Can workers' compensation insurance carrier suspend my temporary workers' compensation benefits?

Navigating Temporary Disability Benefits in Arizona Workers' Compensation

The workers' compensation system in Arizona aims to protect employees injured on the job, providing necessary medical care and replacing lost wages while they recover. One of the key benefits offered is temporary disability, providing financial support to workers who are temporarily unable to work due to their injuries.

However, situations may arise where an insurance carrier's claims representative may need to consider suspending temporary disability benefits or changing the compensation status. This decision should not be taken lightly, as it directly impacts the injured worker's financial well-being.

This blog post will explore the circumstances where such actions may be warranted, shedding light on the legal framework and best practices in Arizona's workers' compensation system.

When Can Temporary Disability Benefits Be Suspended?

Arizona law outlines specific situations where a carrier can unilaterally suspend temporary disability benefits. These include:

• Leaving the State: If an injured worker leaves Arizona for more than two weeks without obtaining written approval from the Industrial Commission of Arizona (ICA), the carrier can suspend benefits effective from the 15th day after departure.

• Refusal to Attend IME: A carrier can suspend benefits if the worker refuses to submit to or obstructs an Independent Medical Examination (IME). An IME is an evaluation conducted by a physician chosen by the carrier to assess the worker's medical condition and work restrictions.

• Failure to Submit Annual Report: If the worker fails to submit the required Annual Report of Income, which documents their earnings and employment status, the carrier can suspend permanent disability benefits. This ensures that the worker is not receiving benefits while working and earning wages beyond their established earning capacity. This only applies to permanent disability benefits.

  
  

Changing Temporary Compensation Status

Apart from suspending benefits, the claims representative may also need to adjust the temporary compensation status based on the worker's medical progress and work restrictions.

Temporary Total Disability (TTD) is paid when the worker is completely unable to work due to their injuries. As the worker recovers and their medical condition improves, they may be released to return to work with restrictions, transitioning to Temporary Partial Disability (TPD).

This transition is supported by medical reports from the treating physician that outline the worker's work capabilities and restrictions. The carrier must issue a Notice of Claim Status (Form 104) each time there is a change in the compensation status. Importantly, any change in status cannot be retroactive for more than 30 days.

Suspending temporary disability benefits or changing the compensation status is a serious decision that requires careful consideration. By adhering to the legal framework, conducting thorough investigations, and communicating clearly with the injured worker, the claims representative can ensure that decisions are made fairly and in accordance with the principles of Arizona's workers' compensation system.