Claims Employee Rejection of Terms Form

Arizona law presumes that all employees have elected to be subject to the provisions of Arizona’s workers’ compensation laws.  However, an employee is permitted to reject the provisions of Arizona’s workers’ compensation laws by completing the Employee’s Notice of Rejection of Terms of the Arizona Workers’ Compensation Law.  See A.R.S. § 23-906(B)-(C).  To be valid, the Employee’s Notice of Rejection of Terms of the Arizona Workers’ Compensation Law must be filled out in duplicate (i.e., two times) and must be filed with the employer prior to the employee sustaining workplace injuries.  The employer must, in all cases, file a copy of the Employee’s Notice of Rejection of Terms of the Arizona Workers’ Compensation Law with the employer’s workers’ compensation insurance carrier.