Arkansas Forestry Commission
Workers Compensation (Job Related Illness and
Injury)
Policy and Procedure Statement
§15
Required: Workers Comp Forms
I-A1,
AR-N, AR-S,
PECD 1, and
PEDC 2
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The AFC provides Workers’
Compensation benefits under the plan for Arkansas state employees
administered by the state agency, Public Employee Claims. This plan
provides reasonable medical costs and applicable benefits to
employees sustaining injury or illness arising out of and during
employment, in accordance with the Workers’ Compensation Act and the
Uniform Attendance and Leave Policy Act, as amended.
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All forms should be legible and
faxed to AFC Personnel Forms same day as injury to 501/296-1973. If
employee is unable to complete forms due to severity of injury, do
not hold paperwork more than 24-hours. Send in Supervisor forms and
have employee to complete his forms as soon as possible.
All witnesses shall write a statement
as soon after the incident as possible and attach to
PECD2.
| Form |
Description |
Complete Form By |
| 1 A-1 |
Employer's Report of Injury |
Supervisor |
| PECD1 |
Employee's Report of Accident |
Employee |
| AR-N |
Employee's Notice of Injury |
Employee |
| |
Note: Injured employee must receive copy of front and back of
Form N |
|
| PECD2 |
Workers' Comp Information Sheet |
Supervisor |
| AR-S |
Employer's Supplemental Report |
Supervisor |
Optional: Employee may complete
Medical Mileage Form for mileage reimbursement for trip(s) to
physician/treatment if personal vehicle used.
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If circumstances surrounding the
incident are questionable, the supervisor should report the
information on PECD2 Form and attach a memo with specifics. The AFC
and Public Employee Claims have the prerogative to contest a claim
and request a hearing before an administrative law judge at the
Workers’ Compensation Commission. The action by the administrative
law judge is binding on all parties, subject to appeal to the
Workers’ Compensation Commission and subsequent appeal to the
Arkansas Court of Appeals.
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Employees that
suffer minor injuries and refuse to see a physician must document
the accident on Form A15.100 -
Arkansas Forestry Commission Accident/Injury Incident Report.
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Posting of Workers’ Compensation
posters Form H and Form P is required at all AFC offices.
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Except for
emergency treatment, only physicians on the Workers Compensation
Preferred Provider List may be used. For a current listing of
physicians and hospitals see
http://www.insurance.arkansas.gov/PECD/divpage.htm or
contact the AFC Personnel office.
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Except for emergency treatment,
do not pre-approve medical treatment or prescription medication.
Refer all calls to AFC Personnel Manager.
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If a full time employee is unable to
work due to injury, the AFC will retain the employee on full wages
and benefits for 14-calendar days per claim under job injury leave.
Employees on job injury leave will not lose accrued annual or sick
leave.
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A full time employee, whose injuries
incapacitate him from regular work in excess of 14 calendar days,
will be placed on Workers’ Compensation benefits. The employee may
use accrued sick, annual, or compensatory time to supplement
benefits, not to exceed normal weekly pay at the time of the
compensated injury, until he is physically able to return to work or
reaches maximum medical improvement. The attending physician’s
release to return to regular duty is required.
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The AFC’s Return to Work Policy will
enable an employee to return to work on light duty basis as soon as
authorized by the physician if an accommodation can be made to do
so.
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If medical evaluation dictates that
the medical impairment is total and the injured employee cannot
return to work, employment with the AFC may end.
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Employees may apply for other job
openings that their physician authorizes them capable of performing.
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Extra Help employees are not
eligible for job injury, annual, or sick leave, but are eligible for
Workers’ Compensation benefits as determined Public Employee Claims.
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This revised AFC Policy Workers’
Compensation (Job Related Injury and Illness) Policy § 15
supersedes all earlier versions of the AFC § 15 and interpretive
memoranda, which are hereby repealed.
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