POLICYHOLDERS
Filing & Managing a Claim
When you are notified of a work-related injury, the law requires that you report it within 10 days using an
Employer’s Report of Industrial Injury—Form 101.
SCF Premier recommends filing the report within 24 hours. To avoid delays that could lead to increased costs, this report should be filled out accurately and completely. The form is to be completed by the employer, not the employee. Filling out this form does not admit liability for the alleged injury.
Currently the Form 101 may be filed one of three ways:
Via e-mail: Download the form, fill it out and send it as an e-mail attachment to
scf101@scfaz.com.
Fax: Download the form and fax it to 877.202.0497.
Mail: Send the original to:
Industrial Commission of Arizona
P.O. Box 19070
Phoenix, AZ 85005-9070
and a copy of the form to:
SCF Premier Insurance Company
P.O. BOX 36070
Phoenix, AZ 85067-6070
Retain a copy for your records.
A fatality must be reported by telephone within eight hours to the Arizona Division of Occupational Safety and Health (ADOSH) at 602.542.5795, and within 24 hours to SCF Premier.
Fraud Prevention
Fraud hurts everyone – when employers incorrectly report the job classifications of their employees, all policyholders end up bearing the cost of that employer’s injuries. If you suspect an employer or another employee is acting fraudulently, call SCF’s fraud hotline at 800.526.5226.
