Injured Worker FAQs

Per the Alabama Department of Workforce Administrative Code 480-5-5.12, your employer or their workers’ compensation insurance company directs all medical care. Except in the case of an emergency, you should be sent to your employer/insurance company’s chosen primary care provider who will treat and recommend referral to a specialist, when necessary.

The insurance company directs the care from the moment the injury notice has been given, not after treatment has been ongoing.

Your employer or their workers’ compensation insurance company controls and/or directs all medical treatment.

If you obtain treatment that has not been approved by either your employer or their insurance company, the treatment will not be covered or paid under your workers’ compensation claim. You will be directly responsible for payment of any medical treatment sought without prior authorization.

Per the Code of Alabama, 1975 §25-5-77(a), upon approval of the workers’ compensation claim your employer is responsible for paying only medical bills for treatment that has been authorized and is directly related to the injury in question.

Prescription medications are an eligible benefit under workers’ compensation.

When you have prescriptions to be filled, you should contact your claim adjuster with the name of the medication, the name of the prescribing doctor, and the name and phone number of the pharmacy where the prescription will be filled. Your adjuster can contact the pharmacy to provide billing information so that you don’t pay out of pocket.

If you are unable to attend a scheduled medical appointment, notify your adjuster or case worker as soon as possible so the appointment can be canceled and rescheduled in a timely manner.

If you are receiving compensation benefits for being off of work, failure to attend scheduled medical appointments may result in suspension of your weekly compensation benefits until you become compliant with medical treatment.

You will need to get a work status form at every doctor’s appointment. It is your responsibility to provide a copy of the work status form to your employer following each doctor’s appointment so that the return-to-work status can be addressed.

If you are receiving compensation benefits for being off work, weekly compensation payments will not be issued without confirmation of the current return to work status from the approved medical provider.

You should contact the medical provider directly to inform them that a workers’ compensation claim has been filed. Provide Alabama Retail Comp’s (ARC) phone number to the provider – (800) 239-5423.

You should forward any medical correspondence or bills received for approved medical treatment directly to your adjuster. Medical bills can also be emailed to claims@alabamaretail.org or faxed to (334) 263-1976.

Per the Code of Alabama, 1975 §25-5-59 (b), after a 3-day waiting period, the compensation period or disability period starts on the 4th day that you are out of work. The 3-day waiting is only paid if/when you are off work for 21 days or longer.

Compensation is due only for the time missed from work under the direction of the approved medical provider.

Once your claim is approved, and after the 3-day waiting period, compensation payments will be calculated at 66 2/3% of your average weekly wage (AWW), subject to the Alabama maximum and minimum compensation amounts. This also depends on the authorized medical provider’s approval of the missed days from work.

The average weekly wage (AWW) is calculated using your gross earnings for the 52 weeks prior to the date of injury that are reportable on a Federal W-2 form. Earnings during the last 52 weeks / 52 weeks = AWW

Example: If your Average Weekly Wage (AWW) is $500.

Your weekly compensation payment would be $500 x 66 2/3 % = $333.35

Compensation is not paid for time missed to attend medical appointments. You should try to coordinate medical appointments around your work schedule whenever possible.

You may submit a mileage reimbursement request for mileage to and from the approved medical provider’s location. Mileage is reimbursed based on the mileage reimbursement rate set by the State of Alabama each year.

There is a 1-year statute of limitations, based on the date of the medical appointment, to file for mileage reimbursement.

Each claim and loss are different. The amount of time needed to investigate a claim varies from claim to claim. Your adjuster will remain in contact with you to update you on the status of your claim until your claim is approved or denied.

Returning phone calls, emails, or paperwork to your adjuster will help expedite in the review of your claim.