Forms

January 1, 2007

Forms & Claims Assistance

The Arkansas Workers' Compensation Commission's forms and other claims adjusting items are available for downloading or printing on the links below.

A list of contacts for questions regarding the filing or completion of the various claim forms can be found via this link - Contact Information.

Supplies should be furnished by carriers or third party administrators to their clients and by self-insureds to all their locations.

Questions regarding this notice may be directed to the AWCC Communications Liaison, 501-682-3930, by electronic mail at AWCC.Info@Arkansas.gov or by writing to Arkansas Workers' Compensation Commission, P.O. Box 950, Little Rock, AR 72203-0950.

You must have Adobe Acrobat Reader Version 5.0 or greater to view or print these forms. If you do not have Adobe Acrobat Reader, you can obtain it by clicking on the icon below.

Acrobat and the Acrobat logo are trademarks of Adobe Systems Incorporated

August 20, 2007

Joint Bulletin issued by AWCC, Arkansas Insurance Department, and the Contractors Licensing Board pertaining to Certificates of Non-Coverage

Click here to view/download this bulletin.
(Adobe Acrobat Reader required)

To download the forms or view the 2007 revised, updated instructions for them, click the appropriate link below. For the Mileage Reimbursement Worksheet or Medical Release, click the Claims Adjusting Aids link.

State of Arkansas
Workers' Compensation Commission
324 South Spring Street
P.O. Box 950
Little Rock, Arkansas 72203-0950
Telephone 1-501-682-3930 / 1-800-622-4472
Legal Advisor Direct 1-800-250-2511
Arkansas Relay System TDD 1-800-285-1131

For information or comments regarding this site
contact the AWCC Communications Liaison