Workers Compensation matters in the state of Arizona are handled within Arizona's Industrial Commission. The Claims Division has the responsibility for the routine regulation of insurance carriers activities. The Claims Division gets claims from attending medical personnel and from workers who have suffered injuries while on the job site. The Claims Division is responsible for notification of the third party processing agent, insurance carrier, or self-insured employer so that the actual claim processing can occur. When such a claim is received, the Claims Division bears the responsibility of ensuring that the processing occurs in accordance with current and applicable State laws, policies and regulations.
Each day, the Claims Division processes over 6000 documents which range from bad faith or unfair claims processing practices to loss of earning capacity,to average wage per pay period, to primary physician change requests and to providing approval of claimants requesting a move out of the State of Arizona.
The inevitable disputes that arise from insurance carriers, employers and claimants all seeking conflicting goals are resolved in the second of the two workers compensation divisions in the State of Arizona--the Administrative Law Judge, commonly known as the Hearing Division. This administrative office deals with a number of issues, ruling on such questions as the loss of capacity for earning, reopening of old claims, supportive care for injured workers families, continuation of benefits, and a determination of whether a claim can be compensated and to what extent or financial level.
In the State of Arizona, workers compensation is administered under a 'no fault' protocol so that employees who are injured on the job are furnished with compensation and medical benefits as needed, regardless of who was the cause of the job site accident or illness.
In the case of an accident or illness which is job related, the injured employee--called an applicant or claimant is provided with medical assistance and may get compensation for lost wages. The eligibility requirements must be met before the benefits are paid, and the compensation is intended to be temporary. Depending on the nature of the injury and the potential for an eligible claimant to recover from the accident or injury, there is the potential for the claimant to get compensation benefits that are permanent. In this instance, the worker may be offered the opportunity to acquire job retraining, so as to fit them for an appropriate alternative job.
In Arizona, issues of compliance and safety in the workplace is handled by a separate division of the Industrial Commission of Arizona. Compliance is largely emphasized through the practice of unannounced visits to employer work sites by field inspectors associated with the Industrial Commission. The purpose of these visits is to assure compliance by employers with the Occupational Safety and Health Act. Inspections may be a follow up for a complaint filed by someone. They may be a follow up to check that compliance issues raised in previous inspections have been corrected. The visit may be a planned and scheduled visit. Finally, a visit to the work site may be a response to a growing or large number of claims by workers. A complaint or referral resulting in an unscheduled or scheduled inspection tour of the facility almost always comes from another government agency. Inspections which are planned or scheduled tend to be those considered hazardous or resulting from an employer who has had a significant number of workers compensation claims.
Arizona is the only state that requires an independent body to review the penalty proposal appropriateness. This leads to a tighter watchdog control over the privacy and a willingness to review the current program for issues of noncompliance.
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