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.