How to Complete Arizona's Workers' Compensation Claim Form

What makes Arizona's workers' comp form unique

Arizona requires the Employer's First Report of Injury (Form WC‑1) to be submitted within ten days of a work‑related incident, and the injured employee must file a Claim for Compensation (Form WC‑2) within 30 days of receiving the WC‑1. Unlike many states, Arizona permits electronic filing through the Workers' Compensation Division's portal, but the paper version remains legally valid.

Key sections of Form WC‑1 (Employer Report)

The employer's report gathers business details, injury specifics, and initial medical response. Critical fields include:

• Employer name, address, and Arizona employer ID
• Employee name, social security number, and job title
• Date and time of injury, location on the worksite, and brief description of the incident
• Whether the injury required emergency care or hospitalization
• Initial wage loss estimate and whether the employee missed work

Missing or inaccurate data can delay claim processing, so double‑check spelling, dates, and the employer's tax identification number.

Completing Form WC‑2 (Employee Claim)

The employee's claim mirrors the employer's report but adds medical and wage details. Important elements are:

• Exact diagnosis and treating physician's information
• Estimated total wages earned in the 52 weeks before the injury
• Current wage loss and any overtime or shift differentials affected
• Signature and date, confirming the claim is truthful

If the employee cannot sign due to injury, a power‑of‑attorney or designated representative may sign on their behalf.

Electronic vs. paper filing

Arizona's online portal (www.azworkerscomp.gov) streamlines submission: upload scanned PDFs, receive instant acknowledgment, and track claim status. Paper filings must be mailed to the Workers' Compensation Division, Phoenix, AZ 85004, with a self‑addressed stamped envelope for any follow‑up correspondence.

Deadlines and penalties

Failure to meet the ten‑day employer deadline can trigger a $500 fine per day, while employee claims filed after 30 days may be denied unless a valid extension is granted. Both parties should retain copies of all documents and any medical records for at least three years.

Comparison of filing options