Workers' Compensation Toolkit

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This kit is provided to new workers' compensation policyholders and their agents, as well as to all current policyholders when their policies renew. It contains important claims department contact information, instructions, and forms.

Arizona Contact Information:

Nationwide Insurance - West Office*
PO Box 182079
Columbus, OH 43218-2079
Fax: (800) 363-8904

Agribusiness Mailing Address for Claims Related Mail
P O BOX 182066
Columbus, OH 43218-2066
Phone: (800) 228-6700
Fax: (800) 842-1482

Below are a few additional tools to help you manage your workers' compensation claim:

Locate medical providers - Are you an employer or injured worker looking for doctors, hospitals or pharmacies? We can help you find local medical professionals.

First Fill program - The First Fill program allows one-time prescription processing before a workers' compensation claim is established, resulting in no out-of-pocket cost for the injured worker. Ask your claims representative for more details.

eBill submission for Medical Providers -

Nationwide Workers’ Compensation accepts eBill submission from medical providers in all states on all claims. Providers seeking eBill submission of medical bills may do so by contacting their own eBill clearinghouse, by registering with a clearinghouse of their choice, or by contacting


WorkCompEDI, Inc.
(800) 297-6909
Payor ID: CB151 (Nationwide, Allied, Harleysville)
Payor ID: 28223 (Nationwide Agribusiness)


NOTE: If you experience difficulty opening/accessing the PDF's using the links below:

Open to access the documents

Arizona Compliance Information:

Posting Requirements
Reporting Of Claim By Employer
Penalties for Late Reporting
Physician Selection

Posters and Publications

POSTER - Work Place Safety (English and Spanish) Required

POSTER - Employer's Compliance with Workers' Compensation Law (English and Spanish) Required

POSTER - Work Exposure to Bodily Fluids (English and Spanish) Required

POSTER - Work Exposure to Methicillin-Resistant Staphylococcus aureus (MRSA), Spinal Meningitis, or Tuberculosis (TB) Required

BROCHURE - Employers Frequently Asked Questions

BROCHURE - Workers' Compensation Information for the Injured Worker


Employer's Report of Injury

Workers' and Physician's Report of Injury

Form 108 - Wage Calculation
- UNAVAILABLE ONLINE. This form can be obtained from The Industrial Commission of Arizona (602) 542-4653

Employee's Notice of Rejection of Terms of the Arizona Workers' Compensation Law

Please Note: The information on this site is maintained by a third-party, Nationwide does NOT warrant or represent that the information will be error-free. Your use of the site is on an as-is basis, at your sole discretion and risk. The site is for informational purposes, and nothing included in the site shall replace the need for qualified legal counsel. We recommend that you consult with legal counsel, agents, or risk managers regarding workers' compensation obligations.

This service uses a proprietary system to pre-fill certain claims office and insurance company data on some forms. This may prompt a request by your Adobe Reader program to "trust" the source of the files. Please designate this as a trusted source in order for that information to be pre-filled for you.

The documents in this system use Adobe Reader to view PDF files. If you do not have Adobe Reader, you may download the latest version here for free. Download Adobe Reader Here