Legal Uninsured Employer Complaint Form
… law requires that all employers have workers’ compensation coverage for their employees. See A.R.S. § 23-961. Any …
Special Fund Uninsured Claimants
… Section of the Special Fund processes workers’ compensation claims filed by employees of … then pursues against the noninsured employer for reimbursement of all benefits paid, …
ADOSH Discrimination Complaint Form
… An employee may use this form to file a discrimination complaint if the employee believes the employer …
Director's Office - Arizona Physicians' Fee Schedule - Sign In for Access
… - Arizona Physicians' Fee Schedule - Sign In for Access …
Claims Annual Report of Income Form
… This form is made available for use on this website but is not filed with the Commission. Carefully follow the directions on …
Special Funds Workers Supplemental Claim For Compensation
… and treating physician will be instructed to complete this form while the injured worker is on a no work …
Claims Dependent Benefits Claim Form
… the deceased worker must file a claim with the Commission (“Claim for Dependent’s Benefits - Fatality”) to secure …
Claims Petition to Reopen Form
… temporary or permanent condition by filing this form with the Commission. IMPORTANT : This petition to …
Claims - Filing a Professional Employer Organization (PEO) Agreement
… AZ 85716 - Phone: (520) 628-5181 FAX (use for either office): (602) 542-3373 Phone List of … to file this Notice with the PEO's Workers' Compensation Insurance Carrier and The …