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How Long Before My Workers’ Compensation Benefits Begin?

Posted on behalf of Phillips Law Group on Apr 20, 2017 in Workers' Compensation

work injury claim formWorkplace injuries can be expensive for an injured employee, who may face costly medical expenses and suffer financially from lost wages due to his or her condition.

The starting point for when workers’ compensation benefits are provided is often unique to the claim and can depend on several factors. If your workers' compensation claim has been denied or you were made an unreasonably low offer, contact our Phoenix attorneys for experienced legal help.

Medical-Only Claims

Medical-only claims require an insurer to assume financial responsibility for all medical costs related to the worker’s injury, such as:

  • Emergency room charges
  • Doctors’ fees
  • Doctor visits
  • Prescriptions
  • Medical equipment

Compensation for claims involving medical treatment often begin once the claim is accepted by the insurer.

Workers who file medical-only claims are typically out of work for no more than seven days, and therefore cannot seek temporary disability benefits for lost wages.

Injured workers may not be notified of their medical-only claim’s acceptance. The insurer will cover all medical bills associated with the workplace injury until a physician determines that medical treatment is no longer needed. Should the worker stop treatment, the claim may be closed by the insurer without physician discharge.

Once a medical-only claim has been accepted, the injured worker is no longer financially liable for his or her medical expenses.

If you receive a bill in the mail regarding a workers’ compensation claim, contact our attorneys for qualified legal assistance.

Time Lost Claims

An employer’s workers’ compensation insurance will provide an injured employee with partial lost wages if he or she is required to miss more than seven consecutive calendar days from work.

The claim must be approved by a physician who states that you are unable to work for more than seven consecutive calendar days. Once a doctor or physician approves your claim, you may be provided temporary total disability benefits (TTD).

TTD includes 66 and two-thirds of a workers previous average monthly wages before his or her injury. Your average monthly wage is typically calculated on your earnings during the 30 days before your injury. The maximum TDD a worker can receive is $4,337.82.

The first seven days of lost earnings are not paid unless you miss at least 14 days of work because of your injury. This means if your injury caused you to miss 10 days of work, you will only be paid for the last three days of your absence.

However, if your injury causes you to miss 14 days or more, your compensation will be retroactive and you will be provided benefits for all previous missed days except for the first day.

If you are missing significant time from work, Arizona law requires your employer’s insurance carrier to inform you of your claim’s acceptance by sending a Notice of Claim Status.

The notice will also contain your first temporary compensation check and will inform you of your average wage as calculated by the employer.

When you receive the notice, it should contain a Wage Calculation Sheet, which details how the insurance carrier reached this figure.

If you have any concerns regarding your claim’s average monthly wages, you will need to contact the Wage Division of the Industrial Commission of Arizona (ICA).

ICA will receive a copy of your claim and is charged with reviewing the estimated average monthly income made by your employer’s insurance carrier.

You only have 90 days from receiving the Notice of Average Monthly Wage to dispute the accuracy of the carrier’s estimate.

Temporary Compensation

The first payment for temporary total compensation will be processed within 21 days of receiving a notification from ICA that a workers’ compensation claim has been properly filed.

Temporary compensation must be paid every two weeks during the period that a doctor places you on a no-work status. During this time, you should be receiving treatment and following the doctor’s directions to heal yourself.

There is no time limit for how long you can receive temporary compensation. It is instead based on when the doctor believes you can return to work.

When you are under active medical care, your doctor may allow you to return to a new line of work, light duty tasks or your regular job. Your claim’s status will change and your carrier will inform you by issuing another Notice of Claim Status form informing you of the date you can return to work.

During this time, you must make a sincere effort to find work suitable to your condition. You are required to report any attempt you make at finding a means of income, including unemployment benefits, to the carrier listed on the form provided to you.

The carrier will review each case to determine if temporary benefits will continue. If the carrier finds your injury caused you to lose wages, it will pay you 66 and two-thirds percent of the difference between the wages you are currently earning and your average monthly wage.

If you returned to your normal wage after the injury, your benefits will stop.

While you are under active medical care, your carrier has the right to request you be periodically examined by a doctor of its choosing. If you fail to attend these evaluations, your benefits could be suspended.

If you cannot to return to work at your original job and take a new job with a lower rate of pay, compensation may continue, paid at 66 and two-thirds percent of the difference between your established average monthly earnings and new wages.

After you have recovered from your injury, your doctor should inform your carrier and your temporary compensation benefits will stop.

Permanent Compensation

If you have received medical treatment for your work-related injury and a doctor decides that nothing further can be done to improve your condition and you are permanently disabled, he or she must inform your carrier.

The doctor will rate your injury by determining a percentage of impairment and you will be provided compensation once per month. Your payments will begin following ICA’s decision of whether your injury is scheduled or unscheduled.

Scheduled Injuries

A scheduled injury is one that is inflicted upon a certain part or area of the body, such as an eye, hand, arm, foot or leg. The part of the body and the timeframe allowed for compensation is set by Arizona’s Workers’ Compensation Law.

Your carrier will issue a Notice of Permanent Disability form, which states the amount the carrier will pay each month and the number of months the payments will continue.

Your compensation will be determined in three different ways for scheduled injuries:

  • For partial loss of function, you will be paid 50 percent of your average monthly wage.
  • Amputation or total loss of function will provide you with 55 percent of your average monthly wage.
  • If your doctor believes your injury will prevent you from returning to your regular work, you will receive 75 percent.

Facial Scarring & Permanent Tooth Loss:

If your injury has caused you permanent disfigurement, such as facial scarring or loss of teeth, you may be entitled to compensation.

The compensation you can receive from facial scarring is based on the intensity of the disfigurement, as well as the manner in which you sustained it.

Compensation for facial scarring and permanent teeth loss is calculated at 55 percent of your average monthly income and lasts for a period of up to 18 months.

Unscheduled Injuries

Unscheduled injuries include those that are not directly focused within one are of the body or do not make a surface appearance like scarring or disfigurement.

Examples of unscheduled injuries include:

  • Occupational diseases
  • Hip, back or shoulder injuries
  • Combinations of impairments
  • Past history of impairments

ICA will determine the amount of compensation you are owed for this permanent disability. Its decision is based on how the injury affects your life, your ability to return to work, and the wages you are able to earn compared to your average monthly income when you were injured.

ICA also considers your:

  • Age
  • Education
  • Previous occupations
  • Physical limitations
  • Wages earned after the injury

Your compensation will be figured at 55 percent of the difference between your monthly wages and the amount ICA will estimate you can earn per month given your injury or at 66 and two-third percent if you are totally disabled.

The Claims Division of ICA will explain how much compensation you will receive each month. The money is paid by your carrier and it will include the period of time that began when you were discharged by your doctor.

It is important you understand that ICA may find that because you have returned back to work and are earning similar or increased wages compared to before your injury, you have sustained no loss of income. This means ICA may recognize that you have an impairment, but it has not affected your earning capacity at this time.

If you disagree with ICA’s decision, you can request a hearing. This request must be filed within 90 days from the issuance date of the awarded compensation.

Experienced Workers’ Compensation Lawyers

Workers are extended several rights that protect their deserved benefits after sustaining a serious workplace injury.

If you were injured in a work-related accident, you may be entitled to compensation that may cover all medical expenses and partial lost wages.

The Phillips Law Group’s attorneys may be able to help you ensure your rights are met from your employer and his or her insurance provider.

We can review your claim through a free, no obligation consultation to determine if your workers’ compensation benefits provide fair and accurate financial relief for your injury.

Fill out a Free Case Evaluation form to get started now.

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