Workers’ Compensation CLAIM KIT – Arkansas

Who will handle your claims?

The Dallas Regional Claim Office will handle your Arkansas claims, located at:

2400 Lakeside Boulevard , Suite 200
Richardson, TX 75082

Phone (800)527-5531
Mike Hicks, Regional Director

How to Report Workers’ Compensation Claims?

To report via the Internet: Log on to the Crum & Forster website at https://cfconnect.cfins.com. Use your assigned User ID and Password. If you do not have a current User ID, please contact your local Crum & Forster Claims or Marketing resource.

To report via e-mail:                                     [email protected]
To report via fax:                                           1-877-622-6218
To report claims via telephone:                1-800-690-5520

(7 day/24 hour toll free reporting line for all states)

  • In the event of a serious or fatal injury, notify the local claim office immediately by telephone.

What are the Reporting Requirements?

Please report all workers’ compensation claims promptly.  Rule 8 of the Arkansas Workers’ Compensation Commission’s (AWCC) Rules and Regulations indicates “employers shall report all on the job deaths and/or injuries causing loss of time in excess of seven days within 10 days.”  The AWCC tracks timeliness of reporting, payment of benefits, and filing of forms.  The carrier is subject to penalties when the time requirements are not met, which could impact operational costs.  Please assist us in meeting the AWCC time requirements.

What forms does the employer need to be aware of?

Form AR-P – W/C Posting Notice:
Review the instructions and prominently display the form where each employee is likely to see the notice on a regular basis. The Arkansas posting notices are available on the Crum & Forster website.

AWCC Form 1 / First Report of Injury or Illness:
If you report the claim via telephone, you do not need to fill out this form. Please refer to the Form 1 Required Data attachment below, where you will find a Form 1 that marks which data is required.

If you report the claim via fax, complete this form, and fax it to the Crum & Forster fax number – fax # 1-877-622-6218

AR Form 1
AR Form 1 – Required Data Updates

Form AR-N / Employee’s Notice of Injury :
Review the instructions for details regarding form filing.

AR Form N 0806
AR Form N – Spanish 0806-(Notice in Spanish)

Form AR-W / Employer’s Wage Statement:
Fill out this form when the claimant is losing time from work. Read the instructions for more specifics on form filing.

AR Form W

Direct Payment of Medical Bills:
Per Bulletin No. 10-2009 of the Arkansas Insurance Department, “directly paying medical bills for injured employees may be considered a violation of Arkansas Code Ann. 11-9-106(a), which deals with making materially false representations for the purpose of avoiding payment of proper insurance premium.” “The law simply does not allow for such direct payments, with or without a valid deductible program. Even with an authorized deductible program, all claims must be submitted for “first dollar” payment by the insurer.”

What is the Waiting Period for Lost Wages in Arkansas?
The waiting period is 7 days. If the employee is off for 2 weeks, the 1st 7 days is paid retroactively.

What are the Choice of Physician Rules in Arkansas?
The employer/insurer chooses the treating physician. The employee is entitled to a one-time change of physician.  They must send the request in writing to the AWCC, and must have approval to make the change.

Preferred Provider Organization Network (PPO):
Crum & Forster has a PPO network available. Follow the instructions below to access the PPO Network:

Logon to the website at:   www.talispoint.com/conduent/cfi

  • Search by Provider Address, Name or Region
  • Select the Distance, Provider Type and Specialty
  • Results can then be exported to a directory or excel.
  • You can obtain a Map List or text message by selecting a specific provider

Where should all medical bills be sent?

Crum & Forster
PO Box 14801
Lexington, KY 40512

Important Websites:
Arkansas Workers’ Compensation Commission (AWCC)http://www.awcc.state.ar.us/

Arkansas W/C Formshttp://www.awcc.state.ar.us/forms.html

Multi-State Information: http://www.workerscompensation.com/