So much of your general well-being depends on your relationship with your doctor.
That includes guidance toward overall wellness and treatment of acute injury or illness. If you suffer a work-related injury, you should receive the same level of treatment as you would for any other issue.
A new Arizona law signed in April 2021 allows private self-insured employers to direct care and permit mail-order pharmacy use for workers’ compensation claims.
Here’s how it works:
New Arizona workers’ comp law
New reimbursement guidelines now apply to medication that is dispensed from mail-order pharmacies that are not normally accessible to the general public, as long as the referring doctor does not receive any rebates, refunds, commissions, or other compensation for using that provider.
Under the new law, an employer that is self-insured may direct medical, surgical or hospital care for an injured employee. It could allow for a health care provider or pharmacy to form a separate contract that sets its own workers’ compensation fees, and the provider is reimbursed at a negotiated rate.
Choosing a doctor for an Arizona work-related injury
Each state has its own laws for workers’ compensation claims and benefits. Under Arizona law, your employer can require you to visit a specific doctor for a one-time evaluation if you suffer a work-related injury or illness. Once that doctor provides an evaluation, usually you can then choose your own doctor for treatment.
The exception is if your employer is self-insured and contracts care with a physician registered with the Industrial Commission of Arizona (ICA).
How important is your doctor in a workers’ compensation claim?
Very!
The opinion of the physician who oversees your treatment will be the biggest determinant of how much you can recover in benefits.
The physician will determine:
- How much time you need to recover (i.e. time off from work),
- The type of treatment you need, and
- Whether your injury is temporary or permanent.
What’s more, you have to see the doctor regularly to be entitled to workers’ compensation benefits. If you decide not to go to the doctor, your employer or their insurance company could argue that you’re disrupting your medical care willfully and refuse to pay you benefits.
Self-insured employers in Arizona
Most employers use a third-party insurance company for workers’ compensation. If a worker is injured, the insurance carrier pays for medical treatment and a portion of lost wages.
There are some large employers in Arizona that are self-insured. That means they pay their own workers’ compensation benefits and can have more control over the claims process. The employer — not the insurer — determines whether or not to approve a claim.
A large company might choose this option because if the amount they pay out in benefits is less than what they would pay in premiums to an insurance company, then the employer saves money.
This does have implications for the injured worker. The employer would be the deciding party for how payments are made for your benefits. In other words, the employer chooses which claims and treatments to approve or deny.
If your employer is self-insured, you need to file a Request to Change Doctors with the ICA. This will request permission from your employer to change doctors.
Why do you need a workers’ compensation lawyer?
You should know what you’re entitled to receive as part of your workers’ compensation claim.
First, understand that any illness or injury you suffered that happened either because of your work or while at work is covered under workers’ compensation.
There are 2 ways to look at this:
- “Because of your work” refers to an injury like carpal tunnel, hearing loss, neck or back pain, or other types of illnesses or injuries that are not the result of a specific accident but that are caused by how or where your job is performed.
- “While at work” means ANY injury — even if unrelated to your job duties — that happens while you’re on a work site or “on the clock” for work. In other words, if you trip and fall on a piece of loose carpet while in your office building, your injuries would qualify for workers’ compensation benefits.
If you’re injured in either of these 2 ways, these are the types of benefits you can expect to recover through an Arizona workers’ compensation claim:
- Medical treatment that’s reasonable and necessary
- Mileage reimbursement for medical appointments
- Wage loss benefits
- Temporary or permanent disability benefits (full or partial)
- Death benefits if you’re the survivor of a person who died from a work-related injury or illness
It’s just as important to have a lawyer who will advocate for your needs and ensure that you’re receiving the benefits that you’re entitled to under the law.
If you’re able to choose your own primary care provider for treatment under your workers’ compensation claim, they might not be as familiar with procedures and policies to present your diagnosis and treatment in a way that would result in the maximum amount of benefits.
And, if you are being treated by a doctor selected by your employer as a self-insured provider, the doctor is motivated to keep your employer’s costs as low as possible — and that can definitely affect your quality of medical care.
For these reasons and more, it’s important to consult with a legal professional who understands every aspect of the Arizona workers’ compensation system and who can stay current on changes to the laws and regulations.