Arizona Workers' Compensation and Social Security Disability Law

Wednesday, December 17, 2014

Injured on the Job, Pre-Existing Conditions, and Workers’ Compensation in Arizona

A pre-existing condition does not prevent a worker from getting coverage for a worker related injury in Arizona. The condition could be from a prior accident, a birth defect, or other health problem that occurred before you were hurt on the job (i.e. a prior back injury that was has not completely healed).

Generally, an injured worker is only entitled to benefits for the workplace injury, not for the underlying pre-existing condition. For example, if you were born with scoliosis and later suffer a herniated disc at work, your employer’s insurance company may be responsible for costs to treat the herniated disc (the injury that happened on the job), but not the scoliosis. Likewise, if you already had a torn meniscus in your knee and you suffer further deterioration of the knee cartilage at work, you may be entitled to compensation for the percentage of knee damage that occurred while on the job, but denied compensation for the pre-existing impairment of the meniscus. However, Arizona courts have provided workers’ compensation benefits when an industrial injury aggravates a pre-existing condition.

Of course, there are many variations to the situations mentioned above. Courts handle these issues on a case-by-case basis. Defining Arizona workers’ compensation benefits based on aggravation of an existing injury can be complicated. Most of the time, there isn’t a clear line between an old injury and a new one. This leaves room for interpretation from you and your employer’s insurance company.

If you are already receiving treatment for the pre-existing condition, your on-the-job injury should not interfere with your rights to continued coverage of the pre-existing condition under your health insurance. Your employer’s workers’ compensation insurance is responsible for coverage of the work-related part of your condition. The dual coverage, however, may require you to see two or more doctors. Although this may be inconvenient, it may allow you to receive more comprehensive health coverage with minimal out-of-pocket expenses.

It is important to note that it’s wise to disclose a pre-existing condition to your attorney and to your doctor. A prompt disclosure can ensure that your attorney has all the important information he may need to properly structure your workers’ compensation claim. It will also help your doctor to provide the best possible care and to be prepared to discuss your condition if your case ever goes to court.

Weston Montrose, Esq.

Attorneys at Taylor and Associates, PLLC are happy to answer any questions you may have regarding your Arizona workers’ compensation claim and pre-existing conditions. Our lawyers will help protect you from the common tactic used by insurance companies that claim your work injury was pre-existing and therefore not covered by workers’ compensation.

Attorney Advertising. This web site is designed for general information only. The information presented at this site should not be construed to be neither formal legal advice nor the formation of a lawyer/client relationship. The information of this blog was believed to be accurate at the time that it was written.

Friday, October 31, 2014

Workers Compensation | Forthwith Reporting

In Arizona employers are required to provide worker’s compensation insurance to their employees in case of an injury on the job. If the employee is injured, he has a duty to report the injury to his employer in a timely manner. This is called “forthwith reporting.” Reporting the injury means that the injured worker needs to inform their employer that they have an injury and that it occurred doing work activities. It is usually not enough to just say, “My back hurts” without also letting the employer know it was due to work activities unless other information is available to show a “reasonably conscientious” employer that the injury was caused by work.

The duty to report the injury in a timely manner allows the employer to then investigate the accident promptly and send the injured worker for medical care before the injury worsens. The “timeliness” of the reporting is open to interpretation. If the injured worker waits to report the injury that leads to witnesses disappearing or their injury worsening then they may have prejudiced the employer and this can result in the Industrial Commission judge denying their claim.

The Commission may excuse late reporting if the delay in reporting was because the injured worker did not realize they were injured right away or did not realize that the injury was caused by work activities right away. Sometimes injuries are not readily apparent or the cause of the injury is not clear. This may be a valid excuse for reporting an injury late. Additionally, the Commission may also excuse late reporting if the applicant can show their employer was not prejudiced in their ability to provide early diagnosis and treatment or in investigating the claim.

Ben Manion, Esq.

In conclusion, it is important to report your injury to your employer in a timely manner in order to quickly receive the proper medical care and investigation of the accident. If an accident is reported late it may be excused if the employer’s investigation was not hampered and the worker’s injury was not aggravated due to the delay in reporting. In general, the more quickly an injury is reported the better for both the employee and employer.

Friday, September 12, 2014

Workers’ Comp and Third Party Claims

Arizona Workers’ Compensation law prevents injured workers from suing their employer or co-workers for an injury at work. Many folks assume that they are not entitled to a civil action because they are receiving workers compensation from their employer, but that it not always the case. Injured workers may be entitled to a civil action against a third party (someone other than your employer or co-worker) when the third party was responsible for causing your injury.

Although third party claims vary from case-to-case, there are general rules that need to be considered to successfully recover. These rules are important because workers’ comp may not always fully compensate the harm you have suffered, and a third party claim might be your only chance of being fully compensated.

Many rules govern workers’ compensation and third party claims. However, the rules below are some very important rules you should be aware of if you intend to make a third party injury claim for an on the job injury.

Deadline to file claim – if you are entitled to workers’ comp benefits, the deadline for filing a claim against a third party is one year after the accident that caused the injury. Once this deadline passes, the right to file a claim is assigned to the insurance carrier. Under certain circumstances you may be able to have the claim re-assigned back to you by the workers compensation insurer, but this may not be possible in all cases. Therefore, it is very important to take the steps necessary to pursue a third party claim within the first year following the accident.

Notice – the injured worker is required to provide written notice to the insurance carrier of their intent to bring a claim against a third party. In addition, the injured worker is also responsible for providing the insurance carrier with timely notice of all of the pleadings, and rulings regarding the status of the action.

Settling claims – when settling a claim with a third party, you must obtain the workers compensation insurer’s written consent before settling, failing to do so may jeopardize your right to workers compensation benefits in the future.

Settlement liens – if you settle a claim with a third party, the workers compensation insurer might be entitled to a lien against your recovery from the third party. If this is the case, the insurer is entitled to a lien against “compensation, and medical, surgical and hospital benefits.”[i] It is important to note that an insurer cannot recover for any administrative expenses or the cost of an IME (independent medical examination) from a settlement lien.

Sebastian Brugliera, Esq.

Being aware of these rules will help your chances to recover in a civil action against a third party. We understand that remembering all of the rules can be quite difficult and there may be other rules, and shorter time limits that apply in some cases. Contact Taylor & Associates to help make this difficult process as easy as can be. Our attorneys are experienced, and will assure that your claim is properly handled.

[i] Ariz. Rev. Stat. § 23-1023(C)

Thursday, August 21, 2014

Workers' Comp | Statute of Limitations

Don’t Wait To File Your Claim

You want to be sure that you take all of the necessary steps in filing your workers’ compensation claim, so you do not lose your rights to workers’ compensation benefits. Injured workers have a limited time to file a claim for a work related injury. Many times, injured workers across Arizona are unable to file workers’ compensation claims because they simply wait too long.

A statute of limitations is a legally established deadline for filing a claim with an administrative agency or court. The deadline is intended to promote fairness to all parties involved in the legal process (i.e. the injured worker, employer, judge, insurance company, and lawyers).

The statute of limitations for filing your workers’ compensation claim in Arizona is one year from the date you were injured or became aware of your injury or disease. If the signs of the injury or symptoms of the disease occur after the event itself, the statute of limitations begins to run when you discover the injury or when your doctor diagnoses the disease. This happens when:

The symptoms of a disease do not present themselves until years after exposure. For instance, certain types of cancer caused by contact with toxic chemicals may take years to develop or even be diagnosed by your doctor.

A repetitive stress injury resulting from performing the same movement over, and over again during the life of your working career develops progressively. Many times, it is not obvious until the disability is irreversible and severe. These stress injuries are often seen in factory workers, people who use a keyboard constantly, and construction work.

Damage to an internal organ that is not immediately noticed. This may be the case with a brain injury that shows no outward signs, but is present as headaches, memory loss, and cognitive impairment over time.

If you fail to file your claim by the one-year deadline, you run the risk of losing your right to workers’ compensation benefits for your injury. Furthermore, unless your claim meets one of the rare exceptions, you do not have the right to sue your employer in civil court to collect damages.

THINGS TO REMEMBER:

Promptly notify your employer of your worksite accident or job-related illness.

Be aware that you should receive a letter from the Industrial Commission of Arizona within 14 days of the date the incident was reported, informing you that the insurance company has been notified of your claim.

Your employer’s insurance company has 21 days from the date it receives notification from the Industrial Commission of Arizona to either accept or deny your claim.

You have 90 days to protest a denial of your claim.

Do not miss the statute of limitations when filing your workers’ compensation claim. Consult with a qualified attorney in good standing with the Arizona State Bar as soon as possible.

Roger A. Schwartz, Esq.

Taylor and Associates, PLLC was founded in 1975, as a workers compensation law firm based on the belief that injured workers throughout Arizona should be represented with compassion and integrity. For more than 35 years, we've provided help with claims for workers compensation, personal injury, and Social Security. For your convenience, Taylor and Associates services the entire state of Arizona.

Tuesday, May 20, 2014

Which way does the scale tip?

If you are hurt on the job and file a workers’ compensation claim, chances are that you will have to meet with a healthcare professional to discuss your injury. It is very common that a doctor or medical examiner will ask you a series of questions to determine the level of pain you are experiencing. It is important to properly answer the questions asked by the healthcare professional because it can affect your pain management.

It is common for your doctor or medical examiner to ask you questions to help determine the amount of pain you are experiencing so they can better manage your pain. You are expected to answer the questions to the best of your ability. Doctors and medical examiners administer a very common questionnaire called the Visual Analog Scale. This questionnaire might seem simple at first, but may actually be quite difficult if you do not know how to properly answer the questions.

The questionnaire asks questions, and you are to answer the questions based on a scale (i.e. 1 to 10 or 1 to 5). Sometimes, the scale has images associated with each number. The images are very helpful because they are normally faces that are expressing levels of pain. If there are no images, there should be instructions. The instructions will most likely have a statement of an amount of pain that is associated with a number on the scale. It is important you know what the scale actually means. Below is an example of a set of instructions for a scale found in a questionnaire[1]:

Level 1 = My pain is barely noticeable.

Level 2 = My pain is noticeable with no distress.

Level 3 = My pain is disturbing but with no distress.

Level 4 = My pain causes me some distress, but I have no coping problems.

Level 5 = My pain causes me distress; I have some coping problems.

Level 6 = My pain causes me distress; I have significant coping problems.

Level 7 = My pain is starting to interfere with my ability to function.

Level 8 = My pain is causing moderate interference with my ability to function.

Level 9 = My pain is causing sever interference with my ability to function.

Level 10 = I’m unable to function at all because of my pain.

Please remember that this is only an example of what a set of instructions may look like. Also, if you are unsure of what something means in the instructions provided to you, be sure to ask your doctor.

Tom Whitley, Esq.

The questions become more difficult if there are no instructions or images provided. If this is the case, be sure to ask the medical examiner to tell you the actual meaning of the scale and numbers. Always remember to keep the instructions in mind because your answers will provide the doctor with valuable information that can alert him to changes in your condition.

If you were hurt on the job, you may have many questions regarding your injury and what steps you need to take. The experienced and knowledgeable attorneys at Taylor and Associates, PLLC are ready to answer your questions. Contact us at help@injuredworker.com or by phone at 1-800-358-CATS (2287).

Attorney Advertising. This web site is designed for general information only. The information presented at this site should not be construed to be formal legal advice nor the formation of a lawyer/client relationship.

[1] Pain Scale document provided by Sierra Tucson.