Insurance Carrier - Quarterly Tax Form

Instructions

Any Insurance Carrier which paid or is required to pay a tax of two thousand dollars or more for the preceding calendar year must file an Insurance Carrier - Quarterly Tax Form. This completed form must be submitted by the end of the month following the quarter together with a payment in an amount equal to the tax due at the rates prescribed on the form. Failure to do so may cause a delay in processing and will result in the assessment of interest and penalties. 

NOTE:  AS OF APRIL 1, 2023, THE INDUSTRIAL COMMISSION WILL NO LONGER ACCEPT PAPER FORMS. ALL FORMS MUST BE FILED ELECTRONICALLY THROUGH THE WEBFORM LINKS ON THE LANDING PAGE OF THE ICA COMMUNITY. THE LINK TO THE ICA COMMUNITY IS BELOW. INSURERS ARE NOW REQUIRED TO USE THEIR NAIC NUMBER TO ACCESS THE FORM.

The quarterly schedule and form dues dates are as follows:

Quarter Ending Form Due
March 31 April 30
June 30 July 31
September 30 October 31
December 31 January 31

Please direct questions regarding the filing of all Workers’ Compensation Taxes to [email protected] or call (602) 542-1836.

Arizona Revised Statutes

Any insurer failing to pay taxes on time shall be charged a penalty of the greater of twenty-five dollars, or five percent of the tax due plus interest at the rate of one percent per month from the date the tax was due. A.R.S. § 23-961 (K)

Any insurer, which has paid or is required to pay a tax of two thousand dollars ($2,000) or more for the preceding calendar year, shall file a quarterly report accompanied by a payment in an amount equal to the tax due.  A.R.S. § 23-961 (I)

Administrative Fund Tax

A.R.S. § 23-961 (G) Every insurance carrier on or before March 1 of each year shall pay to the state treasurer for the credit of the administrative fund, in lieu of all other taxes on workers' compensation insurance, a tax of not more than three per cent on all premiums collected or contracted for during the year ending December 31 next preceding, less the deductions from such total direct premiums for applicable cancellations, returned premiums and all policy dividends or refunds paid or credited to policyholders within this state and not reapplied as premiums for new, additional or extended insurance.

Special Fund Tax

A.R.S. § 23-1065 (A) The Industrial Commission may direct the payment into the state treasury of not to exceed one per cent of all premiums received by private insurance carriers during the immediately preceding calendar year. The same percentage shall be assessed against self-insurers based on the total cost to the self-insured employer as provided in section 23-961, subsection G. Such assessments shall be computed on the same premium basis as provided for in section 23-961, subsections G, H, I, J and K and shall be no more than is necessary to keep the special fund actuarially sound. Such payments shall be placed in a special fund within the administrative fund to provide, at the discretion of the commission, such additional awards as may be necessary to enable injured employees to accept the benefits of any law of this state or of the United States, or both jointly, for promotion of vocational rehabilitation of persons with disabilities in industry.

Apportionment Tax

A.R.S. § 23-1065 (F) ... If the total annual reserved liabilities of the special fund obligated under subsections B and C of this section exceed six million dollars, as determined by the annual actuarial study performed pursuant to subsection I of this section, the commission, after notice and a hearing, may levy an additional assessment under subsection A of this section of up to one-half per cent to meet such liabilities…