When an Arizona resident is injured on the job, the workers' compensation program compensates for medical care and other expenses incurred as a result of the injury. Typically, a worker and the medical provider of choice determine treatment decisions. Now, worrisome trends involving a neighboring state, and in other states, may threaten that arrangement.
Arizona workers watched with concern as a California woman ceded control of her medical treatment and compensation to independent medical reviewers. Almost two decades ago, the woman tripped and broke her foot at her magazine publishing job. Although the break appeared to be clean, it caused severe nerve damage and led to a condition known as chronic or complex regional pain syndrome.
Unlike most people who recover completely from broken bones within a few months, to this day the woman suffers debilitating pain when she walks, brushes against her bed sheets or puts on socks - even when she takes a shower. For all these years, workers' compensation payments paid for her medical bills and replaced some of her lost wages.
Now, however, changes to workers' compensation administration at the state level threaten to topple her support structure. In her case, independent medical reviewers are contradicting her medical provider's treatment recommendations and triggering a denial of benefits. The reviewers don't have to be licensed in her state or even examine her in person. Instead, they can review her medical records remotely and issue decisions that changed her life for the worse.
California is one of 10 states that have enacted legislation in recent years giving more control over medical decisions to employers and insurance companies. Luckily, Arizona is not part of this trend. In fact, Arizona has increased the maximum wage replacement and survivor benefits from $1,600 to $2,400 per month. However, in 2013 Arizona did enact legislation that excluded out-of-state employees who get injured in Arizona from receiving workers' compensation coverage.
Could new legislation bringing independent medical reviewers to our state be close at hand? No one knows for sure. Nevertheless, even without such worrisome legislation, injured workers in Arizona already face many legal and procedural hurdles. As a result, many find it necessary to get more information in order to help them obtain medical and other benefits they are entitled to under the existing workers' compensation laws.
Source: KNAU, Arizona Public Radio, "Employers And Insurers Gain Control In Workers' Compensation Disputes," March 30, 2015