Workers’ Compensation
Insurance
EMPLOYERS’
FREQUENTLY ASKED
QUESTIONS
Rev. 11/2015 yb
1
INTRODUCTION
This information is intended to provide employers with a basic overview
of the workers’ compensation system in Arizona. The information
provided does not cover every aspect of workers’ compensation law.
There are often exceptions to general rules, unsettled areas of law, and
recent changes in the system. Therefore, it is strongly recommended that
you consult with an attorney for competent and comprehensive advice
based on your individual business or the facts of your particular legal
issue. Additionally, information regarding any aspect of other non-
workers’ compensation law related or applicable to an
employer/employee relationship or otherwise enforced by the ICA is not
addressed herein.
WHAT ARE THE LAWS AND RULES THAT GOVERN WORKERS’
COMPENSATION?
Workers’ compensation is governed by the laws found in Article 18,
Section 8 of the Arizona State Constitution, Chapter 6 of Title 23 of the
Arizona Revised Statutes (A.R.S. § 23-901 et seq., also sometimes
referred to as “the Act”) and Workers’ Compensation Practice and
Procedure rules contained in the Arizona Administrative Code (A.A.C.
R20-5-101 et seq.). All parties to a workers’ compensation claim should
familiarize themselves with these provisions of law. You can obtain
copies free of charge at either Industrial Commission office. Copies may
also be available for the cost of copying at county law libraries and many
local libraries including the Maricopa County Superior Court Law
Library located at 101 West Jefferson Street, East Court Building, first
floor, Phoenix, Arizona. The Arizona State Constitution and statutes are
available on-line at www.azleg.gov. The rules are available online at
www.azsos.gov.
WORKERS’ COMPENSATION INSURANCE
Under Arizona law, it is mandatory for employers to secure workers’
compensation insurance for their employees. Workers’ compensation is
a “no fault” system in which an injured employee is entitled to receive
benefits for an industrial injury, no matter who caused the job-related
accident. If an illness or injury is job-related, then the injured worker
(also known as a claimant or applicant) receives medical benefits and
may receive temporary compensation, if eligibility requirements are met.
In some cases, a claimant may also receive permanent compensation
benefits, “job retraining,” and supportive medical care.
2
WHAT IS A “NO FAULT” SYSTEM?
Workers’ compensation is a “no fault” system in which an injured
employee is entitled to receive medical and compensation benefits no
matter who causes the job-related accident. This means that even if the
employee was at fault or partially at fault in causing the industrial injury,
he/she will, in most instances, be entitled to benefits under the workers’
compensation system. There are some exceptions, however. For
example, an employee is not entitled to workers’ compensation benefits
for injuries that are “purposely self-inflicted.”
HOW CAN I OBTAIN WORKERS’ COMPENSATION INSURANCE
FOR MY EMPLOYEES?
Workers’ compensation insurance can be obtained from an insurance
company licensed to issue workers’ compensation insurance in the State
of Arizona. For a listing of these companies you may contact the
Arizona Department of Insurance at (800) 325-2548 or
www.azinsurance.gov. Employers who meet certain requirements can
also apply to the ICA for permission to be self-insured for workers’
compensation. Once an employer obtains insurance or authority to self-
insure, the employer is required to post a notice of workers’
compensation insurance advising their employees of the coverage and of
the employee’s right to reject this coverage. The employer is also
required to supply “rejection” forms for employees who chose to reject
their employer’s workers’ compensation coverage.
AM I REQUIRED TO HAVE WORKERS’ COMPENSATION
INSURANCE IF I HAVE ONLY ONE WORKER OR PART-TIME
WORKERS?
If an employer regularly hires workers in its customary business then the
employer is required to carry workers’ compensation insurance
regardless of the number of workers they have, whether those workers
are part-time, full-time, minors, aliens, or family members. Workers’
compensation insurance is not required for an independent contractor, or
a worker whose employment is both casual and not in the usual business
of the employer. Also, workers’ compensation insurance is not required
for a domestic servant who works in your home.
3
AM I REQUIRED TO HAVE WORKERS’ COMPENSATION
INSURANCE IF I AM A SOLE PROPRIETOR?
Although a sole proprietor having no employees is not required to
maintain workers’ compensation insurance on himself/herself, the sole
proprietor may elect to secure coverage for himself/herself. However, if
there are any employees working for the sole proprietor, the sole
proprietor must maintain workers’ compensation insurance on them.
AM I REQUIRED TO HAVE WORKERS’ COMPENSATION
INSURANCE IF MY BUSINESS IS A CORPORATION?
A corporation is an employer under the Act and, therefore, must obtain
workers’ compensation insurance for its employees which may include
officers, directors or shareholders.
AM I REQUIRED TO HAVE WORKERS’ COMPENSATION
INSURANCE IF MY BUSINESS IS A LIMITED LIABILITY
COMPANY (L.L.C.)?
If an L.L.C. employs one or more employees, an L.L.C. is required to
obtain workers’ compensation insurance for its employees. Employees
may include members and managing members.
CAN AN EMPLOYEE ELECT NOT TO BE COVERED UNDER MY
WORKERS’ COMPENSATION INSURANCE?
An employer may not require the employee to waive rights to workers’
compensation as a condition of employment, nor require an employee
pay any portion of the employer’s workers’ compensation insurance
premium. An employee may, however, voluntarily reject workers’
compensation insurance by providing a written notice to the employer
which the employer files with his workers’ compensation insurance
carrier. In most instances, this rejection must be filed before the
employee suffers an industrial injury. An employee may also later
rescind that rejection in writing but must do so before the occurrence of
an industrial injury.
4
AM I REQUIRED TO HAVE WORKERS’ COMPENSATION
INSURANCE IF I HIRE AN INDEPENDENT CONTRACTOR AND
HOW DO I KNOW IF A WORKER IS AN INDEPENDENT
CONTRACTOR?
Generally, you do not have to provide workers’ compensation insurance
for an independent contractor. But, there are often disputes over whether
a worker is an employee or an independent contractor. To resolve these
disputes courts consider the “totality of facts” on a case-by-case basis.
Some of the factors a court might consider include: the duration of the
employment, the method of payment, the right to hire and fire, the extent
to which the employer may exercise control over the work, who supplies
the tools, who sets the hours of work, and whether the work was
performed in the usual and regular course of the employer’s business.
There may be other factors the court will consider and no one factor is, in
itself, conclusive. Therefore, even if you believe you have an
“independent contractor” relationship, a court could still decide that
based on the totality of the facts, the worker was an employee entitled to
workers’ compensation benefits.
WHAT DO I DO IF AN EMPLOYEE IS INJURED ON THE JOB?
Immediately upon notice of an industrial injury, an employer is required
to provide certain information to the injured worker who reports the
injury. This information includes the name and address of the workers’
compensation insurance carrier, the policy number, and the date of
expiration of coverage. An employer is also required to notify their
workers’ compensation insurance carrier and the Industrial Commission
of Arizona within ten days after receiving notification of a work related
injury or disease using the Employer’s Report of Industrial Injury form
which is available from the ICA and online at www.azica.gov. For
fatalities, an employer is required to notify the ICA Claims Division
immediately by telephone or telegraph. Other reporting obligations are
required under the Arizona Occupational Safety and Health Act, but are
not addressed here.
CAN I TELL MY EMPLOYEE WHICH DOCTOR TO SEE?
An employer can direct an injured employee to a physician of the
employer’s choice for a one-time evaluation. Following that visit, the
injured worker may return to that physician or pursue treatment with a
physician of his/her choice. There are exceptions to this rule for a self-
insured employer that has complied with the requirements of A.R.S. §
23-1070.
5
WHAT WILL HAPPEN IF I DO NOT HAVE INSURANCE AND MY
EMPLOYEE CLAIMS A WORK RELATED INJURY?
If an employee is injured but you do not carry workers’ compensation
insurance, your employee can choose to file a civil suit against you or file
a workers’ compensation claim with the ICA. If the employee files a
civil lawsuit, proof of the injury is evidence of negligence on the
employer’s part. If an employee chooses to file a claim with the ICA, it
will be referred to the Special Fund Division/No Insurance Section. The
Special Fund will process the injured worker’s claim and pay medical
and compensation benefits if the claim is accepted. The Special Fund
will seek reimbursement from the uninsured employer for any benefits
paid to the injured worker plus a penalty of 10% of the benefits paid or
$1,000, whichever is greater (and interest on the total).
IS THERE A FINANCIAL PENALTY IF I DON’T HAVE REQUIRED
WORKERS’ COMPENSATION INSURANCE?
Subject to limited exceptions, an uninsured employer may be assessed a
civil penalty of $1,000 for failure to obtain workers’ compensation
insurance, whether or not an employee files a workers’ compensation
claim. The penalty is increased to $5,000 for a second instance of being
uninsured within a five-year period and $10,000 for a third instance in a
five-year period.
CAN MY BUSINESS BE SHUT DOWN IF I DON’T HAVE
REQUIRED WORKERS’ COMPENSATION INSURANCE?
An employer that fails to obtain the required workers’ compensation
insurance is subject to an action by the ICA for an injunction (Superior
Court Order) that will require the employer to cease the operation of
business until the employer complies with the requirement to maintain
workers’ compensation insurance for its employees.
AM I COMMITTING A CRIME IF I DON’T HAVE REQUIRED
WORKERS’ COMPENSATION INSURANCE?
An employer that does not carry workers’ compensation insurance is
guilty of a Class 6 felony. A.R.S. § 23-932.
6
CAN AN EMPLOYEE SUE ME IN CIVIL COURT IF HE/SHE IS
INJURED ON THE JOB?
In most instances, workers compensation is the exclusive remedy against
an employer that is insured for workers’ compensation. However, if an
employee has rejected workers’ compensation coverage prior to their
injury or if the employer fails to post the notice advising an employee of
the right to reject workers’ compensation, then the employee retains the
right to pursue a civil lawsuit against the insured employer. Additionally,
if an employee is injured through the “willful misconduct” of the
employer or a co-worker, then the injured worker has the right to file a
civil lawsuit against the employer and the co-worker who injured them.
If the employer was uninsured for workers’ compensation at the time of
the work injury, then the injured employee has the option to file a civil
lawsuit against the uninsured employer.
WHAT IS THE DIFFERENCE BETWEEN A CIVIL LAWSUIT AND
A WORKERS’ COMPENSATION CLAIM?
There are many differences between a civil lawsuit and a workers’
compensation claim. For example, in a workers’ compensation claim, an
injured employee is entitled to lifetime medical and compensation
benefits but the compensation for lost wages is capped by law. If you are
sued in civil court, there is no cap on the amount of damages an injured
worker can claim. Under the workers’ compensation system, an injured
worker cannot seek compensation for “pain and suffering” or “punitive”
damages such as can be sought in a civil lawsuit. A workers’
compensation dispute is decided by an administrative law judge whereas
civil lawsuits are usually decided by a jury. A workers’ compensation
claim also has rules of procedure and evidence that differ from those that
apply in a civil lawsuit. Certain legal principles such as “contributory
negligence” that may apply in a civil lawsuit do not apply in a workers’
compensation claim. An attorney can advise you regarding the many
other differences between a civil lawsuit and a workers’ compensation
claim.
WHAT CAN I DO IF I DO NOT BELIEVE MY EMPLOYEE’S
WORKERS’ COMPENSATION CLAIM IS VALID?
If you doubt the validity of a workers’ compensation claim, then you may
state your reasons on the Employer’s Report of Industrial Injury form.
7
You may also provide your insurance carrier with any information or
documentation you have to support your position. As a general rule, any
action or determination taken or made by the insurance carrier is binding
upon the employer, except if the employer provides written notice to the
carrier and the Commission within the applicable protest period that it
disagrees with the carrier’s determination. If you were uninsured for
workers’ compensation at the time of the workers’ injury, then you may
provide information or documentation regarding the validity of the claim
to the Special Fund Division/No Insurance Section. If you disagree with
an acceptance of a claim by the Special Fund, then you only have 30 days
from the notice accepting the claim to file your protest with the ICA.
Other notices issued by the Special Fund may carry a shorter protest
period.
SHOULD I HIRE AN ATTORNEY TO REPRESENT ME?
You should consult an attorney to answer any question you have
concerning your liabilities and obligations under the Workers’
Compensation Act. If you have workers’ compensation insurance, then
you should contact your insurance carrier to determine if they have
assigned an attorney to handle a particular workers’ compensation claim.
If a claim is processed as a “no insurance” claim, then the employer will
be required to hire an attorney if the employer is a corporation or limited
liability company. Corporations and limited liability companies may not
practice law in Arizona, nor be represented by an officer or agent who is
not otherwise an attorney licensed to practice in Arizona. The
appearance and practice before the ICA constitutes the practice of law.
WHAT IS THE INDUSTRIAL COMMISSION OF ARIZONA?
The Industrial Commission of Arizona (ICA) was created in 1925 as a
result of legislation implementing the constitutional provisions
establishing Arizona’s workers’ compensation system. The ICA
divisions administer and enforce all applicable laws and regulations not
specifically delegated to others, relative to the protection of life, health,
safety, and welfare of employees within the State. The ICA does not
issue workers’ compensation insurance policies. The ICA’s general
number is (602) 542-4411. Additional information and forms are
available on the online at www.azica.gov.
8
WHAT ARE SOME OF THE DIFFERENT DIVISIONS AT THE ICA?
Ombudsman
The Ombudsman is available to offer assistance to injured workers in
processing workers’ compensation claims and to make referrals to other
agencies when appropriate. The Ombudsman does not provide legal
advice.
Claims
The Claims Division regulates workers’ compensation insurance carriers
and self-insured employers to ensure that workers receive those benefits
to which they are entitled under the Arizona Workers’ Compensation
Act. The Claims Division also maintains the “file of record” for Arizona
workers’ compensation claims, and in certain circumstances, is involved
in claims processing (e.g. issuance of Average Monthly Wage and Loss
of Earning Capacity Awards).
Legal Division
The Legal Division represents the ICA in all legal matters affecting the
agency in order to ensure that the agency’s regulatory, enforcement and
quasi-judicial mandates and functions are carried out in accordance with
all applicable laws.
The Special Fund
The Special Fund is a “trust fund” legislatively created for the express
purpose of providing workers’ compensation benefits in limited areas.
For example, the Special Fund Division/No Insurance Section processes
and pays workers’ compensation claims involving an uninsured
employer. In certain cases, the Special Fund may also provide vocational
rehabilitation benefits, supportive care, and apportionment benefits.
Administrative Law Judge Division (ALJ)
The ALJ Division resolves disputes in cases referred to it, including
workers’ compensation and occupational safety and health matters.
Occupational Safety and Health (ADOSH)
The Arizona Division of Occupational Safety and Health (ADOSH)
enforces state occupational safety and health regulations for both public
and private employers within the state. ADOSH also provides free
consultation services for both public and private employers upon request.
9
CAN THE ICA GIVE ME LEGAL ADVICE?
No one at the ICA can give you legal advice. This includes ALJs, their
secretaries, and other ALJ Division staff. If an employee or a worker
needs assistance regarding the processing of their claim, they can contact
the Ombudsman’s Office at (602) 542-4538. If you wish to obtain legal
advice, then you should consult a private attorney.
WHO CAN GIVE ME LEGAL ADVICE?
You may wish to consult a lawyer licensed to practice law in Arizona for
legal advice about a workers’ compensation case. To find a lawyer, you
can call the Maricopa County Lawyer Referral Service at 602-257-4434
or the Pima County Lawyer Referral Service at 520-623-4625. The State
Bar of Arizona does not have a lawyer referral service but it can send you
a list of lawyers who are certified as specialists in workers’ compensation
law. Specialists have been certified after an investigation of their
qualifications and experience. You can search for a certified specialist on
the State Bar of Arizona’s web site at www.azbar.org or by calling the
Hotline for Certified Specialists at (602) 340-7300. You can also look in
the Yellow Pages of your telephone book under Attorneys or ask friends,
family members, co-workers, or colleagues who may have used a lawyer
in the past.
HELPFUL CONTACT INFORMATION
Industrial Commission of Arizona
Website Address: www.azica.gov
Phoenix Office: 800 West Washington St.
P.O. Box 19070
Phoenix, Arizona 85005-9070
Claims: Main Number (602) 542-4661
Fax Number (602) 542-3373
Hearings (ALJ): Main Number (602) 542-5241
Fax Number (602) 542-4135
10
Ombudsman: Main Number (602) 542-4538
Toll Free (800) 544-6488
Safety & Health: Main Number (602) 542-5795
Labor: Main Number (602) 542-4515
Tucson Office: 2675 East Broadway Blvd.
Tucson, Arizona 85716-5342
Hearings (ALJ): Main Number (520) 628-5188
Safety & Health: Main Number (520) 628-5478
Arizona Department of Insurance
www.azinsurance.gov
Phoenix Area: (602) 364-2499
Tucson Area: (520) 628-6370
Statewide: (800) 325-2548
State Bar of Arizona
www.azbar.org
4201 N. 24th Street, Suite 200
Phoenix, Arizona 85016-6288
602-252-4804
1-866-48-AZBAR (outside Maricopa County)
Maricopa County Lawyer Referral Service
www.maricopabar.org
602-257-4434
Pima County Lawyer Referral Service
520-623-4625
Arizona State Legislature
www.azleg.gov
Arizona Secretary of State
www.azsos.gov