Accounting Insurance Carrier Annual Tax Letter

All insurance companies authorized to write workers’ compensation policies in the State of Arizona are required to file Annual Workers’ Compensation Tax forms, and any associated payment, on or before March 1.

Below is the list of the annual forms that are required:

  1. Insurance Carriers Tax Year Report of Annual Workers’ Compensation Administrative Fund and Special Funds Premium Tax Form 200
  2. Certified Copy of Statutory Page 14 (Business page for Arizona of the “Annual Statement, Exhibit of Premiums and Losses)
  3. State of Arizona Substitute W-9, if a return of overpayment is due

Please ensure the following information is included as part of your annual PREMIUM TAX FORM 200:

Enter “DIRECT LOSSES PAID” (From Column 5 of Statutory Page 14) in the appropriate box of Form 200.
Enter “TOTAL DEDUCTIBLE POLICY LOSSES PAID” in the appropriate box of Form 200. These are total deductible policy losses processed and paid by the insurance carrier that are/were reimbursable by the employer up to the policy deductible amount (losses not included in column 5 of the Statutory Page 14).

If quarterly tax payments for the year exceeded the required annual Administrative Fund tax or Special Fund taxes for the tax year, the Industrial Commission of Arizona will issue a return of overpayment. Overpayments will not be credited against future quarterly taxes. The State of Arizona Substitute W-9 may be found here with instructions found at the bottom of the page. Return of overpayments will not be processed without a completed current State of Arizona substitute W-9.

Return the completed original Tax Form 200, a certified copy of the company’s Statutory Page 14 (Business page for Arizona) as filed with the Arizona Department of Insurance, and if applicable, a completed Arizona Substitute W-9 to:

The Industrial Commission of Arizona

Attention: Tax Accountant

800 West Washington Street, Room 301

Phoenix, Arizona 85007

 IMPORTANT NOTICE: Completed forms with original signature and payments must be postmarked on or before March 1, or penalties will be assessed according to A.R.S. §23-961 (K).

 Please direct questions regarding the filing of all Workers’ Compensation Taxes to [email protected] or call (602) 542-1836.


Any insurer failing to pay taxes on time shall be charged a penalty of the greater of twenty-five dollars, or five percent of the tax due plus interest at the rate of one percent per month from the date the tax was due. A.R.S. § 23-961 (K)

Any insurer, which has paid or is required to pay a tax of two thousand dollars ($2,000) or more for the preceding calendar year, shall file a quarterly report accompanied by a payment in an amount equal to the tax due.  A.R.S. § 23-961 (I)


A.R.S. § 23-961 (G) Every insurance carrier on or before March 1 of each year shall pay to the state treasurer for the credit of the administrative fund, in lieu of all other taxes on workers' compensation insurance, a tax of not more than three per cent on all premiums collected or contracted for during the year ending December 31 next preceding, less the deductions from such total direct premiums for applicable cancellations, returned premiums and all policy dividends or refunds paid or credited to policyholders within this state and not reapplied as premiums for new, additional or extended insurance.


A.R.S. § 23-1065 (A) The industrial commission may direct the payment into the state treasury of not to exceed one per cent of all premiums received by private insurance carriers during the immediately preceding calendar year. The same percentage shall be assessed against self-insurers based on the total cost to the self-insured employer as provided in section 23-961, subsection G. Such assessments shall be computed on the same premium basis as provided for in section 23-961, subsections G, H, I, J and K and shall be no more than is necessary to keep the special fund actuarially sound. Such payments shall be placed in a special fund within the administrative fund to provide, at the discretion of the commission, such additional awards as may be necessary to enable injured employees to accept the benefits of any law of this state or of the United States, or both jointly, for promotion of vocational rehabilitation of persons with disabilities in industry.


A.R.S. § 23-1065 (F) ... If the total annual reserved liabilities of the special fund obligated under subsections B and C of this section exceed six million dollars, as determined by the annual actuarial study performed pursuant to subsection I of this section, the commission, after notice and a hearing, may levy an additional assessment under subsection A of this section of up to one-half per cent to meet such liabilities…