How to apply for Workers Compensation

Coping with an unexpected injury or work-related illness is never easy. At UAMS you can count on your supervisor, our medical staff, and the support staff in the Office of Human Resources to lend a helping hand.
ALL employees on UAMS payroll are entitled to apply for workers’ compensation. If you have an on-the-job injury, you may be eligible for benefits – including medical care and income replacement – under workers’ compensation. Because UAMS is a public institution, worker compensation claims are submitted first through the Office of Human Resources, then to the State of Arkansas’ carrier which is the Public Employees Claims Division (PECD) of the Arkansas Insurance Department.
PLEASE SEE BELOW FOR FREQUENTLY ASKED QUESTIONS:

Workers Compensation: What an Employee needs to know!

Workers Compensation: What a Supervisor needs to know!

Employee Instructions

Immediately advise your supervisor.
Seek emergency care at once if your situation is life threatening.
Complete Section A of the I&I Form. (UAMS Employee/Student/Visitor Injury and Incident Report) This form is also available for you to complete online (preferred). This form is required for any on-the-job injury, even if you do not require medical attention.
Take the I&I Form with you when you seek medical treatment. Your attending physician or nurse will complete Sections B and C and return the form to you.
If you receive medical care, you MUST also complete these forms (1 & 2) in order to have your medical bills considered for coverage (payment) by workers’ compensation:
(Form AR-N, Employee’s Notice of injury, Arkansas Worker’s Compensation Commission)
(Public Employee Claims Division Employee’s Report of Accident)
Give all 3 forms to your supervisor. They must complete additional forms to finalize the process.
IMPORTANT: You must use the following designated medical facilities: Student Employee Health (Jack Stephens Drive) & Satellite Clinic room G605 in Central Bldg (needle sticks and exposures); Family and Preventative Medicine Clinic (Jack Stephens Drive) (All other injuries); UAMS Emergency Room (Emergency cases); Local AHEC sites; Please refer to the state workers’ compensation directory.

Supervisor Instructions

Complete 2 following forms:
Form 3 (Workers Compensation-First Report of Injury or Illness)
Form 4 (Information Request by Public Employees Claims Division on State Employee’s Claims)
Give a copy of all forms to the employee and keep a copy for your records.
Temporary Prescription Card: When an employee requires medical treatment the supervisor or rep must complete the form, make a copy, and give the original to the employee to present to the pharmacy. the form MUST be faxed to the workers comp carrier at (501) 371-2733.
Send the originals of 5 forms (I & I plus Forms 1-4) to Mabeline Hansberry, Human Resources, campus mail box # 564, or fax 686-8872.
IMPORTANT: Send the forms as soon as possible, preferably within 7 calendar days of the injury. If these forms are not processed and received by PECD within 10 days of the injury, a late fee may be assessed in accordance with Arkansas Workers’ Compensation Commission policy.
Family and Medical Leave Act (FMLA): Workers compensation and FMLA run concurrently (at the same time). Your employee may need to complete the healthcare provider form in cases when it is a ‘lost time’ situation. Please follow the current FMLA guidelines established at UAMS.
When your employee has a ‘lost time’ situation, please be sure to contact Mabeline Hansberry immediately.

OHR will review the forms and submit completed claims to PECD. Workers’ comp benefits, if any, will be determined after PECD receives the forms. Occupational injuries are generally classified as one of the following:

Incident: no time missed from work and medical care not needed
Medical Only: medical care was received but employee is not eligible for lost wages
Lost Time: medical care was received and employee is eligible for lost wagesWorkers’ compensation packets, which contain all the forms and instructions, are available in OHR. Please contact Mabeline Hansberry if you need a supply for your work area. If you would like to schedule a training session on worker’s compensation for your work area, please contact Mabeline Hansberry, (501) 686-7083 or MHansberry@uams.edu .

Following are the forms REQUIRED forms to file a workers’ compensation claim. Send completed forms to Mabeline Hansberry, via fax at (501) 686-8872, or mail slot #564.

Form 1 - Form AR-N, Employee’s Notice of injury, Arkansas Worker’s Compensation Commission
Form 2 – Public Employee Claims Division Employee’s Report of Accident
Form 3 – Workers Compensation-First Report of Injury or illness
Form 4 – Information Request by Public Employees Claims Division on State Employee’s Claims
I & I Form (online) – UAMS Employee/Student/Visitor Injury and Incident Report
I & I Form (print) – UAMS Employee/Student/Visitor Injury and Incident Report
Temporary Prescription Card – Supervisors must sign as Employer Representative and make sure a copy is faxed to the workers comp carrier at (501) 371-2733

UAMS.EDU

Office of Human Resources

How to apply for Workers Compensation

Related Links:

Human Resources for Managers