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Get and Sign Form 18m 2017-2022

Get and Sign Form 18m 2017-2022

Create, verify, and track a form 22 nc 2017 online using a ready-made template.

Number City State Zip City State Zip Insurance Carrier ) Work Telephone M F XXX-XX- Zip ) / / Date of Birth Carrier's Address ( ) ( ) Carrier's Telephone Number Fax Number SECTION A. TO BE COMPLETED BY EMPLOYEE: 1. 2. The above-named employee claims additional medical compensation as a result of an injury by accident or an occupational disease which occurred on or by (Date) because (Reason for Additional Medical Compensation) Additional medical and/or other...
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A guide to workers compensation hearings in Arizona presented by the Industrial Commission of Arizona the Industrial Commission of Arizona also known as the ICA or the Commission is a state agency created in 1925 the main office building is in Phoenix at 800 West Washington Street the phone number is area code 602 five four two four six one in Tucson the Commission is at twenty-six seventy-five East Broadway the phone number is area code five two zero six two eight five one eight the Commission also has a website at WWE star Z us the Commission's hours are 8:00 a.m. to 5:00 p.m. Monday through Friday except legal holidays there are information desks at both the Phoenix and Tucson Commission offices the Industrial Commission is not your employer's insurance company it is not the same as s CF Arizona or any other insurance company your claim is one of 150 thousand workers compensation claims that will be filed this year in Arizona one of the Commission's functions is to oversee the admin

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