Hurt on the Job in Arizona? Your Guide to Workers' Comp Coverage

Getting injured at work can be a stressful and confusing experience. Understanding what types of injuries are covered by Arizona's workers' compensation system is the first step toward getting the benefits you deserve. The good news is that Arizona operates on a "no-fault" principle, which means you are generally entitled to benefits regardless of who caused your job-related accident.

For an injury to be covered, it must arise out of and be sustained in the course of employment, demonstrating both legal and medical causation. This guide will walk you through the various types of injuries and conditions covered.

What Kinds of Injuries and Conditions Are Covered?

Arizona's workers' compensation system is designed to cover a broad spectrum of work-related issues:

1. "Injury by Accident" An "injury" generally refers to objective physical damage, though a specific anatomical or organic change isn't always strictly required. It must involve some loss or expense. An "accident" entails two key elements: unexpectedness and definiteness concerning time, place, or cause. An injury qualifies as "by accident" if either the external cause or the resulting injury itself is unexpected. This can also include injuries considered a "mishap" or misfortune, even if stemming from expected events. For example, a miner who broke his hand while blasting rock would have a compensable "mishap" or "accident" even if the blast was an expected event, as the injury itself was unexpected.

2. Gradual Injuries Workers' compensation laws in Arizona also cover injuries that develop gradually over time due to usual working conditions. This includes conditions resulting from exposure to harmful substances associated with your job, even without a sudden, single event.

3. Aggravation of Pre-existing Conditions If a work-related activity causes a symptomatic aggravation of a pre-existing health problem, it can be considered a new compensable injury. The principle here is that an employer "takes his employee as he finds him"; if a work injury acts upon an existing bodily condition or predisposition to cause a further injury, that result is attributed to the work injury.

4. Occupational Diseases An occupational disease is a compensable injury if certain specific requirements are met, including a direct causal link between the work conditions and the disease. These are diseases specific to a particular trade, not common illnesses the general public is exposed to.

   • Examples include conditions from inhaling silicon dioxide dust, asbestos, beryllium, or fumes from soldering or paint.

   • COVID-19 can be recognized as an "accident" under workers' compensation if it is "definitely work connected," even if not classified as an occupational disease. Other work-connected diseases like pneumonia, Lyme disease, allergies, and hepatitis can also be compensable.

   • For firefighters and peace officers, specific statutory presumptions exist for certain cancers (e.g., brain, bladder, rectal, colon, lymphoma, leukemia) and mesothelioma if specific criteria are met, which lowers the burden of proof for compensability.

5. Mental Injuries, Illnesses, or Conditions Mental injuries are compensable if they are work-related. These can include PTSD, depression, chronic pain syndrome, and other psychiatric disorders.

   • For a mental injury to be covered, the work-related stress must have been a "substantial contributing cause," and the stress itself must have been "unexpected, unusual or extraordinary". This is evaluated using an objective standard, comparing the stress imposed on the worker to that of a reasonable person with similar job duties and training, rather than your subjective reaction.

   • Claims often fall into two types:

     • Single Incident: Mental injuries caused by a sudden, unanticipated work event are generally compensable, such as a deputy who developed PTSD after shooting and killing a man who threatened him during a welfare check.

     • Gradual Build-up: Mental injuries from a gradual accumulation of emotional stress from "usual, ordinary, and expected incidents" of employment are generally not compensable. However, exceptions may exist, like a mental breakdown due to a dramatically increased workload and responsibilities.

   • Mental injuries can also be compensable if they arise from physical trauma (physical-mental injury) or if a mental stimulus leads to a physical injury (mental-physical injury).

6. Heart-Related or Perivascular Injuries These injuries, illnesses, or deaths are compensable if some injury, stress, or exertion related to your employment was a "substantial contributing cause". Notably, for these conditions, the stress or exertion does not need to be "unexpected, unusual, or extraordinary".

7. Hernias The compensability of a hernia is specifically addressed by law (A.R.S. § 23-1043). You must demonstrate an immediate and apparent connection between the hernia and the workplace. For non-traumatic hernias, specific requirements must be met, such as a severe strain or blow, immediate descent, severe pain, and immediate reporting of the injury.

8. Communicable Diseases (HIV, Hepatitis C, MRSA, Spinal Meningitis, Tuberculosis) Special statutory provisions govern the compensability of these diseases. This includes specific reporting requirements and diagnosis within certain timeframes after exposure. For example, post-exposure evaluation and prophylactic treatment for significant work-related exposures are considered medical benefits.

What's Generally NOT Covered (or can lead to loss of benefits)?

While workers' compensation is broad, there are situations where benefits may be denied or forfeited:

• Purposely Self-Inflicted Injuries: Injuries that are intentionally self-inflicted are not compensable. However, this is interpreted narrowly; it typically doesn't apply if you intended the act but not its injurious consequences, or if a work-related injury led to mental disturbance and impaired your judgment.

• Purely Personal Risks / "Going and Coming Rule": Injuries sustained during your ordinary commute to and from work are generally not compensable. However, exceptions exist, such as when you are on a "special errand" for your employer or if the specific hazards of the route become part of your employment risk. Travel for medical treatment of a compensable injury is covered, but travel for an examination to pursue a claim is not.

• Forfeiture of Benefits: You can lose benefits if you:

  • Refuse to submit to or obstruct an independent medical examination (IME).

  • Leave Arizona for more than two weeks without prior approval from the Industrial Commission of Arizona (ICA).

  • Persist in unsanitary or injurious practices that delay recovery.

  • Unreasonably refuse competent or reasonable medical treatment.

  • Make knowingly false statements or representations to obtain compensation, which is a crime.