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 …
Claims Petition to Reopen Form
… temporary or permanent condition by filing this form with the Commission. IMPORTANT : This petition to …
English - Our Official Language
… Industrial Commission of Arizona PHOENIX: 800 W WASHINGTON … FAX: (602) 542-7889 Phone List of ICA Divisions Visit Page English Is Arizona's Official …
Legal Employers Workers Compensation Insurance Inquiry Response Form Instructions
… requires that all employers maintain workers’ compensation coverage for their employees. See A.R.S. § 23-961. Any …
ADOSH - VPP Star List
Claims - Employer's Report of Injury
… to emails) containing sensitive or personal information (such as social security numbers) to … AZ 85007 - Phone: (602) 542-4661 Tucson: 2675 East Broadway, Tucson AZ 85716 - Phone: …
Claims Record Request Form
… can access claim documents through the ICA Community ( https://azica.my.site.com/claims/s/ … ) at no cost and no request form is required. Workers’ compensation claim …
ADOSH Notice of Alleged Safety or Health Hazards Form
… that an imminent danger exists may use this form to file a notice of alleged safety or … description. IMPORTANT: Upon request of the complainant employee or employee representative …
Ombudsman
… law, the Ombudsman Office at the Industrial Commission of Arizona is established to provide information about the workers' compensation system …