Mission and Role

Mission: To administer and enforce Arkansas’s workers’ compensation laws, ensuring timely and fair delivery of medical and indemnity benefits to injured workers.

Key Functions:

• Oversee the administration of claims
• Conduct hearings and appeals
• License and regulate stakeholders (adjusters, TPAs, etc.)
• Maintain claim records and compliance
• Educate stakeholders and promote injury prevention

Structure of the AWCC

Commissioners:

Three commissioners appointed by the Governor:

• One representing labor
• One representing management
• One neutral (Chair)

Divisions:

• Claims Division: Manages claims, provides information and technical support
• Legal/Hearings Division: Administrative law judges (ALJs) conduct hearings
• Health & Safety Division: Promotes workplace safety and prevention
• Administrative Services: Handles finance, HR, and operations

Claim Initiation

Employee Obligation:

• Must report the injury as soon as possible, ideally within 2 days of the incident
• Verbal report is acceptable but documented notice is recommended

Employer Obligation:

• Investigate the report
• Provide the injured worker with medical authorization and physician selection, if applicable
• File Form AR-N (First Report of Injury) with their workers’ compensation insurance carrier and the AWCC

Dispute Resolution Process

1. Informal Mediation (optional)
2. Pre-hearing Conferences: Establish contested issues, assign ALJ and hearing date
3. Hearings Before an ALJ: Evidence presented, judge issues written decision
4. Appeals: Full Commission Review, further appeal may go to Arkansas Court of Appeals

Purpose of Average Weekly Wage

AWW determines the basis for wage-replacement (indemnity) benefits used to calculate TTD, TPD, PPD, and PTD.

Standard Calculation Method

• Use gross wages earned in the 52 weeks prior to the injury
• Add all wages earned during that period
• Divide by the actual number of weeks worked (not a flat 52 unless all weeks were worked)
• Round to the nearest dollar

Benefit Rate Derived from AWW

• TTD and PTD: 66⅔% (two-thirds) of the AWW
• TPD: 66⅔% of the difference between pre-injury AWW and post-injury earnings
• PPD: Generally 66⅔% of AWW, based on impairment rating or wage loss

Overview

Indemnity benefits replace lost income for employees who suffer work-related injuries resulting in temporary or permanent disability. Benefits are calculated based on the employee’s Average Weekly Wage (AWW).

Types of Indemnity Benefits

Temporary Total Disability (TTD)

• Definition: Paid when completely unable to work due to injury and has not yet reached Maximum Medical Improvement (MMI)
• Amount: 66⅔% of AWW, up to state maximum
• Termination: Employee returns to work, reaches MMI, or refuses suitable employment

Temporary Partial Disability (TPD)

• Definition: Paid when returning to modified/part-time work at reduced earnings
• Amount: 66⅔% of the difference between pre-injury AWW and current earnings
• Termination: Employee reaches MMI or returns to full-duty/full-wage work

Permanent Partial Disability (PPD)

• Definition: Paid when employee has permanent physical impairment but can still work
• Types:
  • Scheduled Injuries (fingers, arms, legs): Based on statutory schedule
  • Unscheduled Injuries (back, neck): Based on wage loss capacity
• Amount: 66⅔% of AWW, up to PPD maximum rate

Permanent Total Disability (PTD)

• Definition: Paid when injury renders employee unable to earn any meaningful wage
• Amount: 66⅔% of AWW, subject to state maximum
• Duration: For the duration of disability, potentially lifetime

Death Benefits

Overview

Medical benefits ensure that injured workers receive reasonable and necessary medical care for injuries or occupational diseases sustained in the course and scope of employment.

Scope of Covered Medical Benefits

• Hospital and physician visits
• Surgery
• Diagnostic testing (MRI, X-rays, CT scans)
• Prescription medications
• Physical therapy or rehabilitation
• Durable medical equipment (DME)
• Mileage reimbursement for medical appointments
• Psychological or psychiatric care (if work-related)
• Home modifications or attendant care (in serious cases)

Physician Selection and Provider Networks

Change of Physician

• Injured worker may request a one-time change of physician through AWCC using Form AR-M
• AWCC assigns a new physician from its approved change-of-physician list
• Any further changes require mutual agreement or additional AWCC approval

Medical Fee Schedule

• Administered by the AWCC
• Establishes maximum allowable reimbursement for office visits, procedures, DME, and medications
• Based on Medicare rates with Arkansas-specific adjustments
• Balance billing is prohibited: Providers must accept the fee schedule amount as full payment

Independent Medical Examinations (IMEs)

• Purpose: Resolve disputes about diagnosis, treatment, MMI, or impairment rating
• Who May Request: Insurance carrier, employer, injured worker, or AWCC itself
• Binding Nature: IME findings are not automatically binding, but often carry significant weight in litigation
• Costs: Paid by the requesting party unless ordered by the AWCC

Overview

Most Arkansas workers’ compensation claims are resolved without formal litigation. Disputes that cannot be resolved informally proceed through a structured administrative legal process governed by the AWCC. The process is non-jury, handled by Administrative Law Judges (ALJs).

Common Types of Disputes

• Denial of claim (compensability)
• Discontinuation of benefits (TTD/PPD)
• Disagreement about Maximum Medical Improvement (MMI)
• Impairment rating disputes
• Reasonableness or necessity of medical care
• Return-to-work status
• Permanent disability classification (PPD vs PTD)
• Employer’s liability for medical bills or mileage
• Attorney fees and penalties

Steps in the Litigation Process

1. Claim Filing: Injured worker files Form AR-C (Claim for Compensation)
2. Prehearing Questionnaire: Both parties outline issues, witnesses, and exhibits
3. Prehearing Conference: Clarifies legal and factual issues
4. Mediation: Optional but encouraged, conducted by AWCC mediator
5. Formal Hearing: Evidence presented before ALJ, written opinion issued

Appeal Process

1. Appeal to Full Commission: Must be filed within 30 days of ALJ decision
2. Appeal to Arkansas Court of Appeals: Judicial review of Commission decision
3. Appeal to Arkansas Supreme Court: Discretionary review, rare

Allowable Employer/Carrier Defenses

• No compensable injury occurred
• Injury not timely reported
• Willful misconduct or intoxication
• Idiopathic or personal condition unrelated to work
• Pre-existing condition not aggravated by work
• Lack of objective medical findings
• Failure to follow physician’s orders
• Non-cooperation with return-to-work or vocational rehab
• Injury occurred outside Arkansas jurisdiction

Ex Parte Communication with Administrative Law Judges (ALJs)

Permitted Exceptions

• Scheduling or procedural issues (e.g., continuance requests) may be communicated ex parte, but must:
• Be limited in scope
• Not address substantive issues
• Be followed by written notice or documentation to all parties

Communication with Medical Providers

Defense Medical Communication (Ark. Code Ann. § 11-9-508)

• Employers and carriers have limited ability to communicate with medical providers
• Written requests for records or billing are permitted without claimant consent
• Direct oral or written communication about care or causation is not permitted without notice to the claimant and opportunity to participate

Independent Medical Examinations (IMEs)

• When ordered by AWCC, the IME report is shared with both parties and becomes part of the record
• Communication with the IME doctor must follow Commission guidelines and cannot be unilateral if it concerns case substance

Penalties for Improper Communication

Violation of ex parte rules may result in:

• Exclusion of evidence
• Adverse rulings
• Sanctions or disciplinary action for attorneys

Overview

Penalties in Arkansas workers’ compensation law are used to enforce compliance with statutes and Commission rules, particularly regarding late payment of benefits, failure to file required forms, and maintaining required insurance.

Types of Penalties

Late Payment of Indemnity Benefits (Ark. Code Ann. § 11-9-802)

• Circumstances: Benefits not paid within 15 days of becoming due
• Penalty: 12% penalty added to the unpaid compensation
• Who Pays: The insurance carrier or self-insured employer
• Paid To: The injured worker

Failure to Secure Workers’ Compensation Coverage (Ark. Code Ann. § 11-9-406)

• Circumstances: Employer does not maintain required WC insurance or proof of self-insurance
• Penalty: Up to $10,000 per offense plus criminal misdemeanor charges
• Additional Consequences: Cease and desist order and potential business closure
• Who Pays: The noncompliant employer
• Paid To: AWCC, and potentially into the Death and Permanent Total Disability Trust Fund

Failure to File Required Forms (Ark. Code Ann. § 11-9-705 and § 11-9-801)

• Circumstances: Failure to timely file Form 1, Form 2, or AR-4
• Penalty: Up to $500 per violation
• Who Pays: The employer or insurance carrier
• Paid To: The AWCC

Unreasonable Defense or Controversion (Ark. Code Ann. § 11-9-715)

• Circumstances: Carrier/employer denies claim or delays benefits without valid legal or factual basis
• Penalty: Attorney’s fees awarded to claimant’s attorney (25% of benefits awarded) plus additional 12% penalty
• Who Pays: The employer or carrier
• Paid To: Claimant’s attorney (fees) and claimant (12%)

Violation of a Commission Order (Ark. Code Ann. § 11-9-706)

• Circumstances: Failure to comply with a Commission or ALJ order
• Penalty: Up to $10,000 per violation
• Who Pays: The party in violation, typically the carrier or employer
• Paid To: The AWCC or the affected party, depending on order type

Fraud and Misrepresentation (Ark. Code Ann. § 11-9-106 & § 11-9-108)

• Circumstances: Knowingly making false statements to obtain benefits or reduce liability
• Penalty: Criminal prosecution (Class D felony), restitution, fines, and disqualification from benefits
• Who Pays: The party committing fraud (claimant, employer, or provider)
• Paid To: Restitution may go to the insurer, employer, or AWCC

Appeal Process for Penalties

1. File appeal with Administrative Law Judge (ALJ)
2. Appeal ALJ’s ruling to the Full Workers’ Compensation Commission
3. Further appeal to the Arkansas Court of Appeals (and potentially to the Arkansas Supreme Court)

Appeals must be filed within 30 days of a final order.

General Ethical Principles

Claims Professionals (Insurers, TPAs, Adjusters)

Required by Law/Regulation

• Duty to promptly investigate and pay claims when compensability is not reasonably in dispute
• Mandatory filing of required forms and reports (Form 1, Form 2, Form AR-2)
• Prohibition on bad-faith delays or denials without factual or legal basis
• Maintain confidentiality of medical and employment records

Best Practices

• Communicate clearly and respectfully with claimants and providers
• Explain benefit decisions in plain language
• Provide claimants with timely updates on claim status
• Avoid excessive or repetitive requests for documentation that serve to delay care or payments

Defense Attorneys (Employer/Carrier Counsel)

Required by Law

• Comply with Arkansas Rules of Professional Conduct (ARPC), especially:
  • Rule 3.3 — Candor toward the tribunal
  • Rule 4.1 — Truthfulness in statements to others
  • Rule 1.7 — Avoid conflicts of interest
• Refrain from ex parte communication with the Administrative Law Judge

Best Practices

• Evaluate defenses based on objective merit, not solely to delay benefits
• Engage in early settlement discussions when appropriate
• Maintain professionalism in dealings with opposing counsel and unrepresented claimants
• Educate employer clients about their responsibilities

Claimant Attorneys

Required by Law

• Must file Form AR-1 to disclose representation and ensure proper fee arrangements
• Must not solicit clients improperly or make misleading claims about benefits
• Fees are limited to 25% of indemnity benefits and must be approved by the Commission
• Adhere to ARPC obligations for competence, diligence, and loyalty to the client

Best Practices

• Explain claim process, settlement terms, and medical options clearly to clients
• Avoid filing claims with no factual or medical basis
• Provide timely updates and advice about hearings, evidence, and outcomes
• Avoid prolonging litigation solely to increase fees

Medical Providers

Required by Law

• Provide truthful and complete documentation in reports
• Certify impairment ratings using the AMA Guides
• May not bill above AWCC Medical Fee Schedule (balance billing is prohibited)
• Must participate in Commission processes if treating an injured worker under WC

Best Practices

• Be cautious of dual loyalties (don’t let carrier/employer influence care decisions)
• Avoid rubber-stamping impairment ratings or diagnoses
• Respond to record requests and preauthorization requests promptly
• Notify all parties if treatment is being declined or significantly altered

Employers

Required by Law

• Must maintain required workers’ compensation insurance or approved self-insurance
• Must report injuries timely and not interfere with an employee’s right to file a claim
• Retaliation against employees for filing a claim is strictly prohibited

Best Practices

• Provide injured employees with immediate access to care
• Avoid pressuring providers or employees to downplay injuries
• Cooperate with adjusters and legal counsel to ensure timely benefits delivery

Key Arkansas Workers’ Compensation Webpages

Medical and Fee Information

• Medical Fee Schedule:
  https://www.awcc.arkansas.gov/resources/medical-fee-schedule/
• Provider Information:
  https://www.awcc.arkansas.gov/providers/provider-information/

Employer Resources

• Employer Information:
  https://www.awcc.arkansas.gov/employers/employer-information/
• Employer Insurance:
  https://www.awcc.arkansas.gov/employers/employer-insurance/

Legal and Dispute Resolution

• Legal Advisors Division:
  https://www.awcc.arkansas.gov/legal/legal-advisors-division/
• Public Hearings and Decisions:
  https://www.awcc.arkansas.gov/legal/public-hearings-and-decisions/

Claims and Reporting

• Workers Information:
  https://www.awcc.arkansas.gov/workers/
• EDI Claims Reporting:
  https://www.awcc.arkansas.gov/insurance/edi-claims-reporting/

Special Funds

• Death and Permanent Total Disability Trust Fund:
  https://www.awcc.arkansas.gov/resources/dptd-trust-fund/