4/18/2024 Notice of Public Hearing Regarding One-Half Percent Assessment Under A.R.S. § 23-1065(F) on May 30, 2024
… 4/18/2024 Notice of Public Hearing Regarding One-Half … Under A.R.S. § 23-1065(F) on May 30, 2024 …
Claims - Petition to Reopen
… Washington St, Phoenix AZ 85007 - Phone: (602) 542-4661 Tucson: 2675 East Broadway, Tucson AZ … undiscovered conditions. IMPORTANT: The completed form must be filed at an Industrial …
ADOSH Discrimination Complaint Form
… may use this form to file a discrimination complaint if the employee believes the employer … to Arizona Revised Statutes (A.R.S.) section 23-425. It is not necessary to use this form. ADOSH …
Claims - Workers' Compensation Compliance Poster
… Claims Division The Workers' Compensation Compliance Poster Ruby Tate, Claims … Washington St, Phoenix AZ 85007 - Phone: (602) 542-4661 Tucson: 2675 East Broadway, Tucson AZ …
Claims Employer Report of Injury Form
… notice of the accident, an employer must complete an Employer’s Report of Injury and … used to report the accident to the Commission online. It must be completed in its entirety. …
Claims Record Request Form
… can access claim documents through the ICA Community ( https://azica.my.site.com/claims/s/ … or (2) a court order. See A.R.S. § 23-941(H); A.A.C. R20-5-108. If you are requesting …
ADOSH - Forms, Brochures, and Posters
… (ADOSH) Jessie Atencio, ADOSH Director Email: Com[email protected] Phoenix Office 800 W … Box 19070, Phoenix AZ 85005-9070) Phone: (602) 542-5795 Toll Free: (855) 268-5251 FAX: (602) …
Fee Schedule Corrections & Changes Log - 2011
… Schedule DATE CORRECTION OR CHANGE MADE 1/24/2012 It has come to the Commission's attention that the 2011 …
2015 FS Summary of Commission Action
… & Pharmaceutical Fee Schedule 2015 Summary of Commission Action On April 30, 2015, the … and Pharmaceutical Fee Schedule to the 2014 & 2015 editions of the CPT-4 and to update …
Claims Dependent Benefits Claim Form
… the deceased worker must file a claim with the Commission (“Claim for Dependent’s Benefits - Fatality”) to secure …