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IN The I.C. File # is the unique identifier for this injury. It will be provided by return letter and is to be referenced in all future correspondence. The Use Of This Form Is Required Under The Provisions of The Workers' Compensation Act ( Employee s Name Employer's Name Address Employer s Address City ( State ) ( Zip M Social Security Number F / Sex Telephone Number City State Insurance Carrier Policy Number Carrier s Address City Carrier s Telephone Number Carrie.

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Arizona's workers' compensation statute of limitations requires an injured worker to report his or her work-related injury within 1 year from the date of injury. If the worker doesn't file a claim before the 1 year deadline, he or she may forfeit their right to receive compensation.

In Arizona, if a worker is unable to work for at least 14 consecutive days due to a job-related injury, they will be eligible for retroactive workers' compensation benefits. This provision ensures compensation for workers throughout their inability to work, including the initial seven-day waiting period.

In Arizona, workers' comp covers all medical expenses to heal the work-related injury or illness. It can also provide some of the missed wages when injured workers need time off to recover. Coverage requirements in Arizona say you must provide workers' comp for full-time and part-time workers.

Injured employees must file a claim using one of the Arizona workers' compensation forms. The claim must be filed with the ICA within 12 months of the date of the injury. Filing a claim involves completing the Worker's Report of Injury Form (0407) or the Worker's and Physician's Report of Injury Form (0102).

Injured employees must file a claim using one of the Arizona workers' compensation forms. The claim must be filed with the ICA within 12 months of the date of the injury. Filing a claim involves completing the Worker's Report of Injury Form (0407) or the Worker's and Physician's Report of Injury Form (0102).

Form 25PR, Request for Preauthorization of Medical Treatment. Form 25R, Evaluation for Permanent Impairment. Form 25T, Itemized Statement of Travel Charges. Form 26, Supplemental Agreement as to Payment of Compensation. Form 26A, Employer's Admission of Employee's Right to Permanent Partial Disability.

A Form 18 establishes a legal claim of injury on your behalf if filed within two years of the date of injury or occupational disease, and gives the required written notice to the employer if a copy is submitted to the employer within 30 days of the injury.

Under Arizona's law, if you have one or more workers, you must carry workers' compensation insurance. What's covered? In Arizona, workers' comp covers all medical expenses to heal the work-related injury or illness. It can also provide some of the missed wages when injured workers need time off to recover.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232