Arizona Workers's and Physician's Report of Injury

State:
Arizona
Control #:
AZ-ICA-0102
Format:
PDF
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Description

Workers's and Physician's Report of Injury The Arizona Workers' and Physicians' Report of Injury (WEI) is a form used by Arizona employers to report workplace injuries to the Arizona Industrial Commission. The form includes information about the employee, the employer, the date of the injury, the type of injury, the medical treatments received, and the results of the investigation into the cause of the injury. The form is used by employers to collect information required by the Arizona Industrial Commission for the administration of workers' compensation claims. The WEI is divided into two sections: the employer section and the physician section. The employer section of the WEI requires the employer to provide information such as the date of the injury, the type of injury, the date of the first medical visit, the date of the last medical visit, and the name and address of the insurance carrier. The employer must also provide information regarding the employee's medical treatments, the results of the investigation into the cause of the injury, and the employee's wage information. The physician section of the WEI requires the physician to provide information such as the diagnosis and prognosis of the injury, the medical treatment prescribed, any work restrictions imposed on the employee, and the date of the last medical visit. The physician must also provide information regarding the employee's medical history, any pre-existing medical conditions, and any other relevant information. The Arizona Workers' and Physicians' Report of Injury is required for all workplace injuries in Arizona. There are two different types of WEI: the Standard WEI and the Complex WEI. The Standard WEI is used for less serious injuries, while the Complex WEI is used for more serious injuries.

The Arizona Workers' and Physicians' Report of Injury (WEI) is a form used by Arizona employers to report workplace injuries to the Arizona Industrial Commission. The form includes information about the employee, the employer, the date of the injury, the type of injury, the medical treatments received, and the results of the investigation into the cause of the injury. The form is used by employers to collect information required by the Arizona Industrial Commission for the administration of workers' compensation claims. The WEI is divided into two sections: the employer section and the physician section. The employer section of the WEI requires the employer to provide information such as the date of the injury, the type of injury, the date of the first medical visit, the date of the last medical visit, and the name and address of the insurance carrier. The employer must also provide information regarding the employee's medical treatments, the results of the investigation into the cause of the injury, and the employee's wage information. The physician section of the WEI requires the physician to provide information such as the diagnosis and prognosis of the injury, the medical treatment prescribed, any work restrictions imposed on the employee, and the date of the last medical visit. The physician must also provide information regarding the employee's medical history, any pre-existing medical conditions, and any other relevant information. The Arizona Workers' and Physicians' Report of Injury is required for all workplace injuries in Arizona. There are two different types of WEI: the Standard WEI and the Complex WEI. The Standard WEI is used for less serious injuries, while the Complex WEI is used for more serious injuries.

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Arizona Workers's and Physician's Report of Injury