s Claims - Request to Leave the State
Protection of life, health, safety, and welfare of Arizona’s most valuable assets

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2016 Wage Info
•  AMW Statutory Max - $4,428.91

•  Arizona Minimum Wage - $8.05
(no change from 2015)

•  Get Info:2015 Az Minimum Wage
•  Get Info:2016 Az Minimum Wage
•  Get Info:2015 Az AMW Max
•  Get Info:2016 Az AMW Max

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Claims Division
Request to Leave the State

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

Click for Phone List of ICA Divisions

Request to Leave the State

Click here to download form :     Request to Leave the State (PDF)

The injured worker must apply in writing to the ICA requesting permission to be out of the state of Arizona for any period exceeding fourteen days. The ICA issues an award either approving or disapproving the request. If approved, the claim continues to be processed in accordance with Arizona Workers’ Compensation Law.

If you fail to get approval prior to leaving the state, the insurance company may suspend your benefits.