Q: What is the penalty, if any, in AZ for failure to abide by a judicially approved stipulation in a work comp case?
The insurance company stipulated in writing to provide among many other things, an electric cart to a disabled employee as part of a settlement that included an award for future medical support care. The stipulations were approved by the Industrial Commission. Now, three years later the insurance company incredibly states that an electric cart was never required because of the industrial injury and therefore, despite approved stipulations, they will not replace an old, existing cart that they themselves purchased for the employee several years ago. This is ridiculous as the injured worker was easlily able to walk prior to the accident and the only reason he can't walk now is because of his catastrophic on the job injury. What is the penalty, if any, for deliberately disregarding an approved stipulation?
A: Thank you for your inquiry. There is no automatic right to the same medical benefits permanently and there is no automatic penalty. if benefits are being denied the first option is to request a hearing investigation under ARS 23 1061J. The industrial commission will send a notice to the insurance company, which will have an opportunity to explain why the benefits are not being covered. The insurance company may have a medical opinion that the medical equipment is no longer necessary but it would be unusual for them to get away saying it is not necessary from the work injury if there was an agreement earlier that it was. Unusual and not impossible. If there is no resolution the industrial commission will schedule a hearing and take testimony from the injured worker and the healthcare providers, including the doctor who ordered the equipment and any doctor who disagrees with that order. This also may be an opportunity to settle out future medical benefits and how that happens will depend on many many factors including the age of the injured worker, the actual nature and extent of the injuries, and if the worker is now eligible for Medicare. The issue is eligibility and not actual enrollment in Medicare so again it gets very complicated. The injured worker should contact a lawyer, especially if they had one before for the case.
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