Arizona Damages Form 104
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Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.
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If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.
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How to fill out Arizona Out Of Pocket Damages Worksheet?
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FAQ
Reporting an Industrial Injury (Filing a Claim) If the injury is not life-threatening, notify your supervisor immediately. Call 800-685-2877 within 24 hours to report the injury. This service is available 24 hours a day/ 7 days a week to facilitate the reporting of your injury to Risk Management.
If you have to take time off from work due to your injuries, workers' comp will pay for that time. If you are back at work, but you have to take some time off to visit the doctor, workers' comp will pay for the time you take off, your travel and other expenses.
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.
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. Both of these reports constitute a "claim form."
Arizona law prohibits employers from firing an injured employee strictly because they filed a workers' compensation claim, and your employer cannot prevent you from filing a claim by firing you. However, injured status doesn't protect your job, even if your employer is at fault for your injury.
