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Legal Uninsured Employer Complaint Form

… Any member of the public may use this form to report an employer that does not have … (preferred): Via the Commission’s Website ( …
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Insurance Carrier Annual Tax Forms

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Resources for the 2025 ICA Claims Seminar

… the 2025 ICA Claims Seminar Manual designed to help you continue learning and applying what … event.  Explore, download, and invest in the tools that will keep you growing beyond the …
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CS2018-Menu

… 1 2018 ICA Workers Compensation Seminar | August 9 – 10, 2018 … Honey & Butter A Selection of Breakfast Cereals to include Kashi with Whole, 2% & Skim Milk …
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On May 22, 2015, Governor Ducey appointed Dale L. Schultz Chairman of the Industrial Commission of Arizona. To review Chairman Schultz's biography, and the biographies of the other commissioners

… Dale L. Schultz Chairman of the Industrial Commission of Arizona. To review Chairman Schultz's biography, and the …
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Motion to Appoint Guardian Ad Litem for a Minor

Motion to Appoint Guardian Ad Litem for a Minor

Instructions

Use this motion form if a claimant or a beneficiary is a minor. Pursuant to law, a Guardian Ad Litem (GAL) must be appointed for such persons. Additionally, the law requires that the GAL must be an attorney licensed in the State of Arizona. You will need to provide the attorney’s bar license number in the motion form. If you do not have an attorney to request for appointment as GAL, an Administrative Law Judge will appoint one at no cost to the parties.

E-sign Electronic Submission Form

Motion for Guardian Ad Litem

Printable Form

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Notice of Public Hearing Regarding "Process for Streamlining the Authorization Process for Treatment that is Within the Evidence-Based Treatment Guidelines

… the Authorization Process for Treatment that is Within the Evidence-Based Treatment Guidelines …
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Fatal Injury Graphs (Set I)

… by Gender2013 -Arizona, all ownerships (95 total fatal injuries) Workplace fatal injuries … by persons or Contactwith objects animals 26 3%) and equipment (8.4%) Falls, sips,tips …
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Commission publishes revised Notice of Claim Status (Form 104 - Rev 01/2016) - use of new form is mandatory effective March 1, 2016.

… Commission publishes revised Notice of Claim … 104 - Rev 01/2016) - use of new form is mandatory effective March 1, 2016. …
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Medical Resource Office (MRO)

… does not  provide legal or medical advice to the public. Materials and information … legal or medical advice from a qualified attorney or healthcare professional. … Medical …
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