Forms Hub • Arizona Workers’ Comp

Arizona Workers' Compensation Claim Form (ICA Form 101)

Last Updated: March 5, 2026 · Reviewed by Arizona Workers' Comp Help Group Editorial Team

Many injured workers search online for a workers compensation claim form after an accident in Mesa or Phoenix. In Arizona, the core document is the Industrial Commission of Arizona Worker's Report of Injury (ICA Form 101). This page explains what that form does, how it differs from an employer's internal report, and where to find the official versions on state websites.

1. What Is the Arizona Workers' Compensation Claim Form?

The Arizona workers' compensation claim form is usually the Worker's Report of Injury (ICA Form 101). Filing this document with the Industrial Commission of Arizona (ICA) is what opens a formal workers' comp claim — not just telling your supervisor or filling out a store incident report.

If you were injured while working in Mesa (85201, 85203, 85210) or Phoenix, the same statewide form is used. The mailing address and online options are listed on the official ICA website.

Direct Links · ICA Claim Forms

Always download the most recent version directly from the Industrial Commission of Arizona to make sure you are using the correct form.

2. Employer Accident Reports vs. Official ICA Claim Forms

Many Mesa and Phoenix employers have their own paper or online incident reports. These internal forms are useful for documenting what happened, but they are not a substitute for an official ICA workers' compensation claim form.

Employer forms usually stay inside the company or its insurance carrier.
The Worker's Report of Injury (Form 101) is filed with the Industrial Commission of Arizona to open a legal claim.
In some cases, a doctor, hospital, or employer may submit the claim form for you — but you should still confirm that it was actually filed.

If you are not sure whether a claim has been opened, you can contact the ICA directly or use our free case review form to request a professional follow‑up.

3. Timeline: When to File Your Arizona Workers' Comp Claim Form

Arizona law includes strict time limits. In many cases, you have one year from the date of injury, or from when you reasonably discovered that your condition was work‑related, to file the workers' compensation claim form with the ICA.

1
Report & document the injury.
Notify your employer as soon as possible and make sure there is a written record of where, when, and how you were hurt.
2
File the Worker's Report of Injury.
Use the official workers' compensation claim form (ICA Form 101) and send it to the Industrial Commission of Arizona within the applicable deadline.
3
Track any Notice of Claim Status and appeal deadlines.
If you receive a denial, you may have only 90 days to request a hearing using ICA Form 104. Missing this window can make the decision final.

Educational Notice for Mesa & Phoenix Workers

This page is an educational guide, not a government website. Always rely on the official Industrial Commission of Arizona instructions printed on the forms themselves. If you are unsure about how or when to file a workers' compensation claim form, consider speaking with a professional familiar with Arizona workers' comp law.