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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
    • Data & Statistics
    • 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
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  • Special Fund Apportionment Settlement Letter

Special Fund Apportionment Settlement Letter

Parties interested in settling the loss of earning capacity involving a claim with approved apportionment should complete the attached form and submit for consideration. The claimant and carrier/self-insured/TPA must contribute to the questions and submit the signed certifications before the claim will be reviewed.  After submission of all required information, Special Fund will perform its evaluation of settlement, taking into consideration of all relevant factors, including Roth credits, prior scheduled credits and any overpayments.  Based upon its evaluation, Special Fund will offer to contribute a certain amount towards settling the matter. Under no circumstances, however, will Special Fund contribute more than 50% of the final settlement amount ultimately negotiated by the parties.  

Required Forms

Form Name Last Updated
Apportionment Settlement Letter 02/01/21
Apportionment Settlement Letter 02/01/21

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