TEMPORARY COMPENSATION
Temporary compensation benefits must be paid every two weeks while the doctor has you on a no-work status. It is during this time that your doctor is actively treating you in the hopes of improving your medical condition so that you can eventually go back to work. There is no time limit on how long you can receive compensation; it is based on when a doctor believes you can be released to work.
While under active medical care, a doctor may release you to return to work, light duty or your regular job. If that happens, the status of your claim changes. Your insurance company will officially tell you of the change in your work status by issuing another Notice of Claim Status form informing you of the date you are released to return to work. You must make a sincere and conscientious effort to find work. You must report those efforts to the insurance company on a form provided by it. Once released to work, continuance of temporary compensation benefits is not automatic or guaranteed. The insurance company will review each case to determine if temporary benefits will continue.
If it is determined that you have a loss of wages because of your injury, the insurance company will pay 66-2/3% of the difference between the wages you are now able to earn and the average monthly wage. This compensation is paid once a month instead of every two weeks.
While you are under active medical care, it is important for you to remember that the insurance company has the right to have you periodically examined, at a reasonably convenient time and place, by a doctor of its choosing. Failure to attend the examination could result in suspension of your benefits, and you could be required to pay for the cost of the missed examination. The insurance company may accept the opinion of its consulting doctor and base a change in your claim status, or the closure of your claim, on that doctor’s opinion.
Again, if there is a change in the status of your claim, you will receive a “Notice of Claim
Status” from the insurance company identifying that change.
When you have recovered from your injury, the doctor will report this to the insurancecompany, and your claim will be closed to temporary compensation benefits as of the date your doctor discharges you from treatment. The insurance company will issue a new Notice of Claim Status telling you your claim is closed and the date of closure.
Remember, it is your responsibility to understand all notices. If you disagree, you must file your request for hearing with the ICA within 90 days from the date of the “Notice of Claim Status” or the Notice becomes final.
For more specific information regarding your Phoenix workers compensation claim contact Chris T. Johnson a Phoenix Workers Compensation lawyer.
Call: (602) 254-6461
Monday, September 14, 2009
Types of Claims
TYPES OF CLAIMS
There are two types of Workers’ Compensation claims – (1) those called medical only claims, which means that only medical expenses are paid; and, (2) those called time loss claims, which means medical expenses and temporary compensation benefits for lost wages are paid. A detailed explanation of both types of claims follows:
Medical Only Claims
Medical only claims are those types of claims for which the insurance company will pay all of the medical expenses associated with your injury, but will not pay compensation benefits for lost wages because you did not lose more than 7 days time from work. Examples of medical expenses that are paid are emergency room charges, doctor’s fees, prescriptions, crutches, braces and splints. If you have personally paid for medical expenses related to your injury, send your receipts to the insurance company for reimbursement.
On medical only claims, the insurance company does not have to let you know that they are accepting the claim and you can assume all medical bills will be paid. Even though you do not lose time from work, you will continue to have your medical bills paid until the doctor states you have recovered and do not need further treatment. If you stop treatment because you believe you have recovered, the carrier may close your claim without the doctor’s discharge.
Once your claim is accepted, you are not responsible for the payment of any medical expenses for treatment related to your injury. If you receive a bill and are being asked to pay it, call your insurance company to find out why they have not paid it.
While you are under active medical care, it is important for you to remember that the insurance company has the right to have you periodically examined, at a reasonably convenient time and place, by a doctor of its choosing. Failure to attend the examination could result in suspension of your benefits, and you could be required to pay for the cost of the missed examination. The insurance company may accept the opinion of its consulting doctor and base a change in your claim status, or the closure of your claim, on that doctor’s opinion.
Time Lost Claims
If a doctor states you are unable to work because of your injury and you are off work more than 7 days, you are entitled to compensation for your lost wages. The days off do not have to be consecutive (in a row) but are cumulative (total). Entitlement to compensation is based on calendar days (not work days) and includes Saturdays, Sundays and holidays.
The first 7 days off are not paid for lost wages unless your disability extends to 14 days. For example: If you are off 10 days, you get paid for days 8, 9 and 10 only. If you are off 14 full days, compensation is retroactive (goes back) to the date of injury and you are paid for 14 days. Compensation is not generally paid for the date of injury because you were working that day. Compensation is paid at 66-2/3% of your average monthly wage. The average monthly wage is usually calculated on your earnings during the 30 days before your injury, although there are other methods for calculating the average monthly wage. The law establishes a maximum wage figure which can be used to calculate the average monthly wage. As of January 01, 2009, the maximum 4 monthly wage is $3,600.00. Even though you earned more than $3,600.00 per month, the most a person can receive is 66-2/3% of $3,600.00. The wage is set as of the date of injury. The law does not allow for cost of living increases.
If you are losing time from work, the law requires that the insurance company inform you that your claim is being accepted by sending to you a Notice of Claim Status form with your first temporary compensation check. The Notice will tell you the wage as calculated by the insurance company. A second form, Wage Calculation Sheet, should be attached to the Notice. This form will explain how the insurance company arrived at the figures. The same information is also sent to the Industrial Commission for review.
The ICA reviews the insurance company’s calculations and issues the Notice of Average Monthly Wage which officially sets the wage. If the wage is not calculated correctly, the ICA can disapprove the wage and establish the correct wage. Because the ICA’s review covers only the reasonableness of the data and the accuracy of the calculations, it will send you a letter seeking your assistance in verifying the accuracy of the figures used in the calculations. If there is a question regarding the accuracy of the data used in calculating the average monthly wage, you are asked to contact the Wage Section of the Industrial Commission’s Claim Division.
Remember, you only have 90 days from the issuance date of this Notice to protest the accuracy of the Average Monthly Wage. After that period, the Notice becomes final and can only be appealed under very restricted circumstances. Again, to avoid any delay or loss of benefits, make sure that the insurance company and the Industrial Commission have your current address.
For more specific information regarding your Phoenix workers compensation claim contact Chris T. Johnson a Phoenix Workers Compensation lawyer.
Call: (602) 254-6461
There are two types of Workers’ Compensation claims – (1) those called medical only claims, which means that only medical expenses are paid; and, (2) those called time loss claims, which means medical expenses and temporary compensation benefits for lost wages are paid. A detailed explanation of both types of claims follows:
Medical Only Claims
Medical only claims are those types of claims for which the insurance company will pay all of the medical expenses associated with your injury, but will not pay compensation benefits for lost wages because you did not lose more than 7 days time from work. Examples of medical expenses that are paid are emergency room charges, doctor’s fees, prescriptions, crutches, braces and splints. If you have personally paid for medical expenses related to your injury, send your receipts to the insurance company for reimbursement.
On medical only claims, the insurance company does not have to let you know that they are accepting the claim and you can assume all medical bills will be paid. Even though you do not lose time from work, you will continue to have your medical bills paid until the doctor states you have recovered and do not need further treatment. If you stop treatment because you believe you have recovered, the carrier may close your claim without the doctor’s discharge.
Once your claim is accepted, you are not responsible for the payment of any medical expenses for treatment related to your injury. If you receive a bill and are being asked to pay it, call your insurance company to find out why they have not paid it.
While you are under active medical care, it is important for you to remember that the insurance company has the right to have you periodically examined, at a reasonably convenient time and place, by a doctor of its choosing. Failure to attend the examination could result in suspension of your benefits, and you could be required to pay for the cost of the missed examination. The insurance company may accept the opinion of its consulting doctor and base a change in your claim status, or the closure of your claim, on that doctor’s opinion.
Time Lost Claims
If a doctor states you are unable to work because of your injury and you are off work more than 7 days, you are entitled to compensation for your lost wages. The days off do not have to be consecutive (in a row) but are cumulative (total). Entitlement to compensation is based on calendar days (not work days) and includes Saturdays, Sundays and holidays.
The first 7 days off are not paid for lost wages unless your disability extends to 14 days. For example: If you are off 10 days, you get paid for days 8, 9 and 10 only. If you are off 14 full days, compensation is retroactive (goes back) to the date of injury and you are paid for 14 days. Compensation is not generally paid for the date of injury because you were working that day. Compensation is paid at 66-2/3% of your average monthly wage. The average monthly wage is usually calculated on your earnings during the 30 days before your injury, although there are other methods for calculating the average monthly wage. The law establishes a maximum wage figure which can be used to calculate the average monthly wage. As of January 01, 2009, the maximum 4 monthly wage is $3,600.00. Even though you earned more than $3,600.00 per month, the most a person can receive is 66-2/3% of $3,600.00. The wage is set as of the date of injury. The law does not allow for cost of living increases.
If you are losing time from work, the law requires that the insurance company inform you that your claim is being accepted by sending to you a Notice of Claim Status form with your first temporary compensation check. The Notice will tell you the wage as calculated by the insurance company. A second form, Wage Calculation Sheet, should be attached to the Notice. This form will explain how the insurance company arrived at the figures. The same information is also sent to the Industrial Commission for review.
The ICA reviews the insurance company’s calculations and issues the Notice of Average Monthly Wage which officially sets the wage. If the wage is not calculated correctly, the ICA can disapprove the wage and establish the correct wage. Because the ICA’s review covers only the reasonableness of the data and the accuracy of the calculations, it will send you a letter seeking your assistance in verifying the accuracy of the figures used in the calculations. If there is a question regarding the accuracy of the data used in calculating the average monthly wage, you are asked to contact the Wage Section of the Industrial Commission’s Claim Division.
Remember, you only have 90 days from the issuance date of this Notice to protest the accuracy of the Average Monthly Wage. After that period, the Notice becomes final and can only be appealed under very restricted circumstances. Again, to avoid any delay or loss of benefits, make sure that the insurance company and the Industrial Commission have your current address.
For more specific information regarding your Phoenix workers compensation claim contact Chris T. Johnson a Phoenix Workers Compensation lawyer.
Call: (602) 254-6461
Your Injury & Filing a Claim
INJURY
An injury is covered under Workers’ Compensation if it is job related. It is the your responsibility to make sure the injury is reported to your supervisor/employer as soon as possible. The prompt reporting of the accident to your supervisor/employer will accelerate the processing of your claim and avoid unnecessary delays or denial of possible benefits.
FILING A CLAIM
When you were treated for your injury at either your doctor’s office or an emergency room and you told them you were injured on the job, you should have been given a “pink form” to complete and sign. The “pink form” is a combination form entitled “Worker’s and Physician’s Report of Injury.” By signing that form, you were applying for Workers’ Compensation benefits.
The hospital or doctor sends the original of the form to the Industrial Commission (ICA), a copy to your employer and a copy to the insurance company that wrote the policy for your employer. If you did not complete this pink form at the doctor’s office or at the hospital, another form, entitled “Worker’s Report of Injury,” can be completed and filed with the Industrial Commission. This form will be sent to you by the ICA upon request.
Your claim is officially filed when one of these forms is received by the Industrial Commission. Without a claim signed by you or your legally authorized representative and received by the Industrial Commission, the insurance carrier is not legally required to take any action on your injury or to make any payments. You will know that the claim form has been received because the Industrial Commission will notify you by letter. If you are not notified of the receipt of your claim within a reasonable period of time, (two weeks), please contact the Industrial Commission and a claim form will be sent to you to complete and return.
Remember, that your claim must be filed within one year of the date of injury and that you are responsible for making sure that the claim is filed.
When your claim is received by the Industrial Commission, the insurance company is officially notified by the ICA that you have filed a claim. The insurance company must then either accept or deny your claim within 21 days from the date of the notification. If your claim is denied, you will receive a “Notice of Claim Status” from the insurance company. If you disagree with the insurance company’s denial, this notice will have a 90 day protest period within which you must file your request for hearing with the Industrial Commission by means of a letter or on a form available from the ICA upon request. This request for a hearing must be signed by you or your legal representative. If you file a request for hearing, you will receive a Notice from the Industrial Commission which will tell you when a hearing before an Administrative Law Judge will be set. If you do not file a request for hearing during the 90 day protest period, the decision of the insurance company becomes final.
Remember, it is your responsibility to understand all notices and documents which allow for hearing requests in the event of disagreements, and it is also your responsibility to make your current address known to the Industrial Commission and the insurance company.
For more specific information regarding your Phoenix workers compensation claim contact Chris T. Johnson a Phoenix Workers Compensation Lawyer.
Call: (602) 254-6461
Workers' Compensation Information for the Injured Worker
Workers’ Compensation is a “no-fault” system in which you receive medical and compensation benefits no matter who caused the job-related accident. Lawsuits against the employer, except under very limited circumstances, are not permitted.
If the injury or illness is job related, you receive medical benefits and, if eligible, temporary compensation. In some cases, you may also receive permanent compensation and “job retraining”.
The Industrial Commission of Arizona and the insurance carrier are not identical. The Industrial Commission is a state agency that is responsible for deciding disputes and monitoring the activities of the State Compensation Fund, private carriers and self-insured employers, referred to in this pamphlet, as insurance companies.
One final item – as you read this pamphlet, please pay special attention to your rights and responsibilities. Failure to meet those responsibilities can mean the loss of your rights and benefits under Arizona’s Workers’ Compensation Law.
For more specific information regarding your Phoenix workers compensation claim contact Chris T. Johnson a Phoenix Workers Compensation Attorney.
Call: (602) 254-6461
If the injury or illness is job related, you receive medical benefits and, if eligible, temporary compensation. In some cases, you may also receive permanent compensation and “job retraining”.
The Industrial Commission of Arizona and the insurance carrier are not identical. The Industrial Commission is a state agency that is responsible for deciding disputes and monitoring the activities of the State Compensation Fund, private carriers and self-insured employers, referred to in this pamphlet, as insurance companies.
One final item – as you read this pamphlet, please pay special attention to your rights and responsibilities. Failure to meet those responsibilities can mean the loss of your rights and benefits under Arizona’s Workers’ Compensation Law.
For more specific information regarding your Phoenix workers compensation claim contact Chris T. Johnson a Phoenix Workers Compensation Attorney.
Call: (602) 254-6461
Thursday, September 3, 2009
Phoenix Work Injury Lawyer
Phoenix, Arizona Workers’ compensation entitles you to defined medical and income benefits if you have been injured on your job. If you have experienced an injury while at work, and have lost time and wages as a result, call us now, or email us, to speak with an experienced Phoenix workers’ compensation attorney, consultation is FREE.
Insurance companies are not on your side. We’ll help you with all aspects of your work comp claim including:
1) If your claim denied unfairly
2) Determining your average monthly wage (insurance company usually sets low because benefits are based on the average monthly wage of worker)
3) Has your case been closed without a permanent impairment?
4) Has your case been close without medical care?
5) Are you getting the runaround by the insurance carrier?
It is important to protect your legal rights.
Call (602) 254-6461 to speak with an attorney who will answer all your questions and provide a clear plan of action with your workers’ compensation and/or social security disability claim.
If you or a loved one has been injured at work it is important to protect your legal rights. Click here to fill out our online case evaluation form.
Chris T. Johnson, P.C.
934 W McDowell Road
Phoenix, AZ 85007
Toll-Free: (800) 266-6461
Telephone: (602) 254-6461
Fax: (602) 254-0609
Email Us: law@ctj4workcomp.com
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