What Does Arizona Workers’ Compensation Insurance Cover?

Workers’ compensation is a type of insurance that pays benefits to employees who suffer work-related injury or illness. To the extent that it applies, workers’ compensation replaces the personal injury compensation system used by people whose injuries are not work-related. It is a simplified administrative remedy designed to prevent courts from being clogged with injured workers seeking compensation. 

How Workers’ Compensation Differs From Ordinary Negligence Claims

How Workers’ Compensation Differs From Ordinary Negligence Claims

The upside to workers’ compensation is that, unlike a negligence claim, you don’t have to prove your employer was at fault to win. In most cases, you can qualify for compensation even if you claim for an accident that was your fault. 

The downside is that benefits are very limited compared to personal injury damages. You can claim only a portion of your lost earnings, and you cannot seek non-economic damages such as pain and suffering.

Workers’ Compensation Benefits

Every Arizona employer must carry workers’ compensation, even if they employ only a single part-time worker. Arizona workers compensation offers you the following benefits:

  • All ‘reasonable and necessary’ medical expenses
  • Wage replacement equal to two-thirds of your average wage, up to a maximum of $5,663.04 per month (as of 2024)
  • Death benefits to your family, if you die from a work-related event, process, or injury. 
  • Temporary disability benefits, if you cannot work (or if you must accept lower-paying work) while you recover
  • Permanent disability benefits if you suffer from long-term diminished earning capacity.
  • Vocational rehabilitation to help you return to work, particularly if your injury forces you to change careers.

You might also qualify for other benefits, depending on your case’s circumstances.

Exempt Workers

The following workers are exempt from mandatory workers compensation coverage:

  • Sole proprietors and independent contractors–a freelance plumber with no employees, for example. Coverage is still available if you work in a hazardous environment.
  • Domestic workers employed in a private home–a housekeeper, for instance.
  • Casual workers employed in jobs that are not in the usual course of the employer’s business. A homeowner might hire a teenager to mow his lawn, for example.
  • Members of an LLC (under most circumstances).
  • Corporate officers (under most circumstances). Coverage is still available if you work in a hazardous environment.

When in doubt, make sure you are covered. Talk to your lawyer if you are unsure whether you can or should seek coverage.

Arizona workers’ compensation covers only work-related injuries or illnesses. An injury can be ‘work-related’ under various circumstances. You need medical evidence that your injury or illness was work-related. You must also comply with strict deadlines for reporting an incident and filing a claim.

What Types of Maladies Trigger Workers’ Compensation Coverage?

Arizona workers’ compensation covers all sorts of work-related injuries and illnesses. Following are some examples.

Sudden Physical Injuries

Suppose your hand gets sucked into factory machinery, causing you to lose three fingers. Sudden physical injuries are the easiest type of injury to prove because the link between your injury and your work environment is typically obvious. 

Occupational Illnesses

Occupational illnesses arise gradually from long-term exposure to dangerous work environments. Occupational illnesses include:

  • Respiratory diseases, such as COPD, caused by inhalation of dust, fumes, and other toxins in the workplace.
  • Hearing loss resulting from exposure to loud noise.
  • Skin disorders such as rashes, dermatitis, or other skin conditions caused by contact with workplace irritants.
  • Occupational cancers caused by exposure to carcinogens such as asbestos, benzene, or radiation.
  • Repetitive stress injuries like carpal tunnel syndrome, tendonitis, or back pain caused by repetitive motions.
  • Neurological disorders such as Parkinson’s disease from exposure to chemicals.

This list is far from complete. Many other illnesses can be classified as ‘occupational’ depending on the nature of your work environment.

Stress-Generated Physical Illnesses

In Arizona, workers’ compensation can recognize claims for physical illnesses caused by emotional stress at work, such as:

  • Heart attack
  • Stroke
  • Ulcers
  • High blood pressure
  • Weakened immune system
  • Migraines

These cases are hard to win. You must demonstrate that your mental health condition or physical illness resulted from ‘unexpected, unusual, or extraordinary stress’ related to your job. 

In other words, ordinary work stress will not justify compensation for stress-generated physical illness. Keep in mind, however, that Arizona law does not require first responders (paramedics, police, and others) to prove unexpected, unusual, or extraordinary stress. 

The following mental health conditions frequently arise from work-related injuries;

  • Depression
  • Anxiety
  • Post-Traumatic Stress Disorder (PTSD)
  • Adjustment Disorder
  • Substance Abuse Disorders

It can be challenging to win a workers’ compensation claim for a mental health disorder arising from a physical injury. Typically, the greatest challenge is proving that the physical injury caused the mental health disorder. Even failure to prove the connection, however, won’t stop you from recovering compensation for the physical disorder.

The Effect of a Pre-Existing Condition

Suppose you suffer a back injury at work that worsens your pre-existing back injury. The mere existence of a pre-existing injury does not doom your claim for workers’ compensation. 

It is likely, however, that the value of your claim will reflect not the value of your entire condition, but only the extent to which your workplace injury worsened that malady.

Escaping Workers’ Compensation Limitations: Third-Party Personal Injury Lawsuits

Suppose, for example, that you fall into a trench on the construction site where you work, and you break your hip. Further suppose that a third party, not your employer, owns the site where you fell and that the open trench was a consequence of the owner’s negligence. 

Even though you were injured on the job, you probably have a third-party personal injury claim. You also have a claim if you were injured by third-party negligence on your employer’s property. 

If you have a third-party personal injury claim, you can bypass the workers’ compensation system and proceed directly to file a lawsuit against the third party. You can also use the threat of a lawsuit to open negotiations with the third party. 

Unlike the situation with workers’ compensation claims, you will need to prove that the third party was at fault to win. The good news is that you can demand much higher compensation than any amount available for workers’ compensation claims, including for your pain and suffering. 

The Statute of Limitations

You have only one year from the date of your injury, or from the date that you discovered or should have discovered your claim, to file a workers’ compensation claim. It’s also best to notify your employer as soon as you can after the accident.

Talk to a Phoenix Workplace Accident Lawyer

The Arizona workers’ compensation system is a maze of confusing regulations. If you have a valid claim, even an innocent error could cost you a lot of money. That is exactly why you need to discuss your claim with an experienced Phoenix workplace accident lawyer. Consult a skilled personal injury attorney at (602) 595-5559 if you believe you have a valid claim.