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  • Writer's pictureThe Dr. Lawyer Law Group

Your Arizona Work Injury and the Forms You Need to Know About

If you've been injured on the job in Arizona and seeking workers' compensation benefits, you are entering a process that can be complex and overwhelming. One of the reasons for this is the many forms involved in a workers' compensation claim. These forms are directed by the Industrial Commission of Arizona, which oversees the workers' compensation system in the state.

In this blog post, we'll look at the forms involved in an Arizona workers' compensation claim and what you need to know to navigate this process successfully.

1. Report the injury or illness to your employer:

The first step is to report the injury or work-related illness to your employer as soon as possible. Arizona law requires that you report your injury within one year of the date of the accident or when you became aware of the condition. The sooner you report your work accident to your employer, the better.

After you have notified your employer of your injury or work-related illness, your employer has ten (10) days to complete an Employer’s Report of Injury and file it with the Industrial Commission of Arizona (ICA).

2. Ensure the proper notices are filed with the Industrial Commission of Arizona:

After you notify your employer of your work injury, your employer will likely send you to an urgent care facility for your initial treatment. It is very important that you advise your medical provider that you are suffering from an on-the-job injury. While at the doctor’s office, you should fill out a Worker’s and Physician’s Report of Injury form. This form may be referred to as the “102 Form” or “Pink Form.” Make sure to ask your provider for a copy of this form.

Arizona workers’ compensation laws require your medical provider to file the Worker’s and Physician’s Report of Injury Form with the ICA within eight (8) days after first rendering treatment. However, injured workers in Arizona may also file a Worker’s Report of Injury Form, also known as a “407 Form,” with the ICA, as discussed below.

3. How to file a Worker’s Report of Injury Form (“407 Form”):

The ICA has made it very easy for an injured worker in Arizona to file a Worker’s Report of Injury Form online, with no need to print, fax, or mail anything.

Although the online option is the easiest way to file a 407 Form, you may also print out the form and mail it to:

Industrial Commission of Arizona

800 W. Washington Street

Phoenix, Arizona 85007

Or you can fax your completed form to (602)542-3373. This address and fax number are up-to-date as of March 2023, but you can double-check where to send your completed form here.

4. Do NOT sign any documents provided by your employer or the workers’ compensation insurance company:

Don't sign anything without consulting an attorney: If your employer or the insurance company asks you to sign any documents, don't do so without consulting an attorney. Some documents may waive your rights or limit your ability to receive compensation.

Navigating the workers' compensation system in Arizona can be overwhelming. With so many forms and regulations to navigate, it's easy to feel lost and unsure of your rights. That's why having an experienced workers' compensation attorney, such as The Dr. Lawyer Law Group, is crucial. Our Arizona workers’ compensation firm can help you navigate the rest of your claim, including getting you the best medical care available, securing your wage payments while you’re injured, and obtaining the highest settlement at the end of your claim. Click here to learn more about how The Dr. Lawyer Law Group achieves the best results for our workers’ compensation clients.

If you've been injured on the job in Arizona, don't hesitate to contact The Dr. Lawyer Law Group for a free case strategy session. Let us help you get the compensation and justice you deserve.


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