When and How Compensation is Paid

When a worker is entitled to workers' compensation, the worker may receive medical coverage for treatment, procedures and medical expenses resulting from the injury (doctor visits, nurses, hospital services, medicines, surgical supplies, crutches, artificial limbs, funeral expenses). A worker who misses more than 7 days from work will receive a percentage of wages lost for the time the worker was not able to work because of the injury. Even travel expenses for medical treatment may be paid in some cases. A worker who misses 14 days or more will be entitled to compensation from the first day missed, but if the worker misses less than 14 days, the worker will be entitled to compensation for only those days after the 7th day. AN INJURED WORKER WHO IS ENTITLED TO WORKERS' COMPENSATION DOES NOT RECEIVE ANY MONEY FOR PAIN AND SUFFERING OR OTHER DAMAGES GENERALLY RECOVERED IN "COMMON LAW" LAWSUITS.

Average Monthly Wage (AMW)

The AMW is first recommended by the carrier/employer and then "independently" set by the ICA. Both the carrier/employer and the worker have 90 days to protest the ICA wage determination. The AMW is very important since it is the basis for determining the amount of benefits that the worker may receive during the various stages of compensation and is the basis for determining a loss in earning capacity. The AMW generally includes overtime, food, lodging, tips, uniforms and may include other benefits which the worker receives through their employment. If the employee had more than one job at the time of the injury, the old rule was that the employee could only add "similar" employments together to determine his or her AMW. After March 1993 any employee whose AMW determination is not yet final may add the AMW of all jobs together where he or she was working at the time of the injury to determine the AMW to be used in his or her claim. Generally, the most accurate wage is the amount earned in the 30 days before the injury, but other periods may be used if they are more representative of the correct wage.

A maximum monthly wage is set by law so that even if a worker actually earns more than the maximum at the time of injury, the worker would only receive a percentage of the maximum, not the actual wages earned. The maximum limit depends upon the date of the injury.

Injuries before 8/27/77 $1,000 maximum
Injuries 8/27/77-7/30/80 $1,250 maximum
Injuries 7/31/80-12/31/87  $1,325 maximum
Injuries 1/1/88-6/30/89 $1,650 maximum
Injuries 7/1/89-6/30/91 $1,800 maximum
Injuries 7/1/91-8/5/99 $2,100 maximum
Injuries 8/6/99 and after $2,400 maximum

Remember that THE BURDEN IS ON THE WORKER, not the employer, the insurance carrier or the ICA, TO INVESTIGATE THE ACCURACY OF THE AMW. If you believe the wage should be set higher, contact your employer, the insurance carrier or the ICA and write down the name of the person you talk to and the date you spoke to them and what they said or, better yet, send in your questions in writing and demand they reply in writing. If you are still not sure after investigating the correctness of the wage, consult with the Ombudsperson at ICA (phone (800) 544-6488) or talk to an attorney!

THE WORKER MUST PROTEST AN INCORRECT AMW BY FILING A WRITTEN REQUEST FOR HEARING WITH THE ICA WITHIN THE PROPER DEADLINE. IF THE WORKER DOES NOT PROTEST AN INCORRECT AMW, THE AMW MAY BE FINAL AND WILL AFFECT BENEFITS EVEN IF IT IS WRONG!! The only exception to the above involves the AMW of minors who have suffered a permanent disability as a result of their injury. (Minors are workers under 18 years of age at the time of injury.) Those minors may have their AMW reset based on what they "probably would have earned" as adults. IF YOU HAVE ANY QUESTIONS ABOUT THE AMW, YOU SHOULD CONTACT AN ATTORNEY.

Stages of Workers' Compensation

For workers with serious injuries, with time lost or permanent disability, generally speaking, there are three stages of workers' compensation benefits:

Temporary Total Disability

At this stage, the worker receives active medical treatment for the injury and is not released by any doctor to return to any kind of work. The worker is entitled to receive a check every two weeks for 66 2/3% of the "average monthly wage" at the time of the injury plus a dependent's allowance of $10.00 per month for injuries before 12/31/90 and $25.00 for injuries after 12/31/90. (The allowance is the same whether there is 1 dependent or 10 dependents.) The question of whether there are "dependents" is determined at the time of injury. For injuries after 12/31/90, it is no longer necessary that the dependent's only source of income be from the injured worker.

Temporary Partial Disability

The worker enters this stage of workers' compensation when a doctor releases the worker to return to some type of work. During this stage, the worker still receives active medical care and may also receive a check once a month. The amount of this check will be 66 2/3% of the difference between the "average monthly wage" at the date of injury and what the worker is able to make after being released to work. These payments are not automatic. The worker has to look for work or face the possibility that the employer/carrier will claim that no compensation is due because jobs were available and the worker could have worked if they had looked for work.

Closure/Permanent Disability

Once a medical evaluation determines that no further active medical treatment will improve the worker's condition, the case may be closed with the worker's injury considered "stationary." At this point, the doctor will also determine whether or not the worker has any "permanent disability" or impairment.

Once the injury becomes "stationary" and a physician determines that there is not going to be a total recovery, or there are some permanent restrictions from the injury, some percentage of permanent disability should be assigned by that physician. There are two types of permanent disabilities in Arizona ("scheduled" and ''unscheduled'') and they are treated differently for purposes of payment. (For more information see the section "Types of Disabilities.")