s Claims - Employer's Report of Injury
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•  AMW Statutory Max - $4,428.91

•  Arizona Minimum Wage - $8.05
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Claims Division
Employer's Report of Injury

Molly Jones, Claims Manager
Email: Claims@azica.gov

 Do not use the above email address to send emails (or attachments to emails)  containing sensitive or personal information (such as social security numbers) to the  ICA because neither the website nor email is secure. Instead, FAX such materials to  the FAX number below or mail paper copies to a mailing address below.

Phoenix: 800 W Washington St, Phoenix AZ 85007 - Phone: (602) 542-4661
Tucson: 2675 East Broadway, Tucson AZ 85716 - Phone: (520) 628-5181
FAX (use for either office): (602) 542-3373

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Employer's Report of Injury

Click here to download form :     Employer's Report of Injury (PDF)

The employer must notify his insurance carrier of every known injury or disease suffered by an employee, fatal or otherwise, arising out of or in course of employment.