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Arizona Worker's Report of Injury

Arizona Worker's Report of Injury

Name: Arizona Worker's Report of Injury
Brand: US Legal Forms
Price: 59.00 USD
Rating: 4.83 (246 reviews)

Category:

Arizona Workers Compensation - Claims

State:

Arizona

Control #:

AZ-WC-16

Format:

Instant download

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Public form

Description

File a Report of Injury (If You Are a Worker) The Arizona Worker's Report of Injury is a document used by employers and employees in the state of Arizona to report any workplace injury or illness. It is also referred to as a First Report of Injury (FROM). This report must be completed and submitted to the Industrial Commission of Arizona within 10 days of the incident. The report includes information such as the date of the injury, the name and address of the injured worker and the name of the employer. It also includes the type of injury and the location of the incident. There are three types of Arizona Worker's Report of Injury: FROI-1 for occupational diseases, FROI-1A for injuries resulting from a single incident, and FROI-14 for cumulative trauma. All three must be completed and submitted to the Industrial Commission of Arizona in order for the employer and employee to be eligible for workers' compensation benefits.

The Arizona Worker's Report of Injury is a document used by employers and employees in the state of Arizona to report any workplace injury or illness. It is also referred to as a First Report of Injury (FROM). This report must be completed and submitted to the Industrial Commission of Arizona within 10 days of the incident. The report includes information such as the date of the injury, the name and address of the injured worker and the name of the employer. It also includes the type of injury and the location of the incident. There are three types of Arizona Worker's Report of Injury: FROI-1 for occupational diseases, FROI-1A for injuries resulting from a single incident, and FROI-14 for cumulative trauma. All three must be completed and submitted to the Industrial Commission of Arizona in order for the employer and employee to be eligible for workers' compensation benefits.

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FAQ

In Arizona, injured workers generally have one year from the date of the workplace injury or its discovery to file a workers' compensation claim with the Industrial Commission of Arizona (ICA). This doesn't mean that the case must be resolved within that period.

Immediately following the accident, you should notify your employer and seek medical attention. Your employer is then required to provide you certain information such as the name and address of their workers' compensation insurance carrier, the policy number, and the date of expiration of coverage.

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.

Claims - Filing a Claim It is the injured worker's responsibility to file a claim within one year of the date of injury. The injured worker should also notify the employer as soon as possible that a work-related injury has occurred.

Compensation is payable every 14 to 30 days, depending on the type of disability. No wage loss benefit is payable for the first 7 consecutive calendar days, if total time lost is less than 13 consecutive calendar days. This waiting period occurs only once during a claim.

Form 102 is required by the Industrial Commission of Arizona for a Physician's Initial Report of Injury. The report must be made using or by attaching a report to the form.

All employers are required to notify OSHA when an employee is killed on the job or suffers a work-related hospitalization, amputation, or loss of an eye. A fatality must be reported within 8 hours. An in-patient hospitalization, amputation, or eye loss must be reported within 24 hours.

More info

Instructions: Complete this form as soon as possible after an incident that results in serious injury or illness. Read our guide on responding to and reporting an injury at work.Create a work incident report compliant with workers' compensation reporting procedures. Ideally, employees should report workplace injuries to their employers as soon as possible after the incident takes place. This form is for the employer to report every work-related injury to its insurance company. If you don't report your injury within 30 days, you could lose your right to receive workers' compensation benefits. Get emergency treatment if needed. Please complete in triplicate (type if possible) Mail two copies to: OSHA CASE NO. FATALITY. Failure to complete each item may delay the processing of the injury claim. WC-1 EMPLOYER'S FIRST REPORT OF INJURY OR OCCUPATIONAL DISEASE.

Arizona Worker's Report of Injury

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