Tools & Documents for Policyholders

ACH Form - One Time Draft

Arkansas First Report of Injury Form

Arkansas Sample Drug & Alcohol Policy

Arkansas Sample Drug & Alcohol Policy - Spanish Version

Duties Should Claims Occur - AR

First Fill Program Pharmacy Card

New Policyholder LUBA Care Information Sheet

LUBA Care is a department within LUBA Workers’ Comp and, like our organization, is dedicated to developing relationships with our providers in order to ensure that you, our insured, have a list of options available for medical care. Our staff is available for any assistance or information you may need.

Online Self-Reporting ACH Form

Payment Portal FAQ Document

Policyholders - Do You Know Where to Bring an Injured Worker for Care?

Prompt Return to Work Information Sheet - Policyholder

Prompt Return to Work (PRTW) is a team approach to getting an injured worker back to work as soon as possible. The team consists of the worker’s employer or supervisor, vocational rehabilitation counselor, LUBA’s claims adjuster, injured worker and the assigned physician.

Prompt Return-to-Work Program Booklet

At LUBA Workers’ Comp, our intent in regard to Prompt Return to Work (PRTW) is to create a situation which benefits all parties involved. A PRTW Program is an effective tool in helping us create such a situation. This program is designed to help facilitate the return of an injured worker to the workplace.

Quick Reference Guide for New Class Code 0012 (Paid Furloughed Employees)