Special Fund Apportionments
… Special Fund Division Apportionments Pursuant to A.R.S. § … there are specific instances where permanent compensation benefits may be apportioned or …
Accounting Initial Application for Authority to Self-Insure Instructions
… This application to self-insure is for Arizona … apply for authorization to self-insure workers’ compensation liability pursuant to A.R.S. § …
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: … impairment of earning power generally. Read together, the statutes establish that the …
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 …