Legal Uninsured Employer Complaint Form
… law requires that all employers have workers’ compensation coverage for their employees. See … (preferred): Via the Commission’s Website ( …
Claims Annual Report of Income Form
Claims - Worker's Report of Injury
… numbers) to the ICA because neither the website nor email is secure. Instead, FAX such … AZ 85007 - Phone: (602) 542-4661 Tucson: 2675 East Broadway, Tucson AZ 85716 - Phone: …
Request for Investigation Pursuant to A.R.S. § 23-1061(J) Form
… Hearing Form - Information about the Industrial Commission of Arizona’s claims and hearing … the Industrial Commission offices and the ICA website: www.azica.gov … Request for …
MRO Request for Administrative Peer Review Form
… denied the request, or (3) a Payer failed to communicate its decision on a request for … (using contact information provided on the MRO website). For more information, contact (602) …
ADOSH - VPP Star List
… Phone: (602) 542-5795 Toll Free: (855) 268-5251 FAX: (602) 542-1614 Tucson Office 2675 … 322-8008 Phone List of ICA Divisions Visit Website How to Become a Star The VPP Star …
Claims Request for Hearing Form
… may be used to request a hearing. It must be completed in its entirety including the reason … the Industrial Commission offices and the ICA website: www.azica.gov . … Claims Request for …
Claims Notice of Intent to Suspend Form
… If a completed Workers’ Annual Report of Income form … This form is made available for use on this website but is not filed with the Commission. …
Fee Schedule Corrections & Changes Log
… Fee Schedule Date Correction or Change Made 4/26/2011 Effective July 25, 2011, the Commission is adding language to the 2010 …