Injured Worker Home Injured Workers Injured Workers ICA Community To access claim information and easily check the status of a claim, an account in the ICA Community is needed. Learn More Workers' Compensation Information Workers' Compensation HandbookWorkers' Compensation Statutes - (Title 23, Chapter 6)Workers' Compensation Administrative Rules (Title 20, Chapter 5) Forms Worker's Report of Injury Form - 407Worker's and Physician's Report of Injury Form - 102Petition to Reopen - 528Request for Hearing Form - 446Request to Change Doctor - 121Additional Forms Agency Resources OmbudsmanHearing DivisionMROVocational Rehab Helpful Links Authorized Self InsurersWorkers' Compensation Coverage VerificationPresent Value Tables Definitions Suspension of a ClaimExposure to Bodily FluidsIndependent Medical EvaluationsUninsured EmployersLoss of Earning CapacityLoss of JobGradual InjurySole Proprietor/Independent Contractor Contact Info Ruby Tate, Claims Manager Mailing Address: PO Box 19070 Phoenix AZ, 85005 Phoenix Office: 800 W. Washington St. Phoenix, AZ 85007Phone: (602) 542-4661 Tucson Office: 2675 East Broadway Tucson, AZ 85716Phone: (520) 628-5181 FAX: (602) 542-3373 General Questions:[email protected] Claims Forms
