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Settlement of Workers Compensation Claims

Many times, it is in the interest of both the injured worker and the insurance carrier to settle either part or all of a claim. All settlements must involve a bona fide dispute between the parties and must be approved by a Judge of the Industrial Commission of Arizona. Settlement of a claim prior to the claim being accepted are called “compensability settlements” and are the only settlements that can include future active medical care.

Other issues that can be settled include entitlement to temporary compensation, supportive care, and Loss of Earning Capacity. For accepted claims, future active medical care can never be settled. Because there are numerous factors which determine what a claim is worth, and because insurance companies are for-profit businesses trying to pay as little as possible, it is always a good idea to consult an attorney prior to settling a claim.

Scheduled Injuries

Injuries that result in permanent impairment are categorized as either “scheduled” or “unscheduled”. The distinction is in how these different injuries are compensated. A scheduled injury is an injury to any of the body parts listed at A.R.S. 23-1044(b), so long as no other body part has been previously or currently permanently impaired. “Scheduled” body parts include injuries to the knee, foot, ankle, leg, arm, hand, elbow, fingers, eyes, facial scarring, and hearing. Each of these body parts has a determined value quantified by months of compensation.

That value is multiplied by the percentage of permanent impairment that is assigned by the treating physician to determine the number of months of “permanent compensation” that will be received for that injury. The amount of monthly compensation is arrived at by multiplying the injured worker’s average monthly wage by a factor of 50% if the worker can return to all aspects of their date of injury job, or 75% if there is any part of that job that they can no longer perform because of their injury.

Unscheduled Injuries

Any injury that is not to a “scheduled” body part, or any combination of more than one scheduled type injury is considered “unscheduled”. The most common unscheduled injuries are those to the low back, neck, shoulder, hip, or head. Compensation for an unscheduled injury is based on a determination of the injured worker’s loss of earning capacity (LEC). If the injured worker has permanent work restrictions that preclude a return to his or her date of injury job, a determination is made by the Industrial Commission of Arizona as to what types of jobs exist that the worker could do. Consideration is given to the worker’s age, education, prior work experience, and the labor market where the worker lived at the time of the accident.

If it is determined that the worker can return to work earning an amount equal to or greater than he or she earned at the time of the injury, no permanent compensation is payable. If there is a Loss of Earning Capacity, a permanent monthly award is payable equal to 55% of that loss. This award is subject to annual review and can continue for the remaining life of the injured worker. Determination of Loss of Earning Capacity is a very complex issue in workers compensation and usually involves the hiring of a labor market expert and submission of evidence to the Industrial Commission. Because this determines the amount of benefits that you may receive for the rest of your life, it is highly recommended that you consult an Arizona Workers Compensation Attorney if you have an unscheduled injury.