This is an official Workers' Compensation form for the state of Arizona.
Tucson Arizona Petition For Rearrangement Or Readjustment Of Compensation
Category:
State:
Arizona
City:
Tucson
Control #:
AZ-112-WC
Format:
Word;
PDF;
Rich Text
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Description
How to fill out Arizona Petition For Rearrangement Or Readjustment Of Compensation?
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FAQ
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.
If you have a scheduled injury, you will receive between 50 and 75 percent of your pre-injury wages for a certain number of months. The percentage you receive is based on the extent of the injury, while the state schedule designates the duration of benefits.
What Is the Statute of Limitations for Workers' Comp Claims in Arizona? 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).
Worker's Report of Injury Form.
Temporary Total Benefits Min: $200/month Max: $5161.12 per month effective 1/1/2022 7 day waiting period with retro benefits paid if more than 14 days lost. Benefits paid bi-weekly. Unlimited benefits.
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. Coverage requirements in Arizona say you must provide workers' comp for full-time and part-time workers.
How to File a Workers' Compensation Claim in Arizona Notify your employer. The first thing you'll need to do if you suffer a work-related injury is inform your employer.See a doctor. Seeing a doctor as soon as possible after your injury is extremely important for two reasons.Fill out the proper form.File the form.
The Industrial Commission of Arizona administers and enforces state laws relating to the protection of life, health, safety and welfare of Arizona's employees. This includes laws relating to workers' compensation, occupational safety and health, payment of wages, and child labor.
Claims - Filing a Claim 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.
Workers' compensation benefits, including lost wages, continue while a worker is on light duty. The lost wages benefit is reduced if the person is working to 66 2/3 percent of the difference between what the worker earns on light duty and the average monthly amount earned before the injury.