Who is covered
Workers’ Compensation benefits are provided pursuant to Title 23 of the Arizona Revised Statues. This coverage is the exclusive remedy for state employees injured in the course and scope of their employment. The following individuals are entitled to workers’ compensation coverage:
- Employees of all state agencies, boards and commissions including the three state universities
- Some Volunteers specifically described in A.R.S. Section 23-901
- Employees of Superior Courts of all Arizona counties except Maricopa
Questions concerning who is covered should be directed to the Insurance Department at Risk Management (602) 542-5185.
Reporting An Industrial Injury (Filing a Claim)
- If the injury is life-threatening, seek emergency help immediately by calling 911. If the injury is not life-threatening, notify your supervisor immediately. Your supervisor will complete the Supervisor’s Report of Injury (SRI).
- Call 602-542-WORK or 1-800-837-8583 within 24 hours to report the injury. This service is available 24 hours a day/ 7 days a week to facilitate the reporting of your injury to Risk Management.
- Tell the doctor you were injured at work. They should have you complete and sign the top portion of the “WORKER’S AND PHYSICIAN’S REPORT OF INJURY” form which is available at all occupational medical clinics, emergency rooms and physician’s offices. The physician will complete the bottom portion and will mail a copy to the Industrial Commission of Arizona (ICA), Risk Management, and the employee’s agency. You should retain your copy.
- If you have missed, or anticipate missing, more than 7 calendar days from work, call Risk Management at 602-542-5218 or contact us at email@example.com.
- Cooperate with your Workers’ Compensation claims adjuster for follow-up communication including completing all additional forms and questionnaires received in the mail.
- Follow the doctor’s recommendations.
- Keep your supervisor advised of your medical and work status.
- Notify Risk Management at 602-542-5218 or firstname.lastname@example.org if your work status changes, including when you return to work.
Timeframes for Reporting an Injury
- Risk Management encourages injured employees and agencies to immediately (within 48 hours of occurrence and after medical treatment is received) file a claim with Risk Management’s Workers’ Compensation Section after a work-related injury. Immediate notification allows for more effective management of your claim.
- The law requires the claim must be filed at the Industrial Commission within one year after the injury. The time for filing a workers’ compensation claim begins to run when the injury becomes manifest or when the claimant knows, or, in the exercise of reasonable diligence, should know, that the employee has sustained a compensable injury.
Seeking Medical Care
- In an emergency, seek immediate medical care at the nearest emergency room or urgent care facility. Notify the health care provider that your injury is a work-related injury. Also notify your supervisor as soon as possible that an injury occurred.
- In all other instances, notify your supervisor that you have been injured before seeking medical care preferably at a facility that specializes in treating work-related injuries. Your supervisor will complete the Supervisor’s Report of Injury (SRI).
The Claims Process
- Your claim will be assigned to a professional workers’ compensation adjuster to first investigate to determine compensability and then process payments for medical expenses and any compensation due.
- When we receive your claim, you will receive a packet of information from ADOA Risk Management Workers’ Compensation by US Mail. The packet includes an introductory letter; important prescription information; a flyer listing services for therapy, diagnostic studies, and durable medical goods; and a form to complete and return in the self-addressed, stamped envelope.
- If you have not lost time from work in excess of seven (7) calendar days, you may not be personally contacted by your adjuster. In most cases when your claim is accepted, you will receive a Notice of Claim Status so indicating. A Notice of Claim Status will also be issued when you have been discharged by your medical provider.
- If your attending physician feels you are unable to work, and you are off work for eight (8) or more calendar days, you are entitled to payment for lost wages. Wage loss benefits are payable at 662/3% of your gross monthly salary, up to the maximum as set by the legislature per month. Compensation is payable every 14 to 30 days, depending on the type of disability. No wage loss benefit is payable for the first 7 calendar days, if total time lost is less than 13 calendar days. This waiting period occurs only once during a claim. If a claim has been accepted, authorized medical treatment is paid pursuant to the Arizona Fee Schedule with no out-of-pocket expenses or co-pays.
- If your claim is denied, you will receive a Notice of Claim Status informing you of the denial upon Risk Management’s notification from the Industrial Commission of Arizona. If you sought medical treatment at an occupational medical clinic, you would not pay any out of pocket expenses even if your claim is denied. If you chose to go to your primary care physician and the claim is denied, your co-pay is not reimbursed.
- If you intend to leave the State for more than fourteen (14) days, you must obtain permission from the Industrial Commission at 602-542-4661.
Returning to Work after an Injury
- Notify your Risk Management adjuster when your work status changes, including when you return to work.
- It is not uncommon for physicians to release workers to perform some work-related activities before a full recovery is made. Most state agencies provide temporary assignments to work in a modified capacity. This may mean working fewer hours or shifting job duties. Check with your supervisor to find out what types of modified work opportunities are available in your department. If your physician has given specific physical restrictions and modified work is available within those restrictions, you must return to work. Failure to do so may jeopardize your workers’ compensation benefits.
Types of Compensation Benefits
- Temporary Total Disability: Total disability for eight or more calendar days where the attending physician declares a “no work” status.
- You are paid 662/3% of your average monthly wage up to the maximum amount as set by the Arizona Legislature.
- You are paid an additional $25.00 a month if you support one or more dependents.
- Checks are issued every 14 days.
- Temporary Partial Disability: Released to light (modified) work.
- You are paid 662/3% of the difference between your average monthly wage before the injury and the wage you are able to earn during recovery.
- Checks are typically issued every 30 days.
- Permanent Partial Disability: A permanent impairment is assessed by a qualified physician using the American Medical Association’s Guide to the Evaluation for Permanent Impairment.
- Scheduled: A disabling injury, usually of the extremities (arm, leg) for which permanent disability compensation benefits are statutorily outlined for a specific length of time.
- Unscheduled: If the permanent disability is not scheduled, the benefits are based on the loss of earning capacity as evaluated by a vocational specialist, and may continue until such time as your medical condition improves or your earning capacity changes.
- Checks are issued monthly.
- Fatality: Death as a result of work-related injury.
- Burial expenses up to $5,000.
- The surviving spouse receives 662/3% of the average monthly wage (without dependents). A two year award in one lump sum is payable upon remarriage.
- With dependents, a surviving spouse receives 35% of the average monthly wage. Dependents receive a total of 312/3% of the average monthly wage to be shared equally.
- Benefits are paid until the dependent is 18, or 22 if enrolled full-time in any accredited educational institution.
- Checks are issued monthly.
Third Party Negligence
- If your injury was the result of negligence on the part of a third party (examples include a motor vehicle accident or faulty machinery), you can reserve the right to pursue a claim against the responsible party. However, if you pursue a claim or lawsuit, you must notify and receive approval from Risk Management prior to settlement or you can jeopardize your workers’ compensation benefits. Risk Management will have a statutory lien on your recovery equal to the amount of benefits paid.
- Most claims are processed without incident. If you have a problem, contact your claims adjuster to see if it can be resolved. You may contact the Claims Supervisor or Manager if you wish to elevate your concern.
- If you do not agree with a decision made by Risk Management, you can contact the Ombudsman’s Office at the Industrial Commission of Arizona (602-542-4350).You do not have to be represented by an attorney if you request a hearing; however, the Industrial Commission can provide a list of certified workers’ compensation attorneys.
- If you are still unsuccessful in resolving the dispute, you may request a hearing before a judge by writing directly to the Industrial Commission.