Resources — LUBA Workers’ Comp

2018 Financial Highlights

Type: PDF
Last Updated: 2018-04-11

2018 Owner Exclusions – QUICK REFERENCE GUIDE

Type: PDF
Last Updated: 2018-05-15

2018 Press Kit

Type: PDF
Last Updated: 2018-01-25

Acceptance of Officers Form (LA)

Type: PDF
Last Updated: 2016-05-26

Acceptance of Officers Form (MS, AR, TX)

Type: PDF
Last Updated: 2016-07-19

Additional Entities & Locations Application

Type: DOC
Last Updated: 2016-05-26

American Society of Safety Engineers

Type: Link

Application for Supplemental Income (English)

Application for Supplemental Income Benefits

Type: PDF
Last Updated: 2016-03-18

Application for Supplemental Income (Spanish)

Type: PDF
Last Updated: 2016-03-18

Arkansas Claim Penalties

Type: PDF
Last Updated: 2016-03-23

Arkansas Class Codes and Rates 7-1-2017

Type: PDF
Last Updated: 2017-06-13

Arkansas First Report of Injury Form

Type: PDF
Last Updated: 2016-06-14

Arkansas First Report of Injury Instructions for Completing

Type: PDF
Last Updated: 2016-03-23

Arkansas Sample Drug & Alcohol Policy

Type: PDF
Last Updated: 2017-11-28

Arkansas Sample Drug & Alcohol Policy - Spanish Version

Type: PDF
Last Updated: 2018-01-30

Arkansas Workers' Compensation Commission

Type: Link

Arkansas Workers’ Compensation Commission

Type: Link

Authorization For Release of Medical Records

I hereby authorize the Arkansas Workers’ Compensation Commission to release my medical records in its possession.

Type: PDF
Last Updated: 2016-03-18

Authorization for Release of Protected Health Information

Authorization for release of protected health information (HIPAA compliant)

Type: PDF
Last Updated: 2016-03-18

Banks Supplemental Application

Type: PDF
Last Updated: 2016-07-19

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