Industrial Commission of Arizona Forms & Filing Guide

The ICA Forms, Explained (407 vs. 102 vs. 101 — the Confusion Ends Here)

Many workers mix these up — and the confusion causes real denials. Here is what each form actually is, per the ICA:

Form 407 — Worker's Report of Injury (the form you file)

This is the worker-only claim form. An injured worker (or their authorized representative) can file a workers' compensation claim directly with the ICA by submitting Form 407. Use it if you want to start your claim yourself — for example, if the "Pink Form" was never completed at the doctor's office, your employer is uncooperative, or you're unsure whether a claim was ever actually filed.

Always download the current version from azica.gov — old copies floating around the internet may have outdated instructions or mailing addresses. The ICA also offers an electronic e-sign submission through its online claims portal, reached from the azica.gov form page.

Form 102 — Worker's and Physician's Report of Injury (the "Pink Form")

This form is normally completed at your doctor's office when you first get treatment for a work injury. You fill out the "Worker's Report" section; your physician completes the "Physician's Initial Report" section and is required to file the form with the ICA within eight days of first treatment. Per the ICA, submission of Form 102 constitutes the legal filing of a workers' compensation claim — for many workers, this is how their claim actually starts.

Key point: what you write in your section must match what you tell your doctor and employer. Inconsistent accident descriptions are a classic reason carriers deny claims. Describe clearly and specifically how your job duties caused the injury — the machine, the lift, the fall, the repetitive task. Vague descriptions invite disputes.

Form 101 — Employer's Report of Injury (your employer's form — not yours)

Form 101 is filed by your employer, who must report your injury to the ICA within ten days of learning about the accident. The ICA now directs employers to complete this form online. Two things every worker should know:

• Your employer's Form 101 is not your claim. Neither is an internal company "incident report." If you only filled out paperwork for HR, your claim may not exist yet in the ICA's system.
• If your employer refuses or delays, you don't have to wait — file your own Form 407 with the ICA.

Other ICA forms

If an accepted industrial injury later worsens and you need benefits adjusted, the ICA provides additional petition forms for changed circumstances after a claim is accepted — see the forms section of azica.gov. These post-claim filings have their own legal standards — this is a point where professional guidance pays for itself.

How to File Your Claim Anywhere in Arizona

The same statewide forms are used no matter where in Arizona you were hurt. You have three options:

• Online (fastest): start from the forms section of azica.gov — the ICA's e-sign submission links there take you into the Commission's official online claims portal.
• In person: hand-deliver your documents to an ICA office (addresses below) and ask that they be date-stamped. A date stamp is your proof of timely filing.
• Certified mail: if you can't travel, certified mail with return receipt creates a paper trail proving what you sent and when.

After you file: the ICA states that you should receive a letter from the Commission within 14 days of the reports being filed — this letter contains your claim information, typically including the claim number you'll need going forward. If 14 days pass with no letter, contact the ICA to check your claim's status. A missing acknowledgment sometimes means the claim was never actually filed.

Common Mistakes That Get Claims Denied — A 60-Second Self-Check

Run through this list. If any item makes you hesitate, your claim may be at risk:

• Wrong form. Did you actually file a claim with the ICA (Form 102 via your doctor, or your own Form 407) — or just an internal report with your employer? Confusing Form 101 or an HR incident report for a claim is the classic fatal error.
• Missing or inconsistent dates. Injury date, first-missed-work date, first-treatment date — are they present and consistent across every document?
• Story mismatch. Does your accident description match what you told your doctor, word for word in substance? Discrepancies are the insurer's favorite denial ground.
• Unsigned or incomplete forms. Blank employer details, missing job information, no signature — any of these can stall or sink a filing.
• No copies, no proof. Do you have copies of everything you submitted, plus proof of when (date stamp, certified-mail receipt, portal confirmation)?
• Deadline drift. Are you certain you're inside the one-year filing window — counted from when the injury occurred or became manifest?

When to Involve a Workers' Comp Attorney

The forms are designed to be usable without a lawyer — and for simple, accepted claims, many workers never need one. But the process turns adversarial fast when money is at stake. Strongly consider a free consultation if:

• Your employer has no workers' comp insurance (Special Fund claims are procedurally demanding).
• Your claim was denied or you received any Notice of Claim Status you don't understand.
• You're being rushed back to work by a company-selected doctor before you're physically ready.
• A permanent impairment rating is being set — the rating drives your long-term compensation, and it is worth having someone in your corner who has contested ratings before.