Arizona Launches Major Workers’ Comp Claims-Form Modernization

Phoenix 09/17/2026 
Important Update: ICA Official 104 -108 Modernization 
Launch Sept 22, 2026 

The Industrial Commission of Arizona (ICA) Claims Division has officially modernized the 
Recommended Average Monthly Wage calculation (Form 108) and updated the Notice of Claim 
Status (Form 104). The official go-live date is September 22, 2026. Pursuant to a Governor 
mandate to streamline administrative processes and bring legacy state forms into alignment 
with current claims practices, this modernization effort was completed with extensive 
stakeholder input. The Notice of Claim Status and Recommended Average Monthly Wage forms 
are governed pursuant to A.R.S. § 23-1061(F) and A.R.S. § 23-1041(A). Specifically, A.R.S. § 
23-1061(F) mandates that: 

Specifically, A.R.S. § 23-1061(F) mandates that: 
“...each insurance carrier and self-insuring employer shall report to the commission a notice of 
the first payment of compensation and shall serve on the commission and the employee any 
denial of a claim, any change in the amount of compensation and the termination of 
compensation, except that claims for medical, surgical and hospital benefits that are not denied 
shall be reported to the commission in the form and manner determined by the commission…” 
” Within thirty days after the payment of the first installment of compensation, the insurance 
carrier or self-insuring employer shall notify the employee and commission of the average 
monthly wage of the claimant as calculated, and the basis for such determination…” 
Specifically, A.R.S. § 23-1041(A) mandates that 
.” 
A. Every employee of an employer within the provisions of this chapter who is injured by 
accident arising out of and in the course of employment, or the employee's dependents in the 
event of the employee's death, shall receive the compensation fixed in this chapter on the basis 
of the employee's average monthly wage at the time of injury.  

The modernized Form 108 and updated Form 104 have been restructured as described: 
• Split Architecture for Form 108: Form 108 is now divided into two distinct forms—the Form 
108 Standard for routine 30-day wage calculations (capturing ~90% of filings) and the Form 108 
Supplemental for exception-based, complex earnings scenarios (such as employment under 30 
days, concurrent covered employment, or non-wage remunerations like board and lodging). 
• Integration of Notice of First Payment: Checkboxes 4A and 4B have been permanently 
removed from Form 104 and integrated directly into Section II of Form 108 Standard, which now 
serves as the statutory Notice of First Payment of compensation pursuant to A.R.S. § 23
1061(F). 
• Standalone Form 108 Filings: For previously accepted claims, Form 108 operates as a self
contained, standalone document. Issuing a companion Form 104 is no longer required when 
establishing or adjusting average monthly wages. 

For detailed wage calculation examples illustrating the new 108 forms, please consult 
the Wage Chapter of the 2026 Claims Adjusting Manual. 

The webform versions of the modernized Form 108 (Standard & Supplemental) and updated 
and available on September 22, 2026. Form 104 are available and authorized for use via the 
ICA Community Portal at https://azica.my.site.com/claims/s/.The ICA strongly encourages payer 
representatives, self-insured employers, third-party administrators (TPAs), and workers' 
compensation claim adjusters to submit all claim forms via the Community webforms. 

Payers may integrate the modernized Form 108 and updated Form 104 into their native claims 
management systems (such as Origami) with the formal approval of the ICA Claims Division. 
Payers who wish to integrate these webforms or request custom system onboarding may email 
their request to claims@azica.gov. Requests will be processed as expeditiously as possible. 
Payers who wish to modify or alter the new forms, even for non-substantive adjustments, must 
request prior approval from the Commission by submitting a written request by email to 
claims@azica.gov.  

To ensure a seamless transition and allow carriers and software vendors sufficient time to 
update internal systems, the ICA is providing a 90-day initiation and onboarding period following 
production launch. The initiation period will end December 21, 2026. During this 90-day 
window, payers and authorized payer representatives may continue to utilize existing webforms 
or native system formats while completing ICA system approvals and using New Community 
Webforms or use of Native System forms will be allowed while going through the ICA Approval 
Process. Upon the conclusion of the 90-day onboarding window, December 21, 2026, usage of 
the modernized Form 108 and updated Form 104 formats will become mandatory across all 
filings, and legacy form versions will no longer be authorized for use.  

Specific mandatory training regarding the modernized forms, workflow logic, and testing are 
available through ongoing webinars posted in the ICA Community Portal. Additionally, adjusters 
who attended the 108 form modernization training sessions during the live 2026 Arizona ICA 
Claims Seminar are officially exempt from the webinar requirement and have been granted 
direct access to the mandatory assessment by registering online. The 2026 edition of the ICA 
Claims Adjusting Manual includes complete step-by-step instructions and example 
scenarios for all modernized forms. 

Questions regarding the modernized forms, system integration, or the content of this letter may 
be directed to claims@azica.gov or by calling the ICA Claims Division at (602) 542-4661. 

Sincerely, 
Ruby Tate Claims Manager ICA Claims Division