Claims - Request for Hearing

Claims Division
Request for a Hearing

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

Phone List of ICA Divisions

Request for a Hearing

Request for Hearing Form

When you formally disagree with a document that contains a protest period, you may request a Hearing.

Important: This completed form must be filed at an Industrial Commission of Arizona (ICA) office.