AR Workers' Compensation Commission

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  Claim for Compensation

  ARWCCFC $89.00
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  Claimant’s Lump Sum Request/Respondent’s Position

  ARWCL $69.00
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  Death/Permanent and Total Disability Acceptance/Update

  ARWCD $89.00
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  Employee’s Notice of Injury

  ARWCN $69.00
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  Employer’s Intent to Accept or Controvert Claim

  ARWC2 $89.00
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  Employer’s Supplemental Report

  ARWCE $69.00
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  Health Care Notice for Employees Under Managed Care

  ARWCH $39.00
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  Monthly Report on Medical Only Injury Data

  ARWCM $69.00
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  Physicians Report

  ARWC3 $89.00
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  Report of Compensation Paid/Suspension of Payments

  ARWC4 $89.00
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  Report of Mediation Conference

  ARWCR $39.00
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  Supplemental Report

  ARWCS $69.00
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  Verification of Permanent Total Disability

  ARWCV $39.00
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  Wage Statement Immediately Preceding Injury Date

  ARWCW $89.00