Arkansas Workers' Compensation Acknowledgment Form

State:
Multi-State
Control #:
US-537EM
Format:
Word; 
Rich Text
Instant download

Description

This is an acknowledgement form regarding workers' compensation. The form states that the employee has read and understands the workers' compensation guidelines.

How to fill out Workers' Compensation Acknowledgment Form?

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FAQ

While you do have two years from the date of injury to file a claim with the Arkansas Workers' Compensation Commission, injured employees should not delay. Once you miss this deadline, you will be barred from asserting a claim for workers' compensation benefits.

Arkansas Workers' Compensation Commission. Insurance Requirements: Most employers in Arkansas with three or more employees are required by law to have Workers' Compensation insurance coverage for their employees.

DWC-7 Notice to Employees-Injuries Caused by Work (English and Spanish). This form provides your employees with information regarding workers' compensation benefits and the Medical Provider Network (MPN) in California.

The CA-7 must be filed within one year of the dates claimed, or the date your claim is accepted, whichever is later.

Following the Workers' Comp Claim Process Request an "Employee's Claim for Workers' Compensation Benefits" form from your supervisor (it's also known as a DWC 1 form). Your employer must give or mail you a claim form within one working day after learning about your injury or illness.

Form CA-7 is used by federal workers seeking to claim compensation for traumatic injuries suffered while on the job, as well as those who may have sustained an occupational disease during the performance of work-related duties.

Form CA-7 is used by federal workers seeking to claim compensation for traumatic injuries suffered while on the job, as well as those who may have sustained an occupational disease during the performance of work-related duties. This form may be filled online, or downloaded and filled offline.

Form CA-16 - Authorization for Examination and/or Treatment. This form guarantees payment to the care provider if the employee requires medical treatment because of a work-related traumatic injury. Your supervisor should complete page 1 of Form CA-16 and provide it to you for your attending physicians information.

In case you're receiving continuation of pay, you must ask that form CA-7 be availed to you within 30 days of the COP period, and then sent over to OWCP by the 40th day of COP. Your employer will then have 5 days to submit the form to OWCP after checking it for accuracy and completion.

The Division of Workers' Compensation (DWC) monitors the administration of workers' compensation claims, and provides administrative and judicial services to assist in resolving disputes that arise in connection with claims for workers' compensation benefits.

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Arkansas Workers' Compensation Acknowledgment Form