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

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  • Home
  • Agency Information
    • About Us
    • Commissioners
    • Director's Office
    • Legislation
      • Arizona Statutes
      • Arizona Rules
    • Meetings
      • 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
  • Resources For
    • Resources for Employees
    • Resources for Employers
    • Resources for Insurers
    • Resources for Medical Providers
    • Resources for ICA Community
  • How Do I
  • Online Services
    • Forms
    • Self Service Center
    • ICA Community
  • Payment Portal
  • OMBUDSMAN
  • Home
  • Petition for Attorney’s Fees

Petition for Attorney’s Fees

Instructions

Arizona law permits workers’ compensation claimants and their attorneys to file a petition, prior to a final disposition of the case, requesting that the Commission set reasonable attorney’s fees related to a workers’ compensation claim. See A.R.S. § 23-1069.  Claimants or their attorneys may use this form to request that the Commission set fees.  Please provide the information requested and attach any supporting documents. Failure to provide all requested information may delay processing.

You may submit a Petition for Attorney’s Fees Pursuant to A.R.S. § 23-1069 in the following ways:

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

In-person or by mail:                 
Industrial Commission of Arizona
c/o Legal Division, Attorney’s Fees
800 West Washington Street
Phoenix, Arizona 85007

By Fax:
(602)-364-1395

Sign and Submit Form

Petition for Attorney’s Fees Form

Printer-Friendly Form

PDF icon 4404 Legal_AttyFee_Master_021518.pdf

Related Forms

Public Records Request Form
Uninsured Employer Complaint Form
Employers Workers Compensation Insurance Inquiry Response Form
Petition for Attorney’s Fees

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Contact Us:

Phoenix Office
800 W. Washington Street
Phoenix AZ 85007
602-542-4661

 

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Contact Us:

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

 

 

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