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Injured Worker’s Duty to Inform Carrier of Surgery

Something we’ve run into recently on a couple of cases that bears mentioning here is the duty that a worker injured on the job in Arizona has to notify the employer’s insurance carrier of a pending surgery at least 10 days before it takes place.  This general rule is true for any medical treatment for which the carrier may ultimately be responsible.  It is true even if the carrier has denied your claim or has closed out your accepted claim. 

Many of our clients who have denied or closed claims decide to go ahead and proceed with their surgery through their private health insurance rather than wait the 8-12 months that it can sometimes take to get a decision through the Industrial Commission.  That is fine – if the claim is ultimately accepted or reopened, the industrial carrier simply reimburses the private insurance company for bills they’ve paid.  However, if the injured worker fails to give the workers comp carrier adequate advance notice of the surgery, the carrier can be relieved of their liability to pay for the surgery or other treatment.  The rationale for this is that the carrier has a right to have the worker evaluated by a physician of their choosing prior to undergoing the surgery.  Think of your injured body part as “evidence” – they have a right to examine that evidence before you change it. 

If you fail to give adequate notice and the carrier is relieved of having to pay for the surgery, they may still be liable for compensation and other post-surgical expenses after the date that they are notified. 

Chad T. Snow is a workers (workmans) compensation attorney in Arizona.  He has offices in Phoenix and Tucson. He and his associates at Snow, Carpio, and Weekley can be reached at (602) 532-0700 or (520) 647-9000.