Guide for Professional Athletes Filing Workers Compensation Claims in Arizona or any other workers
Arizona Workers Compensation Issuesfor Professional Athletes
- A compensable injury generally must occur within the course and scope of employment.
· Playing in a game
· Practicing / training
· Traveling with the team (Note: going and coming from home usually is not covered.)
· Other activities required by the team or by the contract.
· Cumulative trauma: Injuries need not be a single event. Cumulative trauma, or multiple small injuries, may result in a compensable injury once it is diagnosed and requires treatment.
- There may be a choice of states where a claim may be filed.
· Where the team is located
· Where the injury occurred
· Where the player entered the contract of employment
Consider where the benefits would be the best when deciding where to file.
- Time limits and filing requirements vary by state
· Usually claims must be filed within a specific time period after the injury by the player. (For example, claims must be filed in writing at the Industrial Commission of Arizona within one year in Arizona; other states have different time limits). Forms for filing a claim may be found online at the Industrial Commission of Arizona website. The form is called Worker’s Report of Injury. A player cannot rely on the team to file the claim.
· In some states, claims must be filed within a specific time period after the injury or after the last period covered by compensation or after medical treatment was last furnished. Arizona has a one year rule with very limited exceptions.
· Some states may allow extended filing periods for injuries not discovered immediately or which later require treatment. California has broader jurisdiction. If a player played one or more games in California he may be able to file there. Consult a California attorney on the NFLPA panel for advice.
· In most states, injury reports must be made in writing to the state’s industrial commission or similar authority (not just to the team’s trainer or workers compensation carrier) in order to be “filed."
· A player does not have to live in a state to make a claim in that state.
· Keep the Industrial Commission and the team’s worker’s compensation carrier informed of your address at all times.
- Compensation for temporary disability varies by state
· Most states provide payment of a percentage of the player’s average weekly or monthly wage during periods of temporary total or temporary partial disability.
· A player’s average monthly or weekly wage may be limited by an arbitrary statutory maximum wage used in a particular state. For example, in Arizona, the current maximum average monthly wage (AMW) for injuries occurring in 2012 is $4062.29. The maximum compensation a player may receive is 2/3 of the AMW, or $2708.20 per month, paid bi-weekly or monthly. The maximum average monthly wage changes each year. Injuries occurring before 2012 are paid based on the reduced AMW in effect at the time of the injury. Benefits such as housing, utilities, etc. and off-season employment earnings are included in the average monthly wage calculation
- Reasonable and necessary medical evaluation and treatment expenses are usually paid 100%, no deductible, no co-payment
· Medical expense payments are paid according to a fee schedule. If a player seeks treatment in another state besides Arizona, medical providers in other states are not bound to accept the Arizona fee schedule payment and may require the player to pay part of the expense, or bill other insurance if available.
· Players have a right to choose the doctors or medical providers who treat them, with some exceptions.
· Supportive medical care benefits may be available to pay the cost of medications, therapy, doctor’s visits, etc, after the player is discharged from active treatment. This benefit requires a doctor’s statement of necessity.
· Payment for treatment is usually limited to what is considered medically reasonable and necessary.
- Compensation is paid in stages
· Temporary disability benefits are paid during periods of active medical treatment. (If the player continues to receive his/her contract salary, no temporary disability compensation is payable for the same period).
· Temporary total disability is paid when a physician has the player off work entirely.
· Temporary partial disability is paid when a physician releases the player to modified work, if there is a loss of earnings or earning capacity.
· Permanent disability benefits are paid after active medical treatment is concluded, depending on a physician’s rating of permanent impairment.
· Scheduled permanent disability benefits are paid for a limited number of months, set by statute, for injuries to one extremity or to one body part. For example, a 20% impairment of a leg after knee surgery for injuries occurring in 2012 results in payment of 10 months of compensation at $2031.14 per month (50% of maximum AMW,) or a total of $20,311.45, if the player is able to return to playing, or $2940.56 per month (75% of maximum AMW), for a total of $30,467.72 if the player cannot return to playing. Injuries occurring in previous years are compensated at lower rates due to the lower average monthly wage ceiling. Scheduled permanentdisability compensation payments can be received even if the player returns to playing with no loss of earnings or earning capacity in Arizona.
· Unscheduled permanent disability benefits are paid for disabilities to the spine or whole person or more than one body part, if there is a loss of earning capacity. The amount depends on the player’s loss of earning capacity. Unscheduled benefits may continue for life. The maximum benefit for an injury occurring in 2012 is $2708.33 per month, continuing as long as the player is unable to work and earn.
· No compensation for temporary disability is ordinarily available while a player is receiving his/her contract salary.
· Compensation for permanent disability usually requires a rating of permanent impairment by a physician using AMA Guides for rating impairments
· Lump sum settlements of temporary or permanent disability compensation payments and medical benefits are possible if both parties agree.
In Arizona, claims that are once accepted may be reopened for the rest of a player’s life, for future medical care or surgery, and additional payments of monthly compensation. It is necessary to have a doctor’s report to reopen a claim, stating that the condition related to the employment injury is new, additional or previously undiscovered and requires medical treatment.
- Third party claims (Negligence and Malpractice)
· If a person or business entity (other than the employer or a co-employee) negligently causes or helps to cause an injury which is covered under workers compensation laws, it may be possible to bring a separate, additional claim for damages against that third party. Such third party claims may include claims for damages for pain and suffering, not included in workers compensation claims, and the full loss of earnings or future earning capacity, and medical expenses.
· State law requires that the workers compensation carrier be reimbursed for payments it makes from any recovery of damages in a third-party case.
· There may be special time limits for “third party" claims. In Arizona such a claim must be filed within one year of the injury, or a reassignment from the workers compensation insurer is required to file the claim in the second year. If you are considering a third party claim, contact an attorney and do not let the first year pass without taking necessary actions to preserve your rights (filing the case or obtaining a reassignment).
· Medical malpractice claims may be brought against doctors or medical providers for injuries caused by negligent medical care provided for a workers compensation injury. In Arizona, these claims must be filed within one year of the injury-causing event or within one year of discovery of the malpractice. After one year, a reassignment from the workers compensation carrier is required in the second year. Carriers frequently do not reassign claims against physicians, especially team physicians, so the claim effectively must be filed within the first year.
- When do you need an attorney?
Common points at which you may need to hire an attorney are:
- If your claim is denied.
- If medical care is denied to you, or limited, or not authorized or not paid for.
- If compensation is not paid to you and a doctor has you in a no work or limited work status, and the team is not paying you.
- If your average monthly wage is set too low (usually anything less than the maximum).
- If the insurance company attempts to close your claim and you are not yet recovered, and still need active medical treatment or rehabilitation.
- If the permanent impairment rating assigned by the insurance company does not match what your doctor told you or is too low.
Any time you have questions about your rights or the actions taken by the insurance company or the Industrial Commission, feel free to contact Wayne Turley at 480-246-6505 or** [email protected]***.* There is no cost or obligation to discuss your claim. The attorney fee is ordinarily a contingent fee of 25% of compensation benefits. That means there is no payment of an attorney fee until there is a recovery of compensation for you. Costs incurred in handling your claim are usually advanced by me and then reimbursed when compensation is received, so you have no out-of-pocket expense. If only medical benefits are involved, a flat fee may be arranged.