Workers’ Compensation CLAIM KIT – Arizona

Who will handle your claims?

The Dallas Claims Office will handle your Arizona claims, located at:

2400 Lakeside Boulevard, Suite 200
Richardson, TX 75082

Phone (800)527-5531
Mike Hicks, Regional Director 

How to Report Workers’ Compensation Claims?

To report via the Internet: Log on to the Crum & Forster website at http://one.cfins.com. Use your assigned User ID and Password. If you do not have a current User ID, please contact your local Crum & Forster Claims or Marketing resource.

To report via e-mail:                                  [email protected]
To report via fax:                                        1-877-622-6218
To report claims via telephone:             1-800-690-5520

(7 day/24 hour toll free reporting line for all states)

  • In the event of a serious or fatal injury, notify the local claim office immediately by telephone.

What forms does the employer need to be aware of?

Click on this link for the Arizona Forms: http://www.ica.state.az.us/HomePage/HOME_Forms.aspx

Form 101 / Employer’s Report of Industrial Injury:  

Arizona Form 1015.02

What is the Waiting Period for Lost Wages in Arizona?
The waiting period is 7 days. If the employee is off for over 2 weeks, the 1st 7 days is paid retroactively.

What are the Choice of Physician Rules in Arizona?
The employee has the freedom of choice after one visit as directed by the employer.

Preferred Provider Organization Network (PPO):
Crum & Forster has a PPO network available. Follow the instructions below to access the PPO Network:

Logon to the website at:   www.talispoint.com/conduent/cfi

  • Search by Provider Address, Name or Region
  • Select the Distance, Provider Type and Specialty
  • Results can then be exported to a directory or excel.
  • You can obtain a Map List or text message by selecting a specific provider

Where should all medical bills be sent?

Crum & Forster
PO Box 14801
Lexington, KY 40512

Important Websites:

Industrial Commission of Arizona: http://www.ica.state.az.us/

Arizona W/C Forms: http://www.ica.state.az.us/HomePage/HOME_Forms.aspx

Multi-State Information: http://www.workerscompensation.com/