Accounting Self-Insured Employer Annual Hospital Report Form
… on or before January 31. The “Hospital Report” is required of self-insurers that operate a … NOTE: AS OF APRIL 1, 2023, THE INDUSTRIAL COMMISSION WILL NO LONGER ACCEPT PAPER FORMS. …
Links to Related Websites
… AZ 85007 - Phone: (602) 542-4411 Tucson: 2675 East Broadway, Tucson AZ 85716 - Phone: … to the services provided by the Industrial Commission of Arizona. It is not meant to be …
Accounting Self-Insured Employer Annual Medical Report Form
… The Arizona Workers Compensation Tax annual forms are due on or … tax forms required for each tax plan are listed below for your convenience. NOTE: AS OF …
Claims - About New Form 104
… AZ 85007 - Phone: (602) 542-4661 Tucson: 2675 East Broadway, Tucson AZ 85716 - Phone: … August 17, 2015 directive. In keeping with our commitment to the improvement of the workers' …
Claims - About Suspension of a Claim
… AZ 85007 - Phone: (602) 542-4661 Tucson: 2675 East Broadway, Tucson AZ 85716 - Phone: … without the written approval of the Industrial Commission. For more information on this topic, …
MRO Trainings
… benefit stakeholders in the Arizona Workers’ Compensation system. Healthcare providers and their staff members must register for an account in the ICA Community by …
AZ Medical Data Reports
… Medical Resource Office Phone List of ICA Divisions Click here Medical Data … Arizona are prepared by the National Council on Compensation Insurance ("NCCI") for those who …
Claims - About Forms 110A and 110B
… AZ 85007 - Phone: (602) 542-4661 Tucson: 2675 East Broadway, Tucson AZ 85716 - Phone: … Click Here About Forms 110A and 110B The Commission has revised two forms, the Worker’s …
Self-Insurance and Tax Office
… Accounting Division - Self-Insurance and Tax Office Phone List … on the Self-insurance Program Download Workers' Compensation Coverage Verification Download …
ALJ Backup
… Phoenix AZ 85007 (602) 542-5241 (602) 542-4135 2675 East Broadway, Tucson AZ 85716 (520) … is to resolve disputed matters in workers’ compensation, youth employment and wages …