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Industrial Commission of Arizona

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

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      • Elevator Section
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      • Research & Statistics (BLS)
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    • Special Fund Division
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  • Claims - Filing a Sole Proprietor/Independent Contractor Statement

Claims - Filing a Sole Proprietor/Independent Contractor Statement

Claims Division
Filing a Sole Proprietor / Independent Contractor Statement

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 Sole Proprietor / Independent Contractor Statement


Click here to download form :     Sole Proprietor / Independent Contractor Statement (PDF)

This form is for use only by a sole proprietor who is working for an employer who has workers' compensation insurance as permitted by A.R.S. §23-961(P). This form is not valid until signed and dated by both the sole proprietor and insurance carrier. If you have questions concerning this form and what it can be used for, contact your workers' compensation insurance carrier or an attorney.

Public Meeting Notices

Location of Public Meeting Notices

Wage Information

  • 2019 AMW Statutory Max - $4,741.57
  • 2018 AMW Statutory Max - $4,625.92
  • 2019 Minimum Wage - $11.00 per hour  
  • 2018 Minimum Wage - $10.50 per hour
  • Get Info: 2019 AZ AMW Max
  • Get Info: 2018 AZ AMW Max

Job Opportunities at the ICA

Job Opportunities at the ICA

Public Notices

  • 01/17/19 Third Notice of Upcoming Changes in Communication Methods
  • 12/24/18 Update to Claims Communication Methods FAQs
Public Notice Archive

Recent News & Events

  • 02/07/19 New Out-of-State Adjuster Authorization Program
  • 11/26/18 The ICA Meets in Tucson
  • 10/03/18 The ICA Meets in Safford
  • 10/01/18 Treatment Guidelines Expansion in Effect
  • 09/20/18 Arizona Adopts Updated Silica Standard
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

 

tucson map

Contact Us:

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

 

 

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