There are several different issues that can arise in an Arizona workers compensation claim. Being able to identify these issues is usually the expertise of a workers compensation attorney. Knowing the difference is extremely important in deciding what evidence to submit, what witnesses to call, and what your burden of proof is. The main issues that we encounter are as follows:
1. Compensability - this refers to whether or not a claim is accepted as an industrial responsibility. For example, if a carrier denies the claim and you request a hearing, the issue at the hearing is compensability. Compensability cases usually have several sub-issues including forthwith reporting, pre-existing conditions, credibility of the witnesses, and many others.
2. Continuing benefits - a case goes to hearing on continuing benefits when it is an accepted claim that is subsequently closed out by the insurance carrier. If the injured worker disagrees with the closure, he or she requests a hearing arguing for continuing benefits. This always requires medical expert witness testmony to prove the need for additional active medical care.
3. Permanent impairment - when there is a dispute about either the existence of a permanent impairment or the extent of the permanent impairment in cases of scheduled injuries. Medical expert testimony is necessary.
4. Loss of Earning Capacity (LEC) - where an injured worker has sustained an unscheduled injury (see prior blog post about scheduled vs. unscheduled injuries) and there is a dispute about his post-injury earning capacity compared to what he earned prior to his injury. If there is a loss of earnings as a result of the injury, he may be entitled to permanent compensation benefits. Usually requires expert vocational testimony and sometime expert medical testimony if there is a dispute about restrictions.
5. Supportive Care - if there is a dispute about the sufficiency of the supportive care awarded by the carrier vs. that recommended by the treating doctor.
These 5 issues encompass about 95% of all hearings at the ICA (in my experience). There are, of course, other issues that rarely come up such as mileage reimbursement, choice of doctors, unpaid compensation, bad faith, and many others.
Chad T. Snow is an attorney who handles exclusively workers compensation claims in Arizona. He can be reached through his website at Snow, Carpio, and Weekley.