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Arkansas

When an employee is injured on the job, proceed with the following:

  1. Complete AWCC Form 1 - First Report of Injury, providing the details of the accident and injury.
  2. If the injured worker is requesting medical treatment, s/he must complete AWCC Form N prior to authorization of any medical care, unless the injured worker requires emergency medical treatment outside of the employer’s normal business hours. However, the injured worker shall provide the AWCC Form N the next regular business day.
  3. Complete AWCC Form W – Wage statement providing Benchmark Administrators with payroll records documenting 52 weeks of the injured worker’s salary history. If 52 weeks are not available, provide payroll records for the time period the injured worker was employed.
  4. If you are a drug free work place, post-accident drug testing must be completed in accordance with your drug free work place policy procedure.
  5. Contact a preferred urgent care facility by telephone prior to sending the injured worker. Inform the urgent care you have an injured worker coming and that Benchmark Administrators is the claims administrator.
  6. Advise the injured worker to return to your office or job site after receiving medical care and provide the doctor’s signed return-to-work slip or documentation of medical disability.
  7. Please forward the return-to-work/disability slip from the doctor to Benchmark Administrators as soon as possible.
  8. If a worker is seriously injured and needs immediate care or is transported by ambulance, the employer should have a co-worker or supervisor go with the injured worker to assist the injured worker with any insurance-related information the medical provider may require.

Required State Forms

Arkansas - First Report of Injury

Additional Forms

Medical Provider Options:

Baptist Health Urgent Care

Sherwood Urgent Care

Correspondence & Prescription Billing

Benchmark Administrators
PO Box 46350
Las Vegas, NV 89114
Toll Free: (800) 362-5198

Medical Billing

Medical Bills Can Be Mailed To:

P.O. Box 14365
Lexington, KY 40512

Process medical bills online by signing up with E-Billing Benefits

Western Integrated Care, on behalf of Benchmark Administrators, Payer ID is LV191.

24-HOUR CLAIM REPORTING HOTLINE: 1-866-337-0891

Customer Service Representatives are on call 24 hours per day to assist you. Please have the injured worker's information available as well as the accident description.