Proving a Compensable Workers' Compensation Claim in Arizona: What Injured Workers Need to Know

Securing workers' compensation benefits in Arizona requires injured workers to demonstrate that their claim is compensable, meaning it meets the legal and medical criteria for coverage under state law.

Here's a breakdown of the essential elements an injured worker must prove to establish a compensable claim:

1. Employment Relationship: The injured worker must prove that they were an employee of the insured employer at the time of the injury. This requires demonstrating a contract of hire and may involve providing evidence of employment records, pay stubs, or witness testimonies. Issues can arise with identity theft and forged documents, making it crucial to establish a legitimate employment relationship.

2. Injury by Accident Arising Out Of and In the Course of Employment: The cornerstone of a compensable claim is demonstrating that the injury resulted from an accident arising out of and in the course of employment.

• "Arising out of" refers to the origin or cause of the injury and focuses on whether the employment created the risk of injury.

• "In the course of" pertains to the time, place, and circumstances of the accident and its relation to the employment.

3. Timely Reporting:

• The injured worker must promptly report the accident and injury to their employer. This allows for a timely investigation and prompt medical treatment.

• Failure to report promptly can bar compensation unless the worker proves the delay didn't prejudice the employer.

• Additionally, a written claim must be filed with the ICA within one year of the injury or its manifestation.

4. Medical Causation: The worker must establish a causal connection between the work-related incident and the injury. If the connection isn't readily apparent, expert medical testimony is often required to link the injury to the work event. This may involve medical records, diagnostic tests, and physician reports.

5. Objective Findings: While subjective pain alone isn't a compensable injury, Arizona courts have recognized the need for objective findings to substantiate a claim. These findings can include:

• Observable physical damage

• Anatomical or organic changes

• Positive straight leg raising tests

• Acute radiographic findings

6. Credibility of the Applicant:  The credibility of the injured worker's account of the incident and their symptoms is a crucial factor. Inconsistencies between the reported mechanism of injury, the onset of symptoms, and medical records can undermine the claim's credibility.

7. Specific Types of Injuries:

• Mental Conditions: Mental conditions, like PTSD, can be compensable if they stem from an unexpected, unusual, or extraordinary work event. A causal connection between the mental injury and the industrial accident must be established, often requiring expert medical testimony.

• Hernias:  For non-traumatic hernias to be compensable, the worker must demonstrate a severe strain, immediate descent, severe pain, and immediate communication of the injury.

Burden of Proof:  The injured worker bears the burden of proving all elements of their claim by a preponderance of the evidence. This means demonstrating that their version of events and the resulting injuries are more likely than not true.

Navigating the complexities of workers' compensation claims can be challenging. Injured workers should meticulously document their injuries, report them promptly, and consult with an experienced attorney to ensure their rights are protected and their claims properly presented.