Arkansas Workers’ Compensation Notice and Instructions to Employers and Employees (Form P) Mandatory

Form AR-PARKANSAS WORKERS’ COMPENSATION
COMMISSION
324 Spring Street, Little Rock, AR 72201
Mail: P. O. Box 950, Little Rock, AR 72203-0950
Little Rock Office - 1-800-622-4472 / 501-682-3930
Springdale Office - 1-800-852-5376 / 479-751-2790P Ark. Code Ann.
 §11-9-403, 407
AWCC Rule7
Updated:
06-16-14
WORKERS’ COMPENSATION INSTRUCTIONS TO
EMPLOYERS AND EMPLOYEES
All employees of this establishment entitled to benefits under the provisions of the Arkansas workers’ compensation laws are hereby notified that their
employer has secured the payment of such compensation as may at any time be due  employees or their dependents.  This employer is required by state
law to provide workers’ compensation coverage or this employer has waived the exclusion or exemption from the operation of the workers’ compensation
laws, and the employer certifies by the display of this poster that workers’ compensation coverage is now provided by a workers’ compensation insurance
policy or by enrollment in the Arkansas Self-Insurance Program or by the Public Employee Claims Division of the Arkansas Insurance Department.
(Place label indicating Insurer’s Name,
Claims Office Address, Claims Office Phone Number
and Policy Expiration Date) 
IN CASE OF JOB-RELATED INJURIES OR OCCUPATIONAL DISEASES
The Employer Shall:
1.Provide all necessary medical, surgical and hospital treatment, as required by law, following the injury and for such
additional time as ordered by the Workers’ Compensation Commission.
2.Provide compensation payments in accordance with the provisions of the law.  The first installment of
compensation becomes due on the 15th
 day after the employer has notice of the injury or death, except in those
cases where liability has been denied by the employer.
3.Provide prompt reporting of accidents to appropriate parties. 
4.Keep a record of all injuries received by its employees.
The Employee Shall:
The employee shall report the injury to the employer on Form N and to a person or at a place specified by the employer,
unless the injury either renders the employee physically or mentally unable to do so, or the injury is made known to the
employer immediately after it occurs. The employer shall not be responsible for disability, medical, or other benefits prior
to receipt of the employee’s notice of injury.  All reporting procedures specified by the employer  must be reasonable and
shall afford each employee reasonable notice of the reporting requirements.  The foregoing shall not apply when an
employee requires emergency medical treatment outside the employer’s normal business hours; however, in that event, the
employee shall cause a report of the injury to be made to the employer on the employer’s next regular business day.
Failure to give such notice shall not bar any claim (1) if the employer had knowledge of the injury or death, (2) if the
employee had no knowledge that the condition or disease arose out of and in the course of employment, or (3) if the
Commission excuses such failure on the grounds that for some satisfactory reason such notice could not be given.  Objection
to failure to give notice must be made at or before the first hearing on the claim.
Statutory Information:
Ark. Code Ann. § 11-9-514(b) states: “Treatment or services furnished or prescribed by any physician other than the ones
selected according to the foregoing, except emergency treatment, shall be at the claimant’s expense.”
Ark. Code Ann. § 11-9-514(f), however, indicates: When compensability is controverted, subsection (b) shall not apply if:
(1)The employee requests medical assistance in writing prior to seeking the same as a result of an alleged
compensable injury; and
(2)The employer refuses to refer the employee to a medical provider within forty-eight (48) hours after such written
request as provided above; and
(3)The alleged injury is later found to be a compensable injury; and
(4)The employer has not made a previous offer of medical treatment.
If you have any questions regarding your rights under the Arkansas workers’ compensation laws, you may call an Arkansas
Workers’ Compensation Commission legal advisor at our toll-free number listed above.
All employers who come within the operation of the Arkansas workers’ compensation laws and have complied with its
provisions must post this notice in a CONSPICUOUS place in or about their place or places of business.
P

Information about Form P is available from the Support Services Division (1-800-622-4472 or 501-682-
3930).AWCC Form P
(Posting Notice)
A posting notice is mentioned in Ark. Code Ann. §11-9-403, Ark. Code Ann. §11-9-407 and
AWCC Rule 7. AWCC Form P satisfies all requirements.
Form P:
1. Is to be on display in a conspicuous place;
2. Tells employers what to do when an employee is injured;
3. Instructs employees to notify the employer immediately (or no later than the close of the next
business day) when injured;
4. Lists the claims office that will be handling the insurance aspects of the case;
 5. Gives the claims office telephone number;
6. Announces the expiration date of the insurance policy; and
7. Provides telephone numbers for Arkansas Workers' Compensation Commission legal advisors if
either party needs assistance.
Employers without Form P may lose the use of Form N as a defense in litigation. Employees
disobeying instructions on Form P may delay their benefits or jeopardize the awarding of any benefits in a
contested case.
The AWCC furnishes samples, not supplies, of Form P. Carriers are to send their insureds an adequate
number, and self-insureds must arrange with a printer for the supply they need.  Carriers and employers may
enlarge Form P for posting purposes.
Ark. Code Ann.    §11-9-106(a): “Any person or entity who willfully and knowingly makes any material
false statement or representation, who willfully and knowingly omits or conceals any material information,
or who willfully and knowingly employs any device, scheme, or artifice for the purpose of: obtaining any
benefit or payment; defeating or wrongfully increasing or wrongfully decreasing any claim for benefit or
payment; or obtaining or avoiding workers’ compensation coverage or avoiding payment of the proper
insurance premium, or who aids and abets for any of said purposes, under this chapter shall be guilty of a
Class D felony.  Fifty percent (50%) of any criminal fine imposed and collected under .... this section shall
be paid and allocated in accordance with applicable law to the Death and Permanent Total Disability Trust
Fund administered by the Workers’ Compensation Commission.”