This is an official Workers' Compensation form for the state of Arizona.
Tempe, Arizona Leave the State Request Form for Workers' Compensation is a legal document that allows injured workers in Tempe to request permission from their employer or insurer to leave the state while still receiving their workers' compensation benefits. This form is meant for individuals who have suffered a workplace injury or occupational illness and need to travel outside of Arizona for personal or medical reasons. The Leave the State Request Form is an essential tool for workers' compensation recipients in Tempe who wish to temporarily relocate outside the state's jurisdiction but continue receiving necessary benefits. By completing this form, injured workers inform their employer or the insurance company about their intention to leave, along with relevant details, such as the reason for travel, duration, and contact information. Workers in Tempe may require the Leave the State Request Form for various reasons, including receiving specialized medical treatment or accessing better healthcare facilities in another state, attending family events or emergencies, or taking a vacation for recuperation purposes. Whatever the reason, it is crucial to complete this request form and obtain approval to ensure continued workers' compensation benefits without interruption. Types of Tempe Arizona Leave the State Request Form for Workers' Compensation: 1. Temporary Out-of-State Travel Request Form: This form is to be used when injured workers intend to travel outside Arizona temporarily but within the United States. It requires detailed information regarding the purpose of travel, dates of departure and return, and contact information while away. 2. Out-of-State Medical Treatment Request Form: This specific form addresses injured workers who require specialized medical care outside Arizona for their work-related injuries or illnesses. It requires detailed documentation of the medical treatment sought, including the healthcare provider's details, treatment plan, and expected duration of stay. 3. Emergency Family Event Travel Request Form: This form is designed for situations when injured workers need to travel out of state due to an unexpected family emergency. Examples include the serious illness or death of a family member. The form may require supporting documentation or verification of the emergency event. It is important for injured workers in Tempe, Arizona, to consult with legal professionals or their employers to ensure they fill out the appropriate Leave the State Request Form accurately, adhere to any specified guidelines or deadlines, and secure approval before commencing their out-of-state travel. Compliance with the required protocols helps maintain worker's compensation benefits and facilitates a smooth transition during travel.
