Arkansas Workers' Compensation Claims: Eligibility, Filing, and Appeals

If you have suffered a work-related injury or disease, you may be entitled to benefits under Arkansas workers' compensation laws. Read on for more information on who is eligible for benefits, how to file a claim, what medical treatment is covered, what benefits are available, and more.

Eligibility

In general, Arkansas employers with three or more employees must carry workers' compensation insurance. Employers with fewer than three employees in certain industries, such as building construction, are also required to secure coverage.

To be eligible for workers' comp benefits, your injury must have occurred in the course of your employment. Most on-the-job accidents are covered by workers' compensation. For example, if you are injured by a machine, trip on something while at work, or hurt your back while performing your work duties, your injury is likely covered. On the other hand, injuries that arise from fights between coworkers, optional social or recreational activities, the use of alcohol or drugs, or off-duty activities, such as meal breaks or commuting to work, are generally not covered.

In addition to injuries from one-time accidents, injuries that develop over time as a result of your job duties are also covered by workers' compensation benefits. These types of injuries may include, among others:

• repetitive motion injuries, such as carpal tunnel
• back or neck injuries
• hearing loss
• hernias
• mental or emotional disorders
• cardiovascular diseases or injuries, and
• occupational diseases, caused by exposure to toxic substances at work (such as asbestosis, a lung disease caused by exposure to asbestos).

Filing a Claim

If you've been injured on the job, you must notify your employer immediately, If you need immediate medical attention or are unable to report to your employer because of the injury, you must report to your employer as soon as you are capable of doing so. You should notify your employer in writing whenever possible. Your employer may ask you to fill out an accident report, asking you to describe how the injury occurred or to identify witnesses to the accident. You should be as accurate as possible when writing about your injury, but don't speculate or fill in details that you don't remember.

After your claim is filed, your employer's insurance company may contact you for more information about your injury or disease. Your employer (or its insurance company) may accept or deny your claim, or this decision may be delayed until more information about your condition is provided. If your claim is denied, you will be able to appeal the decision (see "Appeals" below).

If you are not satisfied with how your claim is being handled by your employer and you are unable to resolve your differences, you may file a claim with the Arkansas Workers' Compensation Commission using this form. You should fill out the form to the best of your ability, generally with the assistance of an attorney.

Medical Treatment

If your claim is accepted, medical treatment related to your work injury is generally paid for through workers' comp. Among other things, this includes payment for medical appointments, surgery, chiropractic services, nursing services, prescriptions, ambulatory devices, artificial limbs, eyeglasses, contact lenses, and hearing aids. You are also ordinarily entitled to mileage for travel to your medical appointments.

Arkansas has a "managed care" system for workers' compensation claims. That means that there are rules and regulations about what treatment is covered—in short, only "reasonably necessary" treatment is covered. Your treatment may be reviewed to determine if it is reasonably necessary to treat your condition or injury before it is paid for. Except for emergency visits, physicians and other medical providers will generally seek authorization in advance before providing any treatment.

However, there are limits for your medical treatment coverage. If you didn't miss work due to your injury, your treatment will be covered for six months after your injury. If you have been receiving authorized medical treatment, your treatment will be covered for six months following your return to work. No more than $10,000 will be paid in medical treatment overall.

Your employer has the right to choose your initial treating physician. You can petition your employer (or its insurance company) to change the treating physician, but you can only do that once.

What to Do at Your Appointments

When you visit any treating physician, you will want to follow a few simple guidelines to ensure that you receive the best care possible and to increase the likelihood your claim is covered:

• Show up on time for your appointment, dress appropriately, and be polite.
• Make sure you can clearly summarize how your injury happened. Be consistent with any accident reports you have previously filed and what you have told any other medical providers.
• Describe in detail any pain, limitations, or other symptoms you are experiencing. Do not exaggerate, but be complete.
• Know your medical history, including any treatment you have already had for similar injuries. Make sure that you point out any differences between what you are experiencing now as a result of your current workplace injury and any previous injuries.
• Do not be afraid to advocate for yourself. If you have questions or concerns about your treatment, respectfully ask your physician.

Disability Benefits

If you are unable to work or have suffered permanent impairment as a result of your work-related injury, you may be entitled to disability benefits. Disability benefits for lost wages are usually subject to a waiting period of seven days, not including the date of injury. However, if you are out of work for more than two weeks, your benefit payment will include those first seven days.

Total Disability

If you are unable to work as a result of your injury or disease, you may be entitled to total disability benefits. You will receive a weekly benefit of 66 2/3% of your average weekly wage, subject to a maximum amount. In 2017, the most you can receive is $661 per week.

If you are temporarily totally disabled, you will receive benefits until you are able to return to work. If you are permanently totally disabled, you will receive benefits for the remainder of your life.

Temporary Partial Disability

If you are able to return to part-time or modified work, but you are earning less than your normal wages, you may be eligible for temporary partial disability benefits. These benefits are 66 2/3% of the difference in your earnings. For example, if your usual wage was $500 per week, and you're earning $400 per week due to your disability, you will receive 66 2/3% of $100 (the difference in your earnings), or $66.23 per week.

Permanent Partial Disability

If you suffered a permanent impairment to your body, but you are not totally disabled, you may receive permanent partial disability benefits. These benefits are 66 2/3% of your average weekly wage. (However, if your total disability rate is $205.35 or more, your weekly benefits will be 75% of your total disability rate.) For 2017, the weekly maximum for permanent partial disability is $496.

How long you will receive benefits depends on what percentage of your body has been impaired. A total body impairment is 450 weeks of benefits, so if you have suffered impairment of 50% of your body, you will be entitled to 225 weeks of benefits.

For amputations or the total loss of use of a limb, you are entitled to a higher weekly benefit. In these cases, you will receive the same amount as your totally disability rate. Arkansas has a schedule stating how long you will receive benefits for these types of injuries, depending on which body party you have lost total use of. For example, if your hand was amputated, the schedule states you will receive benefits for 183 weeks.

Appeals

If your claim is denied, or you disagree with any determination in your claim — for example, what medical treatment is covered or the amount of your disability payments—you can file an appeal with the Arkansas Workers' Compensation Commission.

To initiate your appeal, you should file a "claim" with the Arkansas Workers' Compensation Commission by submitting a Claim For Compensation form or by writing a letter to the Commission to request a formal hearing. You be aware that there are strict time limits for filing your claim:

• If you suffered an accidental injury on the job, you must file your claim within one year from the date of your injury or one year from the time that you last received any compensation.
• If you have an occupational disease, you must file your claim within one or two years, depending on what sort of substance caused your disease.

To ensure you don't miss any time limits, you should file your claim as soon as possible.

After you file your claim, the Workers' Compensation Commission will notify your employer and may start an investigation. Your claim may then be scheduled for mediation, which is an informal meeting where the parties sit down and try to work out a settlement with the help of a neutral third party, if you request it. If you cannot resolve your disputes, either through mediation or other settlement efforts, you may request a hearing before an Administrative Law Judge. If you do not agree with the outcome of the hearing, you may request a review from the full Workers' Compensation Commission. If you disagree with that decision, you may file an appeal with the Arkansas Court of Appeals.

You should consult an attorney, or at the very least speak with a Legal Advisor at the Commission, before filing your appeal.

Consult a Lawyer

If you have questions about what benefits you are entitled to or need assistance with your claim, you should consult a workers' compensation attorney. An attorney can help you file a claim, understand your rights, obtain the maximum amount you're entitled to, and file an appeal, if necessary. See Nolo's lawyer directory for workers' compensation attorneys in your area.