The Arizona ICA Petition to Reopen (form ICA 0446) is the official document an injured worker files with the Industrial Commission of Arizona to reopen a closed workers’ compensation claim and get more benefits when a new, additional, or previously undiscovered condition appears. You file it under A.R.S. § 23-1061(H), and it must come with a supporting doctor’s report.
Getting this form right matters because a small slip can cost you months of care. If you forget the physician’s statement, the insurance carrier does not have to act on your petition at all, under Ariz. Admin. Code R20-5-133. Arizona has no statute of limitations to file a Petition to Reopen, yet the ICA pays medical benefits only back to 50 days before the date you mail the form, so every week you wait is money you lose.
Here is what this guide gives you:
- 📝 A line-by-line walkthrough of every box on form ICA 0446 with sample entries
- 🩺 The exact physician’s statement rules that decide whether your petition even gets read
- ⏱️ The real deadlines, the 21-day carrier response window, and the 90-day protest clock
- 👤 Three full real-world examples you can copy step by step
- 🚫 The top mistakes that get petitions returned or denied, and how to dodge each one
What the Form Is and Who Must File It
The Petition to Reopen is a one-page request that asks the Industrial Commission of Arizona to put an old, closed work-injury claim back into active status. The legal name printed on the document is “Petition to Reopen Based on New, Additional or Previously Undiscovered Disability or Condition,” and the ICA tracks it as form ICA 0446. The form lives inside Arizona’s workers’ compensation system, which is a state program, not a federal one. The Industrial Commission is the state agency that receives the form, logs it, and forwards it to your insurance carrier.
The person who files is almost always the injured worker whose claim already closed. An authorized representative, such as a workers’ comp attorney or a paralegal acting for the worker, may also sign and file it, as the rule allows under R20-5-133(A). Many workers file on their own, with no lawyer, while they are stressed and in pain, so this guide keeps things plain.
You must file this form when three things are true. First, you have a new, additional, or previously undiscovered condition, which the ICA training defines as a real change in your body, not just more pain. Second, that condition ties back to your original work injury, not to aging or a fresh accident. Third, your old claim is closed but was once accepted, because a claim denied by a final Notice of Claim Status cannot be reopened this way. A common example is an old back injury that now shows a worse disc herniation on a new MRI, or a knee that finally needs a full replacement.
You do not use this form to ask only for new tests. The ICA is clear that a claim will not reopen just for extra diagnostic or investigative scans, because the carrier must pay for those without a reopening. Filing for the wrong reason wastes weeks and can draw a fast denial.
Before You Start: Documents and Information You Need
Gather everything before you open the form, because a petition with a missing piece gets returned or ignored. The single most important item is your physician’s statement, and the other items keep the ICA from confusing your claim with someone else’s. Spend an hour collecting these and you save yourself months.
- ICA claim number. This is the number assigned to your original injury claim; without it the ICA may not match your petition to the right file, which delays everything.
- Date of the original injury. The carrier uses this to confirm the claim, and a wrong date can route your form to the wrong claim folder.
- Your full legal name and any prior names. The ICA cross-checks names, so a nickname or new married name with no explanation can slow processing.
- Current mailing address and phone number. Every notice comes by mail, and a stale address means you miss the carrier’s response and your 90-day protest clock.
- Employer’s name at the time of injury. This confirms which insurance carrier covered you, and a blank here can stall the match to the carrier.
- Insurance carrier or self-insured employer name. This is who must act on your petition, so naming it speeds the handoff.
- A supporting physician’s statement. This signed report is mandatory; with no report, the carrier need not act on your petition at all.
- Your prior Notice of Claim Status. This document shows when and how your claim closed and proves the claim was once accepted, not denied.
- A description of the new or worsened condition. Write a few plain sentences so the doctor’s report and your form tell the same story.
If you cannot find your claim number, call the Phoenix ICA office at (602) 542-4661 and ask them to look it up by your name and injury date. Missing the physician’s statement is the most damaging gap, since the ICA gives you only 14 days after it receives the petition to supply the report before it warns all parties that your filing is incomplete.
Where to Get the Form and How to Access It
You can get the Petition to Reopen straight from the Industrial Commission of Arizona, and it is free. The fastest route is the Petition to Reopen page on the ICA website, where you can complete the form online or download a printable copy. The ICA confirms the form can be filled out on its website, printed, and mailed, so you choose the channel that fits you.
If you prefer paper, you can call or visit an ICA office and ask for the form by name. The Phoenix office sits at 800 W. Washington Street, Phoenix, AZ 85007, and the Tucson office is at 2675 E. Broadway Blvd., Tucson, AZ 85716, per the ICA contact page. Staff can hand you a blank form, but they cannot give legal advice or tell you what to write in each box.
Check that you have the current version before you start. The ICA prints a form identifier and revision marking on the document, and the agency tracks it as ICA 0446; using an old version can cause a mismatch with the current online intake. If you download the fillable PDF, type your answers right into the fields so the ICA can read them, since forms must be legible to be processed. Keep a blank copy for your records in case you need to start over.
A quick word on the related forms so you do not grab the wrong one. The Petition to Reopen restarts a closed claim, while the Petition for Rearrangement adjusts a permanent disability award, and the Request for Hearing challenges a decision. Picking the wrong form sends you down the wrong path and wastes weeks.
Step-by-Step: How to Fill Out the Petition to Reopen (ICA 0446) Line by Line
Work through the form from top to bottom, and do not skip a box even if it looks obvious. Each field below tells you what it asks, how to answer, a sample entry, the edge cases, the mistake to avoid, and the myth to drop. Print clearly in blue or black ink if you use paper, or type if you use the online form.
1. ICA Claim Number
This box asks for the number the Industrial Commission gave your original injury claim. Copy it exactly from your old Notice of Claim Status or any prior ICA letter, usually a string of digits with no spaces. For example, Maria Lopez writes 20223456789 in the claim number box.
If you truly cannot find the number, leave it blank only as a last resort and call the ICA first to retrieve it. The most common mistake is transposing two digits, and the direct consequence is that the ICA cannot match your petition to your file, so it sits unprocessed. Many filers believe the claim number is the same as their Social Security number, but it is not; it is a separate ICA-assigned number tied only to that injury.
2. Name of Injured Worker
This field asks for your full legal name as the worker who was hurt. Write your first, middle, and last name the way it appears on your original claim, in standard upper-and-lower case or all caps if the form shows samples that way. For example, Maria Elena Lopez writes her name in full rather than “Mary Lopez.”
If your name changed since the injury, such as after marriage, enter your current legal name and note your prior name nearby so the ICA can connect the records. The common mistake is using a nickname, which can keep the ICA from matching you to the existing claim and delay the whole petition. Some workers think the name must match their paycheck or employer records, but it should match the name on the ICA claim file.
3. Date of Injury
This box asks for the date your original work injury happened. Enter it in month, day, year order, written as MM/DD/YYYY, with no extra words. For example, Maria Lopez writes 04/12/2019 for an injury that occurred on April 12, 2019.
For a gradual condition or an illness, use the date the worker first knew the condition was work related, which is the date tied to the original claim. The frequent mistake is guessing the date or using the date the claim closed instead of the injury date, which sends your form to the wrong claim. People often think any close date works, but the ICA uses the original injury date to pull the correct file.
4. Name and Address of Injured Worker (Contact Information)
This section asks where the ICA and the carrier should mail every notice about your petition. Write your current street address, city, state, and ZIP code, plus a phone number where you answer. For example, Maria Lopez writes 1542 W. Catalina Dr., Phoenix, AZ 85015 with her cell number.
If you use a P.O. Box, that is fine for mail, but add a physical address if the form asks, so process servers and the carrier can reach you. The biggest mistake here is listing an old address, which means you miss the carrier’s response and blow past your 90-day window to protest a denial. Some filers assume the ICA already has their new address from another agency, but you must update it on this form.
5. Name of Employer at Time of Injury
This field asks which employer you worked for when the original injury happened. Write the full business name as it appeared on your paycheck or original claim, not a store nickname or a manager’s name. For example, Maria Lopez writes Desert Sun Hospitality LLC rather than “the hotel.”
If the company changed names or closed since your injury, write the name it used at the time of injury and note the change if you know it. The common mistake is naming your current employer, which confuses the carrier match and can stall the petition. Workers sometimes think the employer must still be in business for them to reopen, but the closed business does not block your right to reopen the old claim.
6. Insurance Carrier or Self-Insured Employer
This box asks who insured your employer when you were hurt, because that party must act on your petition. Copy the carrier’s name from your old Notice of Claim Status, or write “self-insured” with the employer name if the company carried its own coverage. For example, Maria Lopez writes SCF Arizona / CopperPoint as shown on her prior claim letter.
If you do not know the carrier, leave the line and let the ICA route it from the claim number, but filling it in speeds the handoff. The mistake to avoid is naming the wrong insurer, which sends your petition to a company that never covered you and wastes the 21-day response window. Some filers think the ICA pays the benefits, but the carrier or self-insured employer pays, not the state.
7. Description of New, Additional, or Previously Undiscovered Condition
This is the heart of the form, and it asks what changed in your body since the claim closed. Write a few plain sentences naming the body part and the new or worsened condition, and tie it to the original injury. For example, Maria Lopez writes: “My lower back injury from 2019 has worsened. A new MRI on 03/02/2026 shows a herniated disc at L4-L5 that now causes leg numbness.”
If you have more than one condition, list each one briefly so the doctor’s report can match each item. The major mistake is writing only “more pain,” because the ICA requires a real, objective change in your physical condition, not just increased discomfort. Many workers believe a strong description alone reopens the claim, but the medical report, not your words, carries the weight.
8. Date and Signature of Injured Worker
This block asks you to sign and date the petition to make it valid. Sign your legal name in ink, or apply your electronic signature online, and write the date you sign in MM/DD/YYYY form. For example, Maria Lopez signs her name and writes 05/20/2026 as the date.
If an authorized representative files for you, that person signs and dates here instead, as the rule permits. The most damaging mistake is leaving this blank, because the ICA sends an unsigned form back and asks you to sign before it does anything, which can cost weeks. Some filers think a typed name without a signature counts, but the form must be signed and dated to be processed.
9. Attached Physician’s Statement (Required Supporting Report)
This is not a box you fill in, but the form will not work without it, so treat it as a required field. Attach a signed statement from your doctor that names the physical condition behind the reopening and explains its relationship to the industrial injury. For example, Maria’s orthopedic surgeon writes a one-page report stating her new L4-L5 herniation is the direct and natural result of her 2019 work injury.
If your doctor is out of state, know that a party can object and force a deposition under R20-5-133(E), so an Arizona physician is often smoother. The biggest mistake is filing with no report, because the carrier is not required to act on a petition that arrives without one. Many workers think the ICA will get the report from their doctor, but you must supply it within 14 days of filing or the ICA warns all parties that your petition is incomplete.
Three Filled-Out Examples Using Real Scenarios
These three examples show how three different workers complete the same form. Copy the structure, not the facts, and swap in your own details. Each table walks through the major fields in order.
Example 1: Maria’s worsened back disc. Maria hurt her lower back lifting laundry at a hotel in 2019, her claim closed, and a new MRI shows a worse herniation.
| Form Section | What Maria Enters |
|---|---|
| ICA Claim Number | 20223456789 |
| Name of Injured Worker | Maria Elena Lopez |
| Date of Injury | 04/12/2019 |
| Address and Phone | 1542 W. Catalina Dr., Phoenix, AZ 85015 / (602) 555-0148 |
| Employer at Time of Injury | Desert Sun Hospitality LLC |
| Insurance Carrier | CopperPoint Insurance |
| Description of New Condition | “L4-L5 disc herniation, worse on 03/2026 MRI, causing leg numbness, tied to 2019 lift injury.” |
| Physician’s Statement Attached | Yes — orthopedic surgeon’s signed report |
| Date and Signature | 05/20/2026 / Maria E. Lopez |
Example 2: Carlos and a knee that now needs replacement. Carlos tore his knee on a job site in 2015, settled to closure, and years later the joint has collapsed.
| Form Section | What Carlos Enters |
|---|---|
| ICA Claim Number | 20151122334 |
| Name of Injured Worker | Carlos Mendez |
| Date of Injury | 08/03/2015 |
| Address and Phone | PO Box 771, Tucson, AZ 85702 / (520) 555-0193 |
| Employer at Time of Injury | Saguaro Builders Inc. |
| Insurance Carrier | Self-insured: Saguaro Builders Inc. |
| Description of New Condition | “Right knee arthritis from 2015 ACL injury now needs total knee replacement per X-rays.” |
| Physician’s Statement Attached | Yes — orthopedic report linking arthritis to injury |
| Date and Signature | 05/14/2026 / Carlos Mendez |
Example 3: Janet’s hardware complication. Janet had spinal fusion hardware placed after a 2017 work fall, the claim closed, and the hardware has now loosened.
| Form Section | What Janet Enters |
|---|---|
| ICA Claim Number | 20173344556 |
| Name of Injured Worker | Janet R. Whitfield |
| Date of Injury | 11/09/2017 |
| Address and Phone | 908 E. Elm St., Mesa, AZ 85203 / (480) 555-0117 |
| Employer at Time of Injury | Valley Freight Services |
| Insurance Carrier | Travelers Indemnity Co. |
| Description of New Condition | “Lumbar fusion hardware loosened, confirmed by CT on 04/2026, from 2017 fall; needs revision surgery.” |
| Physician’s Statement Attached | Yes — surgeon’s report on hardware failure |
| Date and Signature | 05/22/2026 / Janet R. Whitfield |
In all three, the worker names a concrete, objective change and attaches a doctor’s report that ties the change to the original injury. That pairing is what gives a petition a real chance.
How to File the Completed Form
Once the form is signed and the physician’s statement is attached, you can file through any of these channels. Keep proof of filing no matter which one you pick, because the mailing date sets your benefit start date.
- Online. Complete and submit the form through the ICA Petition to Reopen page. There is no filing fee. Submission is immediate, and you should save or screenshot the confirmation as your proof of filing.
- By mail. Send the signed form and the doctor’s report to the Industrial Commission of Arizona, 800 W. Washington Street, Phoenix, AZ 85007, per the ICA contact details. There is no fee. Use certified mail with return receipt, and keep the receipt, because the postmark date drives your retroactive benefits.
- In person. Drop the form at the Phoenix office above or the Tucson office at 2675 E. Broadway Blvd., Tucson, AZ 85716. There is no fee. Ask the clerk to date-stamp your copy as proof of filing.
- By fax or phone help. Call Phoenix at (602) 542-4661 or Tucson at (520) 628-5181, listed on the ICA page, to confirm the current fax number and mailing steps before you send. Keep the fax confirmation sheet as proof.
There is no filing fee for a Petition to Reopen through any channel, so ignore any site that asks you to pay. Whichever route you choose, send a copy of the petition and the medical report to your insurance carrier as well, so the 21-day clock starts cleanly. Hold onto your stamped copy, certified receipt, or online confirmation for your records.
What Happens After You File
After the ICA logs your petition, it sends a Notice of Petition to Reopen to your insurance carrier so the carrier can respond. The carrier then has 21 days from notification to accept or deny your petition by issuing a Notice of Claim Status. The ICA itself does not judge whether your medical evidence is strong; the agency does not review the medical for appropriateness, leaving that call to the carrier.
If the carrier accepts, your claim reopens for active benefits. That means the insurer pays for reasonable and necessary medical care again, and you may get temporary disability checks if the condition keeps you off work. Reopening usually does not erase a past permanent disability award; it adds medical and wage support for the new problem.
Watch the calendar closely on benefits and protests. Medical benefits run only back to 50 days before the date you mailed the petition, so an early filing protects more of your care. If the carrier denies your petition, you have 90 days to file a Request for Hearing to protest, or the denial becomes final.
If your petition was filed with no medical report, the ICA notifies all parties within 14 days that the filing is incomplete, and the carrier need not act until the report arrives. That is why attaching the doctor’s statement upfront saves the most time.
Mistakes to Avoid When Filling Out the Form
Each error below has tripped up real filers, and each carries a real cost. Read them once before you submit.
- Filing with no physician’s statement. The carrier is not required to act on a petition that arrives without the report.
- Leaving the signature or date blank. The ICA returns the unsigned form and asks you to sign, costing weeks.
- Writing only “more pain.” A petition needs an objective change in your condition, so a pain-only claim invites a quick denial.
- Using the wrong claim number. A transposed digit means the ICA cannot match your file, so the petition stalls unprocessed.
- Entering the close date instead of the injury date. This routes your form to the wrong claim and delays the match.
- Naming your current employer. The carrier match fails when you list anyone but the employer at the time of injury.
- Listing an old mailing address. You miss the carrier’s notice and may blow your 90-day protest window.
- Filing only to get more tests. The ICA will not reopen a claim solely for diagnostic scans the carrier must already pay for.
- Trying to reopen a denied claim. A claim closed by a final denial cannot be reopened through this petition.
- Waiting too long to mail it. Medical benefits reach back only 50 days before mailing, so delay shrinks your coverage.
- Using an out-of-state doctor without planning. A party can object and force a deposition on an out-of-state report.
- Throwing away your proof of filing. With no postmark or confirmation, you cannot prove your benefit start date.
Do’s and Don’ts
These quick rules keep your petition clean and on time.
Do:
- Do attach the physician’s statement first, because without it the carrier need not respond.
- Do sign and date the form, since an unsigned form comes back and wastes time.
- Do file as early as possible, because benefits reach back only 50 days before mailing.
- Do keep proof of filing, so you can prove the date if the carrier disputes it.
- Do describe an objective change, since the law requires more than added pain.
- Do use your name from the ICA claim file, so the agency matches you fast.
Don’t:
- Don’t file for diagnostic tests alone, because the ICA will not reopen for scans the carrier must cover.
- Don’t guess the claim number or injury date, since a wrong entry stalls the match.
- Don’t use an old address, or you miss the carrier’s notice and your protest deadline.
- Don’t try to reopen a finally denied claim, because that path is closed.
- Don’t assume a full and final settlement can be reopened, since it may bar reopening.
- Don’t ignore a denial, because you have only 90 days to request a hearing.
Pros and Cons of Filing on Your Own vs. With Help
Filing alone is free and direct, but a worsening injury raises the stakes, so weigh both paths. Here is how filing pro se compares with hiring a workers’ comp attorney.
| Filing on Your Own (Pro Se) | Filing With an Attorney |
|---|---|
| Costs nothing beyond your time, so you keep more of any award | Costs a contingency fee, but you pay only if benefits come through |
| You control the timing and can file the same day you sign | The attorney handles deadlines, easing your stress while hurt |
| Simple worsening cases with a clear doctor’s report can succeed alone | Complex causation, like arthritis vs. aging, is hard to prove without help |
| No middle person means faster small decisions | A lawyer can prepare a Request for Hearing fast if the carrier denies |
| You learn your own claim deeply | A lawyer knows how to handle a settlement that may bar reopening |
The deciding factor is usually how hard your causation is to prove. A clean MRI showing a new herniation may be fine to file alone, while an arthritis or settlement fight often needs a lawyer.
FAQs
Is there a deadline to file a Petition to Reopen in Arizona?
No. Arizona has no statute of limitations on filing, but medical benefits reach back only 50 days before you mail the form, so filing early protects more coverage.
Do I have to attach a doctor’s report to my petition?
Yes. A signed physician’s statement is mandatory, and the carrier need not act on a petition that arrives without one.
Is there a filing fee for the Petition to Reopen?
No. The Industrial Commission of Arizona charges nothing to file this form through any channel, so never pay a third party to submit it.
Do I write my old employer or my current employer in the employer box?
No, you do not use your current employer. You enter the employer at the time of injury, because that ties the petition to the right carrier.
Do I put the date my claim closed in the date of injury box?
No. That box needs the original injury date, not the close date, because the ICA uses the injury date to pull the correct claim file.
Is “more pain” enough to reopen my claim?
No. You must show an objective change in your condition, such as a new MRI finding, not just increased discomfort.
Do I need to sign and date the form myself?
Yes, unless an authorized representative signs for you. An unsigned form is returned by the ICA before any action is taken.
Is my Social Security number the same as my ICA claim number?
No. The claim number is a separate ICA-assigned number tied only to your injury, so copy it from a prior Notice of Claim Status.
Can I reopen a claim that was denied by the carrier?
No. A claim closed by a final Notice of Claim Status denial cannot be reopened through this petition.
Can I reopen after a full and final settlement?
No, usually not. A full and final settlement that closed your future medical rights can bar reopening, so check your settlement terms first.
Will reopening take away my permanent disability award?
No. Reopening usually adds medical and wage support for the new condition without erasing a prior permanent award.
Does the ICA decide if my medical evidence is strong?
No. The ICA does not review the medical for appropriateness; your insurance carrier decides whether to accept or deny.
How long does the carrier have to respond to my petition?
Yes, there is a set window: the carrier has 21 days from ICA notification to accept or deny by issuing a Notice of Claim Status.
Can I still get benefits if I file from a P.O. Box address?
Yes. A P.O. Box works for mail, but add a physical address if asked so the carrier and the ICA can always reach you.
Related reading
- How to Fill Out Washington L&I Application for Benefits (Form F242-130-000) + FAQs
- How to Fill Out the Washington L&I Notice of Claim Closure Petition (F242-395) + FAQs
- How to Fill Out Arizona ICA Employer’s Report of Injury (w/Examples) + FAQs
- How to Fill Out the Arizona ICA Request for Hearing (Form 0446) — With Examples + FAQs
- How to Fill Out the Arizona ICA Settlement / Lump Sum Petition + FAQs
- How to Fill Out the Arizona ICA Worker’s Report of Injury (With Examples) + FAQs
- How to Fill Out California WCAB DWC-AD 1 (w/Examples) + FAQs