Arizona law requires that all employers have workers’ compensation coverage for their employees. See A.R.S. § 23-961. Any member of the public may use this form to report an employer that does not have workers’ compensation coverage, as required by law. Please provide as much information as possible.
You may submit an Uninsured Employer Complaint Form in the following ways:
Electronically (preferred):
Via the Commission’s Website (http://www.azica.gov/forms)
In-person or by mail:
Industrial Commission of Arizona
c/o Legal Division, Investigations Section
800 West Washington Street
Phoenix, Arizona 85007
By Fax:
(602)-364-1395
You may also report an employer that does not have workers’ compensation coverage by calling the Commission’s Complaint Hotline: (602)-542-5766.