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Industrial Commission of Arizona

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

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  • Agency Information
    • About Us
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    • Director's Office
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      • All Public Meetings
      • Commission Meeting Agendas
      • Meeting Minutes
  • Divisions
    • Administration
      • Accounting
      • Human Resources, Special Services and MIS
      • Self-Insurance and Tax Office
    • Administrative Law Judge (ALJ) Division
    • ADOSH
      • Boiler Section
      • Elevator Section
      • Occupational Safety and Health (OSHA / ADOSH)
      • Research & Statistics (BLS)
    • Claims Division
    • Labor Department
    • Legal Division
    • Medical Resource Office (MRO)
    • Special Fund Division
  • News and Events
    • Public Notices
    • News and Events
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    • Resources for Employees
    • Resources for Employers
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    • Resources for Medical Providers
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Contact Info

Ruby Tate, Claims Manager

Mailing Address:
PO Box 19070
Phoenix AZ, 85005

Phoenix Office:
800 W. Washington St.
Phoenix, AZ 85007
Phone: (602) 542-4661

Tucson Office:
2675 East Broadway
Tucson, AZ 85716
Phone: (520) 628-5181

FAX : (602) 542-3373

General Questions:
[email protected] 
 

Claims Forms

 

ADOSH Advocate and ICA Updates

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Claims Main Page

Claims Division

Serving the workers' compensation community by processing claims efficiently and effectively. 

Workers Compensation Information
Workers' Compensation Information

  • Workers' Compensation for the Injured Worker 
  • Employers' Frequently Asked Questions about Workers' Compensation 
  • Gradual Injury 
  • Independent Medical Evaluations 
  • Permanent Impairment or Loss of Earning Capacity 
  • Loss of Job 
  • Uninsured Employers 
  • Vocational Rehabilitation ("Voc Rehab") 
  • Suspension of a Claim  
  • Exposure to Bodily Fluids 

Claims Resource

Claims Resources

  • 2022 Claims Seminar   
  • Average Monthly Wage Statutory Maximum 
  • Workers' Compensation Coverage Verification  
  • List of Authorized Self-Insured Employers  
  • Claims Division Annual Processing Statistics
  • Commission Ombudsman 
  • Present Value Table
  • Workers' Compensation Handbook  
  • Claims Seminar Videos - (Password)  

ICA Community

ICA Community 

  • ICA Community 
  • Join ICA Community 
  • Community Instructions and Resources 

 

Claims Request

Claims Requests

  • Petition to Reopen a Claim
  • Petition to Rearrange or Readjust Compensation
  • Request to Change Doctors
  • Request to Leave the State
  • Request a Hearing
  • Request Dependents' Benefits

Claims Forms

Claims Forms

  • Worker's Report of Injury Form
  • Employer's Report of Injury Form
  • Worker's and Physician's Report of Injury Form
  • Dependent Benefits Claims Form
  • Sole Proprietor / Independent Contractor Statement 
  • Notice of Intent to Suspend Form 
  • Additional Forms

Claims Posters

Claims Posters

  • Workers' Compensation Law Compliance (La ley de Compensación para las Trabajadores) 
  • Work Exposure to Bodily Fluids
  • Work Exposure to MRSA, Spinal Meningitis, or Tuberculosis 
  • Additional Posters 

 

Adjuster Training

  • ICA Community - Adjuster Subscribe 
  • 2022 Claims Seminar Manual 
  • Adjuster Authorization 
  • ICA Claims Seminar 
  • Arizona Adjuster Training Videos 
  • SB1403 Brief

aGENCY news

  • 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

Legal Information

  • Workers' Compensation Statutes (Title 23, Chapter 6) 
  • Workers' Compensation Administrative Rules (Title 20, Chapter 5) 
  • Substantive Policy Statements 
  • Additional Frequently Asked Questions 

 

 Disclaimer:  The Claims Division of the Industrial Commission does not provide legal or accounting advice to the public.  Materials and information provided by the Claims Division are for informational purposes only, and should not be used as a substitute for obtaining legal or accounting advice from a qualified attorney or accountant. 

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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