Workers’ compensation insurance, or workers’ comp, is a type of protective program that compensates employees if they become injured or ill on the job. This compensation also includes coverage that replaces missed income as well as paying related medical expenses. Most Arizona businesses are legally required to carry workers’ comp for their employees. However, there are some exceptions to the law for specific situations. Just as is the case with other types of insurance, activating workers’ compensation benefits requires an adherence to specific steps. The following is a breakdown of how to file a claim after a work-related injury has occurred:
How to File a Workers’ Compensation Insurance Claim in Arizona
What to Do Immediately After a Work-Related Injury: Employee
If the worst occurs and you suffer injury or illness as a direct result of your job, your first step is to report your injury. As an employee, it is your responsibility to inform your employer that you were injured as soon as possible. If you fail to do this, you can jeopardize your claim’s value. In some cases, if you fail to report your injury in a timely manner, you can forfeit your ability to receive compensation at all. The following are the details you need to give your employee:
- The exact location, date and time of your accident.
- What caused your accident.
- The symptoms or end result of your accident, the severity of your injury.
Some employers might ask you to fill out a written accident report. This can be an important piece of evidence if they decide to dispute your claim. Therefore, it’s vital that you be as accurate on this report as possible.
What to do After an Accident: Employer
After the employee has informed you as the employer of their injury, you have 10 days to fill out the Employer Report of Injury Form. You will then submit this report to the Industrial Commission of Arizona (ICA), along with your company’s insurer. Please note, this report about the accident is not in and of itself a claim. It in fact does not begin the process of procuring workers’ compensation benefits.
Acquire a Professional Medical Opinion: Employee
After you have reported the incident that occurred at your workplace to your employer, it’s now time to seek a proper medical diagnosis about your injury. You most often can see whichever doctor you want but are only legally required to go to one doctor’s visit. In some cases, you as the employee have to visit specific doctors of your employer’s choosing. Your employer should provide you will at least a variety of options to choose from. Be sure to advise any medical professional who evaluates your condition that this is a work-related injury that will be filed with workers’ comp.
The next step in the process is getting a Worker’s and Physician’s Report of Injury Form. Your doctor should provide this for you. It requires both you, the injured employee, and the physician to fill in various information. You will fill in information about the time, location and other details about your accident. The doctor has eight days after treating you to submit this completed report to ICA. One copy goes to your workers’ comp insurer and one must be sent to your employer.
The Next Step in the Workers’ Compensation Insurance Claim ProcessSet featured image
After the ICA receives all the applicable forms, your employer will be notified of your claim and you will receive a letter about the insurance carrier. If you fail to get this letter by 14 days after injury, contact ICA to check on the status of your claim. After the insurer receives your claim, they will have 21 days from the date of notification to either approve or deny your benefits. The insurance company will likely investigate the claim to ascertain if the benefits are needed for your specific injury. Workers’ comp insurers will likely complete the following steps before either accepting or denying a claim:
- Consider your ability or inability to perform work-related duties.
- Order a medical examination to further evaluate your illness or injury.
- Analyze your wages, education, and work experience at the time of your injury.
- Review all your existing medical records from both before and after your injury.
More Tips On How to Increase Your Chances of Receiving a Claim
Because paying a workers’ comp claim is very expensive, insurance companies will carefully investigate any claim for any dishonesty or inconsistencies in either your medical reports or statements. Therefore, it’s so important for you to remain 100% truthful in all your claims. Any inaccuracies on your part will likely result in your claim being denied.
What Can Prevent You From Receiving Benefits?
Workers’ comp is a no fault system in the state of Arizona. This means you can get compensation benefits, even if you are at fault for your injury. You only have to meet the eligibility requirements, of being a medical only or time lost from work claim, and you can claim workers’ comp benefits after your injury. You might also be able to receive additional compensation like either temporary or permanent compensation and even job re-training.
How to Make The Process Easier
Admittedly, procuring workers’ compensation and ensuring it is kept up-to-date and accurate can become overwhelming. Therefore, as an employer, it’s a good idea to get extra help in the form of professional personnel services as we offer at Consolidated Personnel Services. Allow us to help you stay on top of all the tasks necessary to keep your business running smoothly.