University of Arkansas for Medical Sciences - Office of Human Resources

Workers' Compensation

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Useful Contacts

Virginia King

Workers Comp Coordinator 686-7083

Lisa Gay

Workers Comp Assistant

686-6809

UAMS Human Resources/Employee Services

686-5650

Sorry the information on this page has not been finalized.
It will be available soon. Please do not use the forms on this page. Thank you

Coping with an unexpected injury or work-related illness is never easy. But here at UAMS you can count on your supervisor, our medical staff, and the support staff in Human Resources to lend a helping hand.

If you have an on-the-job injury, you may be eligible for benefits – including medical care and income replacement – under workers’ compensation. Because UAMS is a public institution, worker compensation claims are submitted first through Human Resources, then through the State of Arkansas’ carrier which is the Public Employees Claims Division (PECD) of the Arkansas Insurance Department.

I have sustained an injury on the job. What do I do?

Employee Instructions

Immediately advise your supervisor.
Seek emergency care at once if your situation is life threatening.
If you work on or near the main campus and need medical care, you must go to the UAMS Family Medical Center. Call 686-6565 for an appointment. During off hours (night, holidays, weekends), you must go to the UAMS Emergency Department.
If you are not located in the Little Rock area, you must use a facility near you that is approved for state worker compensation cases. Call Virginia King at 686-7083 for assistance, or refer to the state workers’ comp directory.
IMPORTANT: Workers’ Compensation insurance will not cover the injury unless you go to a designated medical facility. UAMS University Hospital, the UAMS Family Medical Center and the AHEC’s are approved, designated facilities. You cannot refer yourself to another facility or provider unless approval is given in advance by PECD.
Complete Section A of the I&I Form. (UAMS Employee/Student/Visitor Injury and Incident Report) This form is also available for you to complete online (preferred). This form is required for any on-the-job injury, even if you do not require medical attention.
Take the I&I Form with you when you seek medical treatment. Your attending physician or nurse will complete Sections B and C and return the form to you.
If you receive medical care, you must also complete these forms in order to have your medical bills considered for coverage by workers’ compensation:
Form 1 (Form AR-N, Employee’s Notice of injury, Arkansas Worker’s Compensation Commission)
Form 2 (Public Employee Claims Division Employee’s Report of Accident)
Give all 3 forms to your supervisor.

Supervisor Instructions

Complete 2 additional forms:
Form 3 (Workers Compensation-First Report of Injury or Illness)
Form 4 (Information Request by Public Employees Claims Division on State Employee’s Claims)

Give a copy of all forms to the employee.

Keep copies for your records.

Send the originals of 5 forms (I & I plus Forms 1-4) to Virginia King, Human Resources, campus mail box # 564-1, or fax 603-1318.

IMPORTANT: Send the forms as soon as possible, preferably within 2 days of the injury. If these forms are not processed and received by PECD within 10 days of the injury, a late fee may be assessed in accordance with Arkansas Workers’ Compensation Commission policy.
If you would like to schedule a training session on worker's compensation, please contact Virginia King, 686-7083.

Human Resources will review the forms and submit completed claims to PECD. Workers’ comp benefits, if any, will be determined after PECD receives the forms. Occupational injuries are generally classified as one of the following:

· Incident: no time missed from work and medical care not needed

· Medical Only: medical care was received but employee is not eligible for lost wages

· Lost Time: medical care was received and employee is eligible for lost wages

Workers' compensation packets, which contain all the forms and instructions, are available. Contact our office if you need a supply.

Worker's Compensation Forms
Following are the forms required to file a workers' compensation claim. Send completed forms to UAMS Human Resources, #564-1, Attention: Virginia King. Or fax to Virginia King at (501) 603-1318.
Form 1	Form AR-N, Employee’s Notice of injury, Arkansas Worker’s Compensation Commission
Form 2	Public Employee Claims Division Employee’s Report of Accident
Form 3	Workers Compensation-First Report of Injury or illness
Form 4	Information Request by Public Employees Claims Division on State Employee’s Claims
I & I Form (online)	UAMS Employee/Student/Visitor Injury and Incident Report
I & I Form (print)	UAMS Employee/Student/Visitor Injury and Incident Report