Fillable Printable Workers' Compensation Insurance - Arizona

Workers' Compensation Insurance - Arizona

Workers’ Compensation Insurance

EMPLOYERS’ FREQUENTLY ASKED

QUESTIONS

INTRODUCTION

This information is intended to provide employers with a basic overview of the workers’ compensation

system in Arizona. The information provided does not cover every aspect of workers’ compensation law.

There are often exceptions to general rules, unsettled areas of law, and recent changes in the system.

Therefore, it is strongly recommended that you consult with an attorney for competent and

comprehensive advice based on your individual business or the facts of your particular legal issue.

Additionally, information regarding any aspect of other non-workers’ compensation law related or

applicable to an employer/employee relationship or otherwise enforced by the ICA is not addressed

herein.

WHAT ARE THE LAWS AND RULES THAT GOVERN WORKERS’ COMPENSATION?

Workers’ compensation is governed by the laws found in Article 18, Section 8 of the Arizona State

Constitution, Chapter 6 of Title 23 of the Arizona Revised Statutes (A.R.S. § 23-901 et seq., also

sometimes referred to as “the Act”) and Workers’ Compensation Practice and Procedure rules contained

in the Arizona Administrative Code (A.A.C. R20-5-101 et seq.). All parties to a workers’ compensation

claim should familiarize themselves with these provisions of law. You can obtain copies free of charge at

either Industrial Commission office. Copies may also be available for the cost of copying at county law

libraries and many local libraries including the Maricopa County Superior Court Law Library located at

101 West Jefferson Street, East Court Building, first floor, Phoenix, Arizona. The Arizona State

Constitution and statutes are available on-line at www.azleg.state.az.us. The rules are available online at

www.azsos.gov.

WORKERS’ COMPENSATION INSURANCE

Under Arizona law, it is mandatory for employers to secure workers’ compensation insurance for their

employees. Workers’ compensation is a “no fault” system in which an injured employee is entitled to

receive benefits for an industrial injury, no matter who caused the job-related accident. If an illness or

injury is job-related, then the injured worker (also known as a claimant or applicant) receives medical

benefits and may receive temporary compensation, if eligibility requirements are met. In some cases, a

claimant may also receive permanent compensation benefits, “job retraining,” and supportive medical

care.

WHAT IS A “NO FAULT” SYSTEM?

Workers’ compensation is a “no fault” system in which an injured employee is entitled to receive medical

and compensation benefits no matter who causes the job-related accident. This means that even if the

employee was at fault or partially at fault in causing the industrial injury, he/she will, in most instances,

be entitled to benefits under the workers’ compensation system. There are some exceptions, however.

For example, an employee is not entitled to workers’ compensation benefits for injuries that are

“purposely self-inflicted.”

HOW CAN I OBTAIN WORKERS’ COMPENSATION INSURANCE FOR MY EMPLOYEES?

Workers’ compensation insurance can be obtained from an insurance company licensed to issue workers’

compensation insurance in the State of Arizona. For a listing of these companies you may contact the

Arizona Department of Insurance at (800) 325-2548 or www.id.state.az.us. Employers who meet certain

requirements can also apply to the ICA for permission to be self-insured for workers’ compensation.

Once an employer obtains insurance or authority to self-insure, the employer is required to post a notice

of workers’ compensation insurance advising their employees of the coverage and of the employee’s right

to reject this coverage. The employer is also required to supply “rejection” forms for employees who

chose to reject their employer’s workers’ compensation coverage.

AM I REQUIRED TO HAVE WORKERS’ COMPENSATION INSURANCE IF I HAVE ONLY ONE

WORKER OR PART-TIME WORKERS?

If an employer regularly hires workers in its customary business then the employer is required to carry

workers’ compensation insurance regardless of the number of workers they have, whether those workers

are part-time, full-time, minors, aliens, or family members. Workers’ compensation insurance is not

required for an independent contractor, or a worker whose employment is both casual and not in the usual

business of the employer. Also, workers’ compensation insurance is not required for a domestic servant

who works in your home.

AM I REQUIRED TO HAVE WORKERS’ COMPENSATION INSURANCE IF I AM A SOLE

PROPRIETOR?

Although a sole proprietor having no employees is not required to maintain workers’ compensation

insurance on himself/herself, the sole proprietor may elect to secure coverage for himself/herself.

However, if there are any employees working for the sole proprietor, the sole proprietor must maintain

workers’ compensation insurance on them.

AM I REQUIRED TO HAVE WORKERS’ COMPENSATION INSURANCE IF MY BUSINESS IS A

CORPORATION?

A corporation is an employer under the Act and, therefore, must obtain workers’ compensation insurance

for its employees which may include officers, directors or shareholders.

AM I REQUIRED TO HAVE WORKERS’ COMPENSATION INSURANCE IF MY BUSINESS IS A

LIMITED LIABILITY COMPANY (L.L.C.)?

If an L.L.C. employs one or more employees, an L.L.C. is required to obtain workers’ compensation

insurance for its employees. Employees may include members and managing members.

CAN AN EMPLOYEE ELECT NOT TO BE COVERED UNDER MY WORKERS’ COMPENSATION

INSURANCE?

An employer may not require the employee to waive rights to workers’ compensation as a condition of

employment, nor require an employee pay any portion of the employer’s workers’ compensation

insurance premium. An employee may, however, voluntarily reject workers’ compensation insurance by

providing a written notice to the employer which the employer files with his workers’ compensation

insurance carrier. In most instances, this rejection must be filed before the employee suffers an industrial

injury. An employee may also later rescind that rejection in writing but must do so before the occurrence

of an industrial injury.

AM I REQUIRED TO HAVE WORKERS’ COMPENSATION INSURANCE IF I HIRE AN

INDEPENDENT CONTRACTOR AND HOW DO I KNOW IF A WORKER IS AN INDEPENDENT

CONTRACTOR?

Generally, you do not have to provide workers’ compensation insurance for an independent contractor.

But, there are often disputes over whether a worker is an employee or an independent contractor. To

resolve these disputes courts consider the “totality of facts” on a case-by-case basis. Some of the factors a

court might consider include: the duration of the employment, the method of payment, the right to hire

and fire, the extent to which the employer may exercise control over the work, who supplies the tools,

who sets the hours of work, and whether the work was performed in the usual and regular course of the

employer’s business. There may be other factors the court will consider and no one factor is, in itself,

conclusive. Therefore, even if you believe you have an “independent contractor” relationship, a court

could still decide that based on the totality of the facts, the worker was an employee entitled to workers’

compensation benefits.

WHAT DO I DO IF AN EMPLOYEE IS INJURED ON THE JOB?

Immediately upon notice of an industrial injury, an employer is required to provide certain information to

the injured worker who reports the injury. This information includes the name and address of the

workers’ compensation insurance carrier, the policy number, and the date of expiration of coverage. An

employer is also required to notify their workers’ compensation insurance carrier and the Industrial

Commission of Arizona within ten days after receiving notification of a work related injury or disease

using the Employer’s Report of Industrial Injury form which is available from the ICA and online at

www.azica.gov. For fatalities, an employer is required to notify the ICA Claims Division immediately by

telephone or telegraph. Other reporting obligations are required under the Arizona Occupational Safety

and Health Act, but are not addressed here.

CAN I TELL MY EMPLOYEE WHICH DOCTOR TO SEE?

An employer can direct an injured employee to a physician of the employer’s choice for a one-time

evaluation. Following that visit, the injured worker may return to that physician or pursue treatment with

a physician of his/her choice. There are exceptions to this rule for a self-insured employer that has

complied with the requirements of A.R.S. § 23-1070.

WHAT WILL HAPPEN IF I DO NOT HAVE INSURANCE AND MY EMPLOYEE CLAIMS A

WORK RELATED INJURY?

If an employee is injured but you do not carry workers’ compensation insurance, your employee can

choose to file a civil suit against you or file a workers’ compensation claim with the ICA. If the

employee files a civil lawsuit, proof of the injury is evidence of negligence on the employer’s part. If an

employee chooses to file a claim with the ICA, it will be referred to the Special Fund Division/No

Insurance Section. The Special Fund will process the injured worker’s claim and pay medical and

compensation benefits if the claim is accepted. The Special Fund will seek reimbursement from the

uninsured employer for any benefits paid to the injured worker plus a penalty of 10% of the benefits paid

or $1,000, whichever is greater (and interest on the total).

IS THERE A FINANCIAL PENALTY IF I DON’T HAVE REQUIRED WORKERS’

COMPENSATION INSURANCE?

Subject to limited exceptions, an uninsured employer may be assessed a civil penalty of $1,000 for failure

to obtain workers’ compensation insurance, whether or not an employee files a workers’ compensation

claim. The penalty is increased to $5,000 for a second instance of being uninsured within a five-year

period and $10,000 for a third instance in a five-year period.

CAN MY BUSINESS BE SHUT DOWN IF I DON’T HAVE REQUIRED WORKERS’

COMPENSATION INSURANCE?

An employer that fails to obtain the required workers’ compensation insurance is subject to an action by

the ICA for an injunction (Superior Court Order) that will require the employer to cease the operation of

business until the employer complies with the requirement to maintain workers’ compensation insurance

for its employees.

AM I COMMITTING A CRIME IF I DON’T HAVE REQUIRED WORKERS’ COMPENSATION

INSURANCE?

An employer that does not carry workers’ compensation insurance is guilty of a Class 6 felony. A.R.S. §

23-932.

CAN AN EMPLOYEE SUE ME IN CIVIL COURT IF HE/SHE IS INJURED ON THE JOB?

In most instances, workers compensation is the exclusive remedy against an employer that is insured for

workers’ compensation. However, if an employee has rejected workers’ compensation coverage prior to

their injury or if the employer fails to post the notice advising an employee of the right to reject workers’

compensation, then the employee retains the right to pursue a civil lawsuit against the insured employer.

Additionally, if an employee is injured through the “willful misconduct” of the employer or a co-worker,

then the injured worker has the right to file a civil lawsuit against the employer and the co-worker who

injured them. If the employer was uninsured for workers’ compensation at the time of the work injury,

then the injured employee has the option to file a civil lawsuit against the uninsured employer.

WHAT IS THE DIFFERENCE BETWEEN A CIVIL LAWSUIT AND A WORKERS’

COMPENSATION CLAIM?

There are many differences between a civil lawsuit and a workers’ compensation claim. For example, in

a workers’ compensation claim, an injured employee is entitled to lifetime medical and compensation

benefits but the compensation for lost wages is capped by law. If you are sued in civil court, there is no

cap on the amount of damages an injured worker can claim. Under the workers’ compensation system, an

injured worker cannot seek compensation for “pain and suffering” or “punitive” damages such as can be

sought in a civil lawsuit. A workers’ compensation dispute is decided by an administrative law judge

whereas civil lawsuits are usually decided by a jury. A workers’ compensation claim also has rules of

procedure and evidence that differ from those that apply in a civil lawsuit. Certain legal principles such

as “contributory negligence” that may apply in a civil lawsuit do not apply in a workers’ compensation

claim. An attorney can advise you regarding the many other differences between a civil lawsuit and a

workers’ compensation claim.

WHAT CAN I DO IF I DO NOT BELIEVE MY EMPLOYEE’S WORKERS’ COMPENSATION

CLAIM IS VALID?

If you doubt the validity of a workers’ compensation claim, then you may state your reasons on the

Employer’s Report of Industrial Injury form. You may also provide your insurance carrier with any

information or documentation you have to support your position. As a general rule, any action or

determination taken or made by the insurance carrier is binding upon the employer, except if the

employer provides written notice to the carrier and the Commission within the applicable protest period

that it disagrees with the carrier’s determination. If you were uninsured for workers’ compensation at the

time of the workers’ injury, then you may provide information or documentation regarding the validity of

the claim to the Special Fund Division/No Insurance Section. If you disagree with an acceptance of a

claim by the Special Fund, then you only have 30 days from the notice accepting the claim to file your

protest with the ICA. Other notices issued by the Special Fund may carry a shorter protest period.

SHOULD I HIRE AN ATTORNEY TO REPRESENT ME?

You should consult an attorney to answer any question you have concerning your liabilities and

obligations under the Workers’ Compensation Act. If you have workers’ compensation insurance, then

you should contact your insurance carrier to determine if they have assigned an attorney to handle a

particular workers’ compensation claim. If a claim is processed as a “no insurance” claim, then the

employer will be required to hire an attorney if the employer is a corporation or limited liability company.

Corporations and limited liability companies may not practice law in Arizona, nor be represented by an

officer or agent who is not otherwise an attorney licensed to practice in Arizona. The appearance and

practice before the ICA constitutes the practice of law.

WHAT IS THE INDUSTRIAL COMMISSION OF ARIZONA?

The Industrial Commission of Arizona (ICA) was created in 1925 as a result of legislation implementing

the constitutional provisions establishing Arizona’s workers’ compensation system. The ICA divisions

administer and enforce all applicable laws and regulations not specifically delegated to others, relative to

the protection of life, health, safety, and welfare of employees within the State. The ICA does not issue

workers’ compensation insurance policies. The ICA’s general number is (602) 542-4411. Additional

information and forms are available on the online at www.azica.gov.

WHAT ARE SOME OF THE DIFFERENT DIVISIONS AT THE ICA?

Ombudsman

The Ombudsman is available to offer assistance to injured workers in processing workers’ compensation

claims and to make referrals to other agencies when appropriate. The Ombudsman does not provide legal

advice.

Claims

The Claims Division regulates workers’ compensation insurance carriers and self-insured employers to

ensure that workers receive those benefits to which they are entitled under the Arizona Workers’

Compensation Act. The Claims Division also maintains the “file of record” for Arizona workers’

compensation claims, and in certain circumstances, is involved in claims processing (e.g. issuance of

Average Monthly Wage and Loss of Earning Capacity Awards).

Legal Division

The Legal Division represents the ICA in all legal matters affecting the agency in order to ensure that the

agency’s regulatory, enforcement and quasi-judicial mandates and functions are carried out in accordance

with all applicable laws.

The Special Fund

The Special Fund is a “trust fund” legislatively created for the express purpose of providing workers’

compensation benefits in limited areas. For example, the Special Fund Division/No Insurance Section

processes and pays workers’ compensation claims involving an uninsured employer. In certain cases, the

Special Fund may also provide vocational rehabilitation benefits, supportive care, and apportionment

benefits.

Administrative Law Judge Division (ALJ)

The ALJ Division resolves disputes in cases referred to it, including workers’ compensation and

occupational safety and health matters.

Occupational Safety and Health (ADOSH)

The Arizona Division of Occupational Safety and Health (ADOSH) enforces state occupational safety

and health regulations for both public and private employers within the state. ADOSH also provides free

consultation services for both public and private employers upon request.

CAN THE ICA GIVE ME LEGAL ADVICE?

No one at the ICA can give you legal advice. This includes ALJs, their secretaries, and other ALJ

Division staff. If an employee or a worker needs assistance regarding the processing of their claim, they

can contact the Ombudsman’s Office at (602) 542-4538. If you wish to obtain legal advice, then you

should consult a private attorney.

WHO CAN GIVE ME LEGAL ADVICE?

You may wish to consult a lawyer licensed to practice law in Arizona for legal advice about a workers’

compensation case. To find a lawyer, you can call the Maricopa County Lawyer Referral Service at 602-

257-4434 or the Pima County Lawyer Referral Service at 520-623-4625. The State Bar of Arizona does

not have a lawyer referral service but it can send you a list of lawyers who are certified as specialists in

workers’ compensation law. Specialists have been certified after an investigation of their qualifications

and experience. You can search for a certified specialist on the State Bar of Arizona’s web site at

www.azbar.org or by calling the Hotline for Certified Specialists at (602) 340-7300. You can also look in

the Yellow Pages of your telephone book under Attorneys or ask friends, family members, co-workers, or

colleagues who may have used a lawyer in the past.

HELPFUL CONTACT INFORMATION

Industrial Commission of Arizona

Website Address: www.azica.gov

Phoenix Office: 800 West Washington St.

P.O. Box 19070

Phoenix, Arizona 85005-9070

Claims: Main Number (602) 542-4661

Fax Number (602) 542-3373

Hearings (ALJ): Main Number (602) 542-5241

Fax Number (602) 542-4135

Ombudsman: Main Number (602) 542-4538

Toll Free (800) 544-6488

Safety & Health: Main Number (602) 542-5795

Labor: Main Number (602) 542-4515

Tucson Office: 2675 East Broadway Blvd.

Tucson, Arizona 85716-5342

Hearings (ALJ): Main Number (520) 628-5188

Safety & Health: Main Number (520) 628-5478

Arizona Department of Insurance

www.id.state.az.us

Phoenix Area: (602) 364-2499

Tucson Area: (520) 628-6370

Statewide: (800) 325-2548

State Bar of Arizona

www.azbar.org

4201 N. 24th Street, Suite 200

Phoenix, Arizona 85016-6288

602-252-4804

1-866-48-AZBAR (outside Maricopa County)

Maricopa County Lawyer Referral Service

www.maricopabar.org

602-257-4434

Pima County Lawyer Referral Service

520-623-4625

Arizona State Legislature

www.azleg.state.az.us

Arizona Secretary of State

www.azsos.gov

Rev. October 2011