Workers Compensation Claim Denied In Arizona

Workers’ Compensation Claim Denied In Arizona

In the state of Arizona, employers are required to carry workers’ compensation insurance to cover workplace injuries. An accepted claim will pay for your medical expenses and wages lost due to your injury. Claims are denied for various reasons. It is important to have an experienced and compassionate workers’ compensation attorney to fight the denial of your claim. 

Workers' Compensation Law in Arizona

The Industrial Commission of Arizona (ICA) resides over all workplace injury claims in the state of Arizona. Employers are required to provide workers’ compensation insurance to cover their employees in the event they are injured or become ill while at work. If you are injured or become ill at work, you must report your injury or illness to your manager or supervisor, preferably in writing, so that they can inform their insurance provider and the Industrial Commission of Arizona. You will also need to submit a Worker’s Report of Injury to the Industrial Commission of Arizona. You only have a year from your date of injury to file a claim. Once the ICA receives your Worker’s Report of Injury, they will notify your employer’s workers’ compensation company, and the ICA will send a letter to you with the name of the insurance company. Once the insurance company is notified of your claim, it is their obligation to accept or deny your claim within 21 days from the date of notification. If the insurance company fails to issue a Notice of Claim Status accepting or denying your claim within 21 days of notification, you may be entitled to penalty benefits. 

If your employer’s workers’ compensation insurance company denies your claim, you have 90 days from the mailing date of the Notice of Claim Status denying your claim to file a Request for Hearing with the ICA. If a request for hearing is filed, you will receive a Notice of Hearing providing you the date, place, and time of the hearing. It is important to have an experienced workers’ compensation attorney to help you navigate a denied claim. 

There are various reasons your claim could be denied. 

Why Your Claim Could be Denied:

• There Were No Witnesses: A claim can be denied by the insurance company if there were no witnesses to your workplace accident.
  

• Pre-Existing Condition: If you have a pre-existing health condition that the insurance company believes caused your injury or illness, they can deny your claim. 
  

• Accident Away from the Workplace: If the injury occurred away from the jobsite or office, the insurance company can claim that the injury was not work related. 
  

• Independent Contractor: If you are a freelance contractor then you may not be eligible for regular employee benefits. However, employers can “disguise” workers as “independent contractors.” Receiving a 1099 does not automatically qualify you as an independent contractor. A balancing test must be utilized to determine if you are an independent contractor or an employee. 
  

• Employee Misconduct: Fault is not a determining factor in workers’ compensation cases. An injured caused by your own misconduct is compensable unless the injury itself is self-inflicted or the misconduct interrupts the course of employment. 
  

• Employer Dispute: Your claim can be denied if your employer disputes the facts surrounding your claim. 
  

• Injury Reported Late: If your injury was not reported immediately to your employer / supervisor, then your claim can be denied. 
  

• Claim Not Filed In Time: If your claim was not filed in a timely manner, then your employer’s insurance company may deny your claim. 
  

Your claim being denied does not mean the process is over. You have every right to appeal your denied claim. You need to discuss this appeal with an attorney to make sure you have the best chance possible to overturn the insurance company’s denial. 

How Fendon Injury Law Can Help

At Fendon Injury Law in Phoenix, Arizona, we have over 40 years of combined experience in Arizona Workers' Compensation Law. We offer a free case evaluation so that we can provide you with the best advice possible in overcoming the denial of your claim. Contact us today!