This is an official Workers' Compensation form for the state of Arizona.
Phoenix Arizona Medical Report for Workers' Compensation
Category:
State:
Arizona
City:
Phoenix
Control #:
AZ-110-WC
Format:
Word;
PDF;
Rich Text
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Description
How to fill out Arizona Medical Report For Workers' Compensation?
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FAQ
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.
While a worker must be out of work for at least 8 days before being eligible, after a certain amount of time he or she may also be able to retroactively replace wages that were lost within the first 7 days as well.
If you have a scheduled injury, you will receive between 50 and 75 percent of your pre-injury wages for a certain number of months. The percentage you receive is based on the extent of the injury, while the state schedule designates the duration of benefits.
Accident at work claim can take 6 to 9 months to reach a final settlement. Slip, trip and fall claims can take anything from 6 to 9 months to reach a settlement. Industrial disease claims can take anything from 12 to 18 months to reach a final settlement.
Claims - Filing a Claim It is the injured worker's responsibility to file a claim within one year of the date of injury. The injured worker should also notify the employer as soon as possible that a work-related injury has occurred.
Temporary Total Benefits Min: $200/month Max: $5161.12 per month effective 1/1/2022 7 day waiting period with retro benefits paid if more than 14 days lost. Benefits paid bi-weekly. Unlimited benefits.
Workers' compensation only provides payment for lost wages and medical expenses related to your workplace injury. However, there are a few exceptions that do allow an injured worker in Arizona to pursue a civil lawsuit and seek compensation for pain and suffering, as well as other damages.
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.
Workers' compensation benefits, including lost wages, continue while a worker is on light duty. The lost wages benefit is reduced if the person is working to 66 2/3 percent of the difference between what the worker earns on light duty and the average monthly amount earned before the injury.