Workers Compensation Information

When An Injury Occurs

1. Contact Human Resources

When a workers' compensation injury occurs, the injured employee or employee’s supervisor should inform Human Resources immediately to initiate the claim process. If the injury occurs after office hours, please leave a message for Janet Brewer at 501-760-4221 or by email at jabrewer@npcc.edu. This is necessary even if medical attention is not received. The following information should be provided:

• Employee's name
• Brief description of injury and how it occurred
• Type of medical care provided, if applicable
• Witnesses, if applicable
• Contact number

2. Complete Appropriate Paperwork / Seek Medical Attention

• Please see "Initial Employee Forms" below.
• An appointment should be made for medical treatment. In cases of an emergency, the injured employee should go directly to an emergency care facility.

3. Keep Human Resources Informed

This includes forwarding any billing information to HR for proper processing. It is important that HR knows the status of the injury and medical care to ensure the injured employee receives the appropriate benefits.

Initial Employee Forms

The Form N and PECD Form 1 are to be completed and signed by the employee at the time of the injury and returned to Janet Brewer.

• Form N
• PECD Form 1
  

Additional Forms

Change of Work Status Form (Form S)

• This form is to be used when there is a change in the injured employee’s work status
• If this form is not promptly processed, there may be a delay in payment of benefits or may cause an overpayment that will be withheld from future benefits.

Mileage Form (Form PECD Form 9)

This form is to be used for the injured employee to receive reimbursement from the Arkansas Insurance Department's Public Employee Claims Division for travel to and from health care provider.

Informational Forms

Form H

• HEALTH CARE NOTICE FOR EMPLOYEES UNDER MANAGED CARE Requirement to receive treatment through the MCO/IMCS listed on this notice.
  • If treatment is not received through this MCO/IMCS without prior approval from Human Resources, the injured employee may be required to pay for the treatment received.
  • Emergency treatment is exempt from this requirement.
  • See Human Resources for a list of preferred providers or view a searchable list online at Arkansas BlueCross BlueShield Workers' Compensation MCO website.

Form P

• WORKERS' COMPENSATION INSTRUCTIONS TO EMPLOYERS AND EMPLOYEES
• Provides detailed instructions to employers and employees.
• Posting required by Arkansas Code §11-9-403 and 11-9-407 and AWCC Rule 7.