Arizona Report of Injury by Employee to Employer to be Filed with Worker's Compensation Agency of State

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Description

Workers' compensation laws are designed to ensure payment by employers for
some part of the cost of injuries, or in some cases of occupational diseases, received by employees in the course of their work. Worker's compensation legislation requires the employer to furnish a reasonably safe place to work, suitable equipment, rules and instructions. State workers' compensation statutes vary by state. The Federal Employment Compensation Act covers non-military federal employees or those workers employed in some significant aspect of interstate commerce.


The compensation acts require that notice of the fact of injury be given to the employer, or to the compensation board or commission, or to the insurance carrier, or to all of them. This form is a generic example that may be referred to when preparing such a form for your particular state. It is for illustrative purposes only. Local laws should be consulted to determine any specific requirements for such a form in a particular jurisdiction.

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FAQ

Report the injury or illness to your employer If you don't report your injury within 30 days, you could lose your right to receive workers' compensation benefits.

1 year In cases in which the worker doesn't immediately discover their work-related injury or illness, the 1 year statute of limitations begins at the point at which the worker becomes aware of the injury. If you are an injured worker, you should inform your employer immediately. Arizona Workers' Compensation Statute of Limitations & Timeline azhurtonthejob.com ? workers-compensation azhurtonthejob.com ? workers-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." Filing a Claim - Industrial Commission of Arizona azica.gov ? claims-filing-claim azica.gov ? claims-filing-claim

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.

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. Employees | Risk Management - az.gov Arizona Department of Administration, Risk Management Division (.gov) ? workers-compensation ? empl... Arizona Department of Administration, Risk Management Division (.gov) ? workers-compensation ? empl...

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.

A physician shall complete and file with the Commission a physician's initial report of injury under A.R.S. § 23-908(A) within eight days after first providing treatment to an injured worker. The physician shall report the injury: 1. Using Commission form 102 (worker's and physician's report of injury), or 2. Physician' Initial Report of Injury, Ariz. Admin. Code § 20-5-112 - Casetext casetext.com ? arizona-administrative-code ? secti... casetext.com ? arizona-administrative-code ? secti...

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Arizona Report of Injury by Employee to Employer to be Filed with Worker's Compensation Agency of State