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Workers Compensation Accident Report Fillable Form for Arizona
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People also ask
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How do I file for workmans comp in Arizona?
Claims - Filing a Claim A claim is made either by filling out and signing a Worker's and Physician's Report of Injury at the doctor's office or by obtaining a Worker's Report of Injury (use download link directly above to obtain report form) from the ICA, and filing either report with the ICA. -
What is the name of the Arizona approved claim form?
Worker's Report of Injury Form. -
What does the Industrial Commission of Arizona do?
The Industrial Commission of Arizona administers and enforces state laws relating to the protection of life, health, safety and welfare of Arizona's employees. This includes laws relating to workers' compensation, occupational safety and health, payment of wages, and child labor. -
What is a 102 form in Arizona?
Form 102 is required by the Industrial Commission of Arizona for a Physician's Initial Report of Injury. The report must be made using or by attaching a report to the form. -
How do I file for workers compensation in Arizona?
Claims - Filing a Claim A claim is made either by filling out and signing a Worker's and Physician's Report of Injury at the doctor's office or by obtaining a Worker's Report of Injury (use download link directly above to obtain report form) from the ICA, and filing either report with the ICA. -
What is the name of the Arizona approved claim form?
Worker's Report of Injury Form. -
What to do if you are injured at work in Arizona?
Immediately following the accident, you should notify your employer and seek medical attention. Your employer is then required to provide you certain information such as the name and address of their workers' compensation insurance carrier, the policy number, and the date of expiration of coverage. -
How do I report a work injury in Arizona?
Form ICA-04-0101 Employer's Report of Industrial Injury. As soon as you have been notified of a work-related injury, please fill out this form and submit it to EMPLOYERS. This form must be completed within 10 days from notice of an accident. Fatalities must be reported within 24 hours.
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