The Workers’ Report of Injury, known as Form 407, is one of the primary ways an injured worker can report a workplace injury to the Industrial Commission of Arizona (ICA).

While a workers’ compensation claim may also be initiated through reports submitted by a physician or employer, filing Form 407 allows the injured worker to provide their own detailed account and helps ensure the claim is fully documented.

Completing this form accurately can help prevent delays and strengthen the foundation of your claim.

What Form 407 Is

Form 407 is the injured worker’s official report to the ICA. The form collects important details about:

• Who was injured
• How the injury happened
• When the injury occurred
• Which body parts were affected
• Who provided medical treatment

Even if an employer or physician submits a report, filing Form 407 ensures your version of events is clearly documented.

Where to Find the Workers’ Report of Injury

You can access Form 407 through the Industrial Commission of Arizona. The form is available:

• Online through the ICA claim portal
• As a downloadable PDF
• In paper form at some medical facilities

Submitting the form online is typically the fastest option and provides confirmation of receipt.

What You’ll Need to Fill Out the Form

Form 407 requires detailed information, including:

• Your name, address, and contact information
• Employer name, address, and your job title
• Date and time of the injury
• A detailed description of how the injury occurred
• Body part(s) affected
• Health care provider information
• Whether the injury was reported to your employer

This information is used by the insurance carrier to investigate your claim and determine eligibility for benefits.

Common Mistakes to Avoid

Errors on Form 407 can lead to delays or disputes. Common mistakes include:

• Leaving sections incomplete
• Underreporting symptoms
• Guessing or omitting medical details
• Using vague descriptions like “I hurt my back”
• Failing to list all affected body parts

Be as specific as possible. Describe the incident clearly, including movements, equipment used, working conditions, and immediate symptoms.

How to Submit Form 407

You can submit Form 407 in several ways:

• Online through the ICA portal
• By mail to the ICA
• In person at an ICA office

Online submission is often recommended because it provides immediate confirmation that your form was received.

Always keep a copy for your records.

What Happens After You File

Once your form is submitted:

• The claim is recorded with the ICA
• The employer’s insurance carrier is notified
• The insurance carrier reviews the claim
• A decision is typically issued within 21 days

You will receive a Notice of Claim Status, which will state whether your claim has been accepted or denied.

During this time, continue any recommended medical treatment and keep copies of all documentation.

Important Timing Considerations

Under Arizona law, injured workers generally have one year from the date of injury to file a workers’ compensation claim.

Filing Form 407 as soon as possible helps ensure compliance with deadlines and preserves your rights.

When to Seek Legal Help

You may want to consult an attorney if:

• You are unsure how to describe your injury
• The insurance carrier delays a decision
• Your claim is denied
• Your symptoms worsen over time
• There is a disagreement about medical treatment

Because Form 407 helps establish the foundation of your claim, completing it accurately is an important first step. Form 407 plays a key role in documenting a workplace injury in Arizona. While it is not the only way a claim can begin, it gives injured workers the opportunity to clearly present their account and ensure important details are included.

Taking the time to complete the form carefully can help reduce delays, avoid disputes, and support a smoother claims process.

A Legacy of Advocacy and Integrity

Recently recognized once again as two of Phoenix Magazine’s Top Lawyers, Adam Palmer and Jett Palmer have built a reputation rooted in advocacy, compassion, and an unwavering commitment to justice. Their work continues to influence Arizona law and ensure that injured workers receive the fair treatment they deserve.

At Palmer Law Offices, P.C., their team carries that same mission forward, providing personalized, knowledgeable representation to clients navigating complex workers’ compensation and injury cases throughout Arizona.