Other Resources
Worker’s Compensation Forms
Industrial Commission of AZ – Employer Report of Injury
7710 Worker’s Compensation Witness Statement of Accident Form
Banner Gateway Occupational Health
Amy Lake
480-543-3300
7710 Insurance – Worker’s Compensation
Terry Regan – Claims Account Rep
239-470-0143
East Valley Wellness
Shelly Leonard
480-373-2399
Industrial Commission AZ
Laura L. McGrory
602-542-5795
Fax: 602-542-1614
Public Safety Officers’ Benefits Programs (PSOB)
888-744-6513
USERRA/ESGR
Patricia Thiel – National Case Manager
800-336-4590, Option 1
Direct: 703-882-5150