Employers Workers Compensation Insurance Inquiry Response Form


Arizona law requires that all employers maintain workers’ compensation coverage for their employees. See A.R.S. § 23-961. Any employer who has received an employers’ workers’ compensation insurance inquiry letter from the Industrial Commission of Arizona, Legal Compliance Section may use this form to submit a response. Please provide as much information as possible.

You may submit an Employers’ Workers’ Compensation Insurance Inquiry Response Form in the following ways:

Electronically (preferred):
Via the Commission’s Website (http://www.azica.gov/)

Via e-mail ([email protected])

In-person or by mail:
Industrial Commission of Arizona
c/o Legal Division, Compliance Section
800 West Washington Street
Phoenix, Arizona 85007

By Fax: