Medical Resource Office (MRO)
… medical advice to the public. Materials and information provided by the Medical Resource Office are for informational purposes only, and should not …
Forms
… Adobe Reader, version 8.0 or later. It is recommended that the user obtain (or upgrade to) … If necessary, please download Adobe Reader Visit Website Static forms need to be printed …
Dental Rate Table Form Website Instructions
… Fee Schedule Dental Rate Table Request Form Instructions for Dental Rate Table Request Form Stakeholders may complete a Dental Rate Table Request Form from …
Fee Schedule Public Comments 2022
… Fee Schedule Staff Proposals and Request for Public Comment Date Posted: 2022/2023 Fee Schedule …
Legal Petition for Attorney’s Fees
… Arizona law permits workers’ compensation claimants and their attorneys to … Claimants or their attorneys may use this form to request that the Commission set fees. …
Informal Payment Dispute Form
… Informal Payment Dispute Resolution Process The … the Medical Resource Office of the Industrial Commission of Arizona to assist stakeholders in …
Claims - Petition to Rearrange or Readjust Compensation
… Division Petition to Rearrange or Readjust Compensation Ruby Tate, Claims Manager Email: … AZ 85716 - Phone: (520) 628-5181 FAX (use for either office): (602) 542-3373 Phone List of …
Claims - About Uninsured Employers
… AZ 85716 - Phone: (520) 628-5181 FAX (use for either office): (602) 542-3373 Phone List of … Employers If an employer has no workers’ compensation insurance, the injured worker has …
… AZ011964 Parker Boiler Company 1974 State of Arizona 09/14/2018WT SH 15 … All Contacts 1There are total objects overdue for inspection based on your search criteria. …
Self-Insurance Forms
… 542-1614 Phone List of ICA Divisions Click here FORM NAME LAST UPDATED Application to … of Self-Insurance Form 11/22/2024 Parent Company Guaranty Form 11/22/2024 Request for …