How to Handle Denied Workers’ Compensation in Arizona?

Facing denied workers’ compensation due to technicalities or misunderstandings in Arizona? You’re not alone. Knowing the law is crucial to tackling these challenges. This article explores a pivotal court ruling to guide you through potential solutions.

Case No. CV-99-0076-PR Situation

Specific Circumstances

In Arizona, there was an incident involving a worker who fell through a roof while he was on the job. This worker, whom we will call the plaintiff, decided to file a workers’ compensation claim. His goal was to get some help for the injuries he suffered from the fall. However, things got complicated. The company he worked for did not have insurance, and they even said they didn’t have any employees. Because of this, the Special Fund Division of the Arizona Industrial Commission, which is the state agency that deals with these cases, denied his claim. To make matters worse, the plaintiff was accused of being drunk at the time of the accident. This accusation was a big reason why his claim was initially denied.

Plaintiff’s Claim

The plaintiff, who was hurt and couldn’t go back to work, argued that he should still get workers’ compensation benefits. He said the claim of him being drunk wasn’t true and that denying his claim was not fair. After his claim was rejected, he tried to make a settlement with the homeowners where he fell, hoping to get some money to help him out. The plaintiff thought he did everything right by getting his employer’s approval for the settlement, but he didn’t ask the Special Fund for their approval.

Defendant’s Claim

The Special Fund Division, which represents the defendant, said that the plaintiff lost his right to get workers’ compensation benefits because he didn’t get their written approval before making a deal with the homeowners. This deal was for less money than what his workers’ compensation claim was worth. They said that not getting this approval was against the Arizona statute A.R.S. § 23-1023(C), and that’s why his benefits were denied.

Judgment Outcome

The court decided that the plaintiff should not lose his workers’ compensation benefits just because he didn’t get written approval for his settlement. The court said that it was up to the compensation provider to prove that the settlement was too low. Since they couldn’t prove that, the court adjusted the provider’s credit to match a reasonable settlement amount. This decision meant the plaintiff could keep his rights to compensation benefits.

Solution

Immediate Actions

If you find yourself in a situation similar to the plaintiff’s, the first thing you should do is gather all relevant documents. This includes any correspondence with your employer, medical records, and evidence that supports your claim, like witness statements or photos from the accident scene. It’s important to act quickly, as there are often deadlines for filing claims and appeals. If your claim is denied, you should request a detailed explanation for the denial. This will help you understand the specific reasons and prepare a response or appeal.

Filing a Claim and Submitting a Petition

When you’re ready to file your claim or petition, make sure you fill out all forms accurately and completely. Missing information can delay the process or lead to a denial. If you’re unsure about any part of the form, it’s better to ask for help than to guess. Once the forms are filled out, submit them to the appropriate agency or court. Keep copies of everything you submit for your records. If your claim involves a third-party settlement, remember to get written approval from the compensation provider to avoid issues later on.

Negotiation and Settlement Strategy

When negotiating a settlement, it’s crucial to be reasonable and realistic about the amount. Consider consulting a lawyer who specializes in workers’ compensation cases. They can provide valuable insights and help you navigate the legal system. If you’re negotiating on your own, be sure to document all offers and counteroffers in writing. If you reach a settlement, ensure that all parties involved sign a written agreement. This protects you if any disputes arise later.

FAQ

What Is A.R.S. 23-1023?

A.R.S. 23-1023 is an Arizona statute that allows a worker to sue third parties responsible for their work-related injuries. This means that if someone other than your employer caused your injury, you can go after them for compensation.

What Is a Third Party Claim?

A third-party claim means you’re asking for compensation from someone other than your employer or coworkers. This usually happens when another person or company is responsible for your injury.

What Is Forfeiture?

Forfeiture means losing your right to workers’ compensation benefits because you didn’t follow the rules, like not getting approval for a settlement.

Who Approves Settlements?

The compensation fund or the person responsible for paying your claim has to give you written approval for any third-party settlements you want to make.

What If There’s No Approval?

If you don’t get approval for your settlement, you might lose your workers’ compensation benefits. However, you can argue that your settlement was reasonable to try and keep your benefits.

What Is Provider Credit?

Provider credit is the amount the compensation provider can offset against the money you got from a third-party settlement. It helps balance out the total benefits you receive.

How Does Intoxication Impact Claims?

Being intoxicated at the time of your injury can be a reason to deny your workers’ compensation benefits, as seen in the Bohn case.

What Is the Special Fund?

The Special Fund is part of the Industrial Commission of Arizona. It deals with claims that involve employers who don’t have insurance.

How to Appeal a Decision?

To appeal a decision, you can ask for special action relief in the court of appeals. This means you’re challenging the decision made by the administrative law judge.

What Is a Workers’ Comp Claim?

A workers’ compensation claim is when an employee asks for benefits because they got hurt while working. These benefits help cover medical bills and lost wages.