Arkansas Monthly Report on Medical-Only Injury Data (Form M) from LaborLawCenter.com

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Arkansas Monthly Report on Medical-Only Injury Data (Form M)

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1. Send Form M to the AWCC Operations/Compliance Division after the close of each month and by the 15th day of the next month.
2. Spell out the name of the carrier or self-insured; do not abbreviate.
3. Count calendar days lost rather than work days.
4. Subtract an MO that develops into a compensable case on a subsequent Form M.
5. Report on this form accidents or injuries resulting in disability of seven days or less. Employers that have coverage with carriers are not required to complete this form.
6. Report expenses each month. If medicals are carried into another month, expenses should be included on future M Forms, but the accident should be counted just once.
7. Submit separate reports for each individual carrier or self-insured FEIN number.
TPAs should not complete this form unless designated to do so by the insurer.
Reports with "No Activity" during the period must be completed and so indicated.
The AWCC may fine a carrier or self-insured for failure to submit the monthly report or for a late submission of this form.
FAX reports are acceptable at 501-682-2777.

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