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Form Claims ICA0102 Worker's & Physician's Report of Injury - Arizona
What Is Form Claims ICA0102?
This is a legal form that was released by the Industrial Commission of Arizona - a government authority operating within Arizona. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form Claims ICA0102?
A: Form Claims ICA0102 is the Worker's & Physician's Report of Injury form specific to the state of Arizona.
Q: What is the purpose of Form Claims ICA0102?
A: The purpose of Form Claims ICA0102 is to report a work-related injury or illness to the Industrial Commission of Arizona.
Q: Who needs to fill out Form Claims ICA0102?
A: Both the worker who was injured and the physician who treated the injury need to fill out Form Claims ICA0102.
Q: What information is required on Form Claims ICA0102?
A: Form Claims ICA0102 requires information such as the worker's personal details, details of the injury or illness, and the treatment provided by the physician.
Form Details:
- Released on May 9, 2017;
- The latest edition provided by the Industrial Commission of Arizona;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form Claims ICA0102 by clicking the link below or browse more documents and templates provided by the Industrial Commission of Arizona.
