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Industrial Commission of Arizona
Protection of life, health, safety, and welfare of Arizona's workforce

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      • Self-Insurance and Tax Office
    • Administrative Law Judge (ALJ) Division
    • ADOSH
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      • Elevator Section
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      • Research & Statistics (BLS)
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    • Legal Division
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    • Special Fund Division
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  • Home
  • Claims - Filing a Claim

Claims - Filing a Claim

Claims Division
Filing a Claim

Ruby Tate, Claims Manager
Email: [email protected]
Phoenix: 800 W Washington St, Phoenix AZ 85007 - Phone: (602) 542-4661
Tucson: 2675 East Broadway, Tucson AZ 85716 - Phone: (520) 628-5181
FAX (use for either office): (602) 542-3373

Click for Phone List of ICA Divisions


Filing a Claim


Click here to download form :     Claims_WorkersReportOfInjury.pdf

It is the injured worker’s responsibility to file a claim within one year of the date of injury. The injured worker should also notify the employer as soon as possible that a work-related injury has occurred. A claim is made either by filling out and signing a Worker's and Physician's Report of Injury at the doctor’s office or by obtaining a Worker's Report of Injury (use download link directly above to obtain report form) from the ICA, and filing either report with the ICA. Both of these reports constitute a "claim form."

IMPORTANT. Do NOT send forms to the ICA as attachments to emails because this can compromise personal identity information. Instead, send them by postal mail to the Phoenix office address given above or FAX them to the FAX number there.

The employer is required to file an Employer’s Report of Injury; however, this is not a claim. It is only a report of the injury.

When either claim form described above is received by the ICA, the employer’s workers’ compensation insurance carrier is notified of the claim. The carrier has 21 days to accept or deny the claim.

When the ICA receives a claim, a notification letter containing general information is sent to the injured worker. The letter advises who the insurance carrier is and provides general claim information.

If the insurance carrier accepts the claim, it is responsible for payment of compensation and the payment of medical bills in accordance with the Arizona Fee Schedule.

If the insurance carrier denies the claim, the injured worker must file a Request for Hearing within 90 days from the date of the denial notice. For more information on Requests for Hearing, click here. The ICA's Administrative Law Judge Division has all kinds of information on hearings also, including a video presentation. To see what all is available, start here.

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Resources for the ICA Community

Wage Information

  • 2023 AMW Statutory Max - $5,393.37 
  • 2023 Minimum Wage - $13.85 per hour
  • 2022 AMW Statutory Max - $5,161.12 
  • 2022 Minimum Wage - $12.80 per hour 

Job Opportunities at the ICA

Job Opportunities at the ICA

Public Notices

  • 12/20/22 ICA Announces Restructured Ombudsman Team
  • 11/16/22 Notice of Public Hearing – Self Insured Premium Rates – December 15, 2022
Public Notice Archive

Recent News & Events

  • 02/01/23 New Medical Resource Office Trainings Available
  • 12/06/22 Rule 20-5-1534 Self-Insurance Q&A
  • 09/15/22 2023 Minimum Wage Increase
  • 06/09/22 Cancer Claim Reporting and MFCR Training
  • 06/01/22 ICA Community Update - Upload Confirmation Email
Recent News Archive

Official Website of the State of Arizona

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Contact Us:

Phoenix Office
800 W. Washington Street
Phoenix AZ 85007
602-542-4661

 

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Contact Us:

Tucson Office
2675 E. Broadway Blvd
Tucson AZ 85716
520-628-5188

 

 

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