Welcome to Arkansas State University!

Workers' Compensation

workers compensation image

Workers’ Compensation Governing Principles

 The following Employee Workers’ Compensation claim forms may be found on the Environmental Health & Safety website http://www.astate.edu/a/ehs/occupational-safety/workers-comp/index.dot   

 Form A1 - First Report of Injury or Illness

The University seeks to maintain a healthy and safe work environment for its employees, while containing cost. Therefore, the University will promptly provide medical services for an injured employee in connection with the injury received. The following are the University procedures for filing a Workers’ Compensation Claim.

 REGULATIONS AND PROCEDURES

  1. Employees are required to notify their direct supervisor immediately following a   workplace injury or illness arising out of and in the course of their employment.  If the employee must leave work to seek medical treatment, no leave time will be charged to the employee the day of the injury per the Arkansas Workers’ Compensation Laws and Rules Annotated #099.09, and Arkansas Code A.C.A. 11-9-501(a).
  2. The injured employee is required to complete Form N (initial and date the 2nd page at the bottom), and Form PECD 1 within twenty-four hours of initial injury.  All forms are to be faxed to 3584, and the originals delivered to Environmental Health & Safety.                                 
  3. The Supervisor is required to complete, Form A1 - First Report of Injury or Illness, and Form PECD 2 within twenty-four hours of initial injury or illness.  All forms are to be faxed to 3584, and the originals delivered to Environmental Health & Safety.
  4. All minor work related injuries can be treated with First Aid Kits found in the respective department.  If an injured employee has a minor work related injury that can not be cared for with the First Aid Kit, those employees need to seek  treatment from the Student Health Center at 333 Stadium Blvd. - B, Jonesboro, AR 72401.  The Student Health Center will refer the injured employee to Occupational Health Partners, 4334 E. Highland Drive, Jonesboro, AR 72401, (870) 802-0012, if necessary for treatment.  The Employer (Arkansas State University) will choose the initial treating physician.  Copies of all paperwork are to be delivered to Environmental Health & Safety. 
  5. All major medical emergencies should be treated at:  St. Bernard’s Medical Center, 225 East Matthews, Jonesboro, AR 72401, (870) 207-5200.  Copies of all paperwork are to be delivered to Environmental Health & Safety. 
  6. The Employer (Arkansas State University) will establish a primary pharmacy for all Workers' Compensation injuries that require a disbursement of medications. All employees needing prescriptions filled must come by the Environmental Health & Safety department to pick up a Temporary Prescription Form before going to the pharmacy.  All employees with work related injuries should take their prescriptions to:  Soo’s Drug & Compounding Center, 2822 East Nettleton Avenue, Jonesboro, AR 72401, (870) 932-6930.
  7. All paperwork associated with the employee’s claim for injury (doctor's reports, return to work slips, referrals to specialty physicians, etc.) must be submitted to the Environmental Health & Safety Department.
  8. All employees will use accrued leave time (sick, vacation, compensatory time) for any work time missed during the first seven (7) calendar days.  Temporary Total Disability (TTD) benefits will begin on the eighth day at a rate of 66 2/3% of the employee’s weekly salary. On calendar day fifteen (15), TTD will go back and pick up the first seven calendar days at the 66 2/3% rate. 
  9. All doctor appointments, pain management treatments, physical therapy, etc. during normal work hours will require the employee to use accrued leave time (sick, vacation, compensatory time) as these times are not covered under Temporary Total Disability (TTD) benefits.  TTD only covers full days off work while under a doctor’s order.  (Any unexcused absence from work without accrued time to cover it, will be dealt with as a personnel issue.)  
  10. All individuals handling the processing of workers’ compensation claims (supervisors, department heads, clerks, etc) will be required to complete training on the completion of all forms and procedures related to Workers' Compensation. 
  11. Employees making false claims, representation or statements for the purpose of obtaining workers' compensation coverage will be guilty of a Class D felony, punishable with up to 6 years in prison and up to a $10,000 fine. 
  12. The provisions of this policy are designed to comply with the rules and regulations of the Arkansas Workers' Compensation Commission.           

Governing Principles

The University seeks to maintain a healthy and safe work environment for its employees, while containing cost. Therefore, the University will promptly provide medical services for an injured employee in connection with the injury received. The following will be the procedures for filing a Worker's Compensation Claim.

Procedures

  1. Employees are required to notify their direct supervisor immediately following a workplace injury or illness arising out of and in the course of their employment.
  2. The injured employee is required to complete a Employee Accident Form, Form N, and Form PECD 1 within twenty-four hours of initial injury.
  3. The Supervisor is required to complete First Report of Injury Form A1, and Form PECD 2 within twenty-four hours of initial injury or illness.
  4. All minor work related injuries can be treated with First Aid Kits found in their respective departments.
  5. The Employer (Arkansas State University) will choose the initial treating Physician. If medical care is needed, escalating care should be used. If the injured person requires medical care, they should go to the Student Health Center. If they more than likely need a physician, go to First Care-Stadium Clinic. If it is an emergency, call (911) if an ASU phone (9-911) and send the injured person to St. Bernard’s Regional Medical Center, 224 East Matthews, Jonesboro, AR 72401, (870) 972-4100.
  6. Prior to having a prescription filled the employee must get a temporary prescription form from the EH&S Office 501 Irroquois Environmental Research Safety & Training Building. The Employer (Arkansas State University) will establish a primary pharmacy for all Workers' Compensation injuries that require a disbursement of medications. Approval for all prescriptions will be phoned into the Environmental Health & Safety Department. All employees with work related injuries should take their prescriptions to: Soo’s Drug and Compounding Center, 2822 East Nettleton Avenue, Jonesboro, AR 72401, (870) 932-6930.
  7. All paperwork associated with the employees' claim for injury (doctor's reports, return to work slips, referrals to specialty physicians, etc.) must be submitted to the Environmental Health & Safety Department.
  8. All individuals handling the processing of worker's compensation claims (Supervisor's, department heads, clerks, etc) will be required to complete training on the completion of all forms and Workers' Compensation processes.
  9. Employees making false claims, representation or statements for the purpose of obtaining workers' compensation coverage will be guilty of a Class D felony, punishable with up to 6 years in prison and up to a $10,000 fine.
  10. The provisions of these procedures are designed to comply with the rules and regulations of the Arkansas Workers' Compensation Commission.