experienced legal team representing your employer/carrier and although you have a choice, it is recommended that you get an experienced lawyer on your side as well. Legal representation might only become important at the claims stage of the process, but it is always good to get legal advice early on in the process.
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