Having successfully represented carriers, employers, third-party administrators and municipalities in defending workers' compensation cases, our lawyers realize how complicated the hearing process can be for our clients.
Lundmark, Barberich, LaMont, & Slavin, P.C., can help you understand the hearing process and ensure that the correct legal steps are taken to preserve your rights and your best interests.
1. Response to Claim Notification
Upon receipt of a claim, the Industrial Commission will send a formal notification to the carrier. The carrier has 21 days from the date of the notification to issue a notice of claim status which either accepts or denies the claim for benefits. Failure to timely issue a notice subjects the carrier to certain penalty benefits under A.R.S. §23-1061(M).
2. Response to a "J" Charge
At any time while a claim remains open for benefits, the claimant can file a request for hearing under A.R.S §23-1061(J) alleging the carrier has failed to pay appropriate temporary compensation or medical benefits, refused to authorize needed medical treatment, etc. Upon receipt of this type of claim, the Industrial Commission will notify the carrier and demand that the carrier provide a response within 10 days.
3. Retroactivity Rule
After a claim has been accepted, any subsequent notices can be retroactive for no more than 30 days. As an example, assume the claims handler receives a medical report which discharges the claimant on August 1. Assume further that the claims handler takes no action on the report until October 1. Due to the retroactivity rule, the earliest date upon which the claim can be closed is September 1. The retroactivity rule does not apply to the initial notice which accepts the claim.
4. Entitlement to Permanent Disability Benefits
In the event a claim is closed with permanent disability, the nature and amount of permanent benefits will depend upon whether the claimant sustained a scheduled or unscheduled permanent disability. With certain exceptions, a claimant with a scheduled disability is entitled to one specific amount of money which is controlled by statute. In the case of an unscheduled disability, permanent benefits are payable only if the claimant sustained a loss of earning capacity.
5. Reopening Rights
Any claimant who has a compensable claim has a potential lifetime right to file a petition to reopen the claim. To do so, the claimant must produce medical evidence that since the date the claim was last closed, that claimant has developed objective evidence of a new, additional, or previously undiscovered condition related to the injury. If the claimant is successful, the claimant again will be entitled to appropriate temporary compensation and medical benefits until such time as the condition again has become stationary. In the case of an unscheduled disability, the claimant's entitlement to permanent benefits must be reassessed at this point because the claimant's earning capacity may be different now than it was at the time of the initial closing.
6. The Hearing Process
When either party files a Request for Hearing, the Claims Division of the Industrial Commission will refer the matter to the Chief Administrative Law Judge. The Chief Administrative Law Judge will, in turn, assign the matter to one of the judges. Thereafter, the presiding judge will schedule the matter for hearing.
Typically, particularly in the case of a medical dispute, the presiding judge will hold three separate hearings before the matter is submitted for a decision.
Once the decision has been entered, either party has 30 days to file a request for review. Thereafter, the judge will reconsider the original decision and then either affirm or reverse it.
Should either party be dissatisfied with the judge's decision upon review, the party may then file a petition for special action with the Court of Appeals.