Navigating Out-of-State Medical Treatment in Arizona Workers' Compensation

If you're an injured worker in Arizona and considering leaving the state while undergoing medical treatment for your work injury, it's crucial to understand the specific rules to avoid jeopardizing your benefits.

When is Approval to Leave the State Required?

Generally, an employee may not leave the state of Arizona for a period exceeding two weeks (which is defined as 15 days or more) while the necessity of having active medical treatment continues, without the written approval of the Industrial Commission of Arizona (ICA). This restriction aims to ensure that employees receive all reasonably necessary medical care during periods of temporary disability.

However, there are exceptions:

• You do not need to request permission to leave the state if you are receiving supportive medical maintenance benefits.

• The rule does not apply if the logical or nearest medical facility is situated across a state border

The Process for Requesting Permission

To request approval to leave Arizona, you must send a written request to the ICA's Claims Division. The ICA will review your request and may solicit comments from your carrier and/or doctor to determine if your condition would be endangered by the absence. The effective date of an order granting or denying a request to leave the state is the date you filed the request with the Commission. If an Administrative Law Judge (ALJ) approves a request after it was initially denied, you are entitled to any forfeited compensation and medical benefits from the date of your initial request.

Consequences of Leaving Without Approval

Failure to obtain written approval before leaving the state for more than 14 days can result in severe consequences:

•You will forfeit your right to compensation during the period of unauthorized absence.

•You will forfeit your right to reimbursement for medical expenses during that time.

Out-of-State Medical Treatment and Reimbursement

While the focus is on permission to leave the state, medical treatment obtained out of state also has specific considerations:

• Arizona Fee Schedule: The Carrier would likely reimburse the out of state provider consistent with Arizona Fee Schedule.

• Travel Expenses for Treatment: The Arizona Workers' Compensation Act typically excludes payment for travel expenses incurred while obtaining industrially related medical treatment. However, reimbursement is allowed if you are directed by a carrier, self-insured employer, or special fund division to report for a medical examination or treatment in a locality other than your residence or employment, in which case travel expenses must be paid in advance. Additionally, an injured worker who must travel outside their area of residence to receive treatment may be entitled to reimbursement for travel expenses. Such travel expenses are considered "medical benefits" subject to a 24-month billing deadline.

• Independent Medical Examinations (IMEs): If you receive a Notice of IME, you must attend unless excused. Written notice for an IME must be sent at least ten days prior, and it must state the time, date, place, and person conducting the IME. If you reside out of state, the employer or carrier may require you to return to Arizona for an examination once a year, or once following a petition to reopen, provided they advance the cost of transportation, food, lodging, and any loss of pay. You may file a motion for a protective order to be excused, but disliking the doctor or believing your doctor has provided enough information are not valid reasons. Failure to attend an IME can result in the dismissal of a request for hearing and/or suspension of benefits.

• Out-of-State Medical Reports: If a medical report supporting a petition to reopen comes from an out-of-state physician and a party objects at least 20 days before a scheduled hearing, the report will not be considered unless the author is produced for cross-examination at the hearing or a deposition. The party submitting the report pays the deposition expenses.

Understanding these guidelines is vital for managing your workers' compensation claim effectively while residing or traveling outside of Arizona.