Arizona Workers Supplemental Claim Form 413 is a document used to submit a supplemental claim for benefits to the Arizona Industrial Commission. This form is typically used by injured workers and their employers, or their representatives, to request weekly benefits to supplement their regular workers' compensation benefits. There are three different types of Arizona Workers Supplemental Claim Form 413: Wage Loss Claim Form, Additional Authorization for Payment Form, and Additional Request for Payment Form. The Wage Loss Claim Form is used to provide information about the injured worker's job duties, wages, and any benefits they are currently receiving. The Additional Authorization for Payment Form is used to authorize a payment for a particular service or treatment. The Additional Request for Payment Form is used to ask for additional benefits or payments related to the injured worker's wage loss or disability.
Arizona Workers Supplemental Claim Form 413
Description
How to fill out Arizona Workers Supplemental Claim Form 413?
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