Arizona law permits workers’ compensation claimants and their attorneys to file a petition, prior to a final disposition of the case, requesting that the Commission set reasonable attorney’s fees related to a workers’ compensation claim. See A.R.S. § 23-1069.  Claimants or their attorneys may use this form to request that the Commission set fees.  Please provide the information requested and attach any supporting documents. Failure to provide all requested information may delay processing.

You may submit a Petition for Attorney’s Fees Pursuant to A.R.S. § 23-1069 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, Attorney’s Fees
800 West Washington Street
Phoenix, Arizona 85007

By Fax:
(602)-364-1395