Arizona Workers Compensation Questionnaire

State:
Multi-State
Control #:
US-Q1038
Format:
Word; 
Rich Text
Instant download

Description

This form addresses important matters that may effect the legal rights and obligations of the parties in a workers' compensation matter. This questionnaire enables those seeking legal help to effectively identify and prepare their issues and problems. Thorough advance preparation enhances the attorney’s case evaluation and can significantly reduce costs associated with case preparation.



This questionnaire may also be used by an attorney as an important information gathering and issue identification tool when forming an attorney-client relationship with a new client. This form helps ensure thorough case preparation and effective evaluation of a new client’s needs. It may be used by an attorney or new client to save on attorney fees related to initial interviews.


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FAQ

Compensation is payable every 14 to 30 days, depending on the type of disability. No wage loss benefit is payable for the first 7 consecutive calendar days, if total time lost is less than 13 consecutive calendar days. This waiting period occurs only once during a claim.

Workers' Comp Exemptions in Arizona. Sole-Proprietors and Partners who include themselves on workers' compensation coverage must use a minimum payroll amount of $31,200 for rating their overall workers' compensation cost.

The average monthly wage statutory maximum payment per month in 2023 for Arizona injured employees on workers' compensation is $5,393.37, up from $5,161.12 in 2022.

If you have an unscheduled injury that results in demonstrable wage loss, your benefits will equal 55 percent of the difference between your pre-and post-injury wages. Permanent total disability (PTD): The rate of these benefits will equal the rate of TTD benefits, or two-thirds of your past monthly wage.

In Arizona, workers' comp covers all medical expenses to heal the work-related injury or illness. It can also provide some of the missed wages when injured workers need time off to recover. Coverage requirements in Arizona say you must provide workers' comp for full-time and part-time workers.

§ 23-908(A) within eight days after first providing treatment to an injured worker. The physician shall report the injury: 1. Using Commission form 102 (worker's and physician's report of injury), or 2. Attaching to form 102 a medical report that contains the information required in form 102.

The employer and their insurance company want to pay the injured worker as little as possible. Once MMI is reached, the injured employee must choose between a final lump sum settlement or ongoing benefits. If they are offered a settlement, they must sign a release, forfeiting their rights to any future claims.

Compensation is calculated in three different ways for scheduled injuries: (1) For partial loss, you will receive 50% of the average monthly wage, (2) for a loss that is the result of an amputation or a total loss of use, you will receive 55% of the average monthly wage, and (3) if the doctor indicates that the ...

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Arizona Workers Compensation Questionnaire