Form 2 – Employer’s Intent to Accept or Controvert Claim

Jurisdiction: Country: United States | Province/State: Arkansas

What is a Form 2 – Employer’s Intent to Accept or Controvert Claim?

Form 2 is Arkansas’s official notice of your decision on a workers’ compensation claim. You use it to tell the state and the worker whether you accept or deny the claim. It applies to workplace injuries and occupational diseases. It is part of the workers’ compensation system in Arkansas, which sits within the Department of Labor and Licensing.

This form serves two key purposes. It discloses your position on compensability. It also records the status of benefits and key claim data. If you accept, you confirm the injury is work-related and that you will provide benefits. If you controvert, you state that you dispute some or all of the claim. You must give a reason. You also use Form 2 when you accept some parts and deny others. For example, you might accept medical treatment but dispute wage loss.

Employers, insurers, and self-insured employers use this form. Third-party administrators file it for insured or self-insured employers. Defense counsel may help draft the form. An authorized claims representative signs it. The form is simple, but it has legal consequences. It sets the record on what you accept and what you dispute. It also shows the compensation rate and benefit start dates if you accept.

You need this form whenever you receive notice of a workplace injury that may lead to benefits. Arkansas expects a timely decision. The law favors quick notice to the worker and the state. Filing Form 2 documents your decision. It also avoids regulatory issues for late notice. Even if you are still investigating, you need to communicate your current position. If your position changes later, you file an updated Form 2.

Typical scenarios include a clear injury on the job with prompt treatment. In that case, you file an acceptance and start benefits. Another scenario is a late-reported injury with conflicting facts. You may file a controversion while you investigate. You can later amend if new evidence supports acceptance. You also use Form 2 to clarify partial acceptance. For example, you accept a back strain but deny a claimed shoulder injury. You state both points on the form. You also use it to adjust wage data. If you discover a corrected average weekly wage, you can file a new form to update the rates.

Think of Form 2 as the official, early statement of your position. It creates transparency. It triggers oversight by the Commission. It keeps the claim moving with timely benefits or a clear path to dispute resolution.

When Would You Use a Form 2 – Employer’s Intent to Accept or Controvert Claim?

You use Form 2 soon after you learn of a claim. That can be when the worker reports the injury. It can also be when a doctor’s note reaches you, or when a claim comes in through your insurer. The clock starts when you have knowledge of a claim that could involve benefits. Arkansas expects you to file promptly, generally within 15 days of notice. Do not wait for every record to arrive. File your current position and adjust later if needed.

Here are common situations:

You receive a report that a worker slipped at work and broke a wrist. The incident occurred on your premises, during a shift, and was witnessed. You decide to accept. You file Form 2, mark acceptance, list the injury and body part, and start medical and wage benefits. You also include the average weekly wage and compensation rate. You state the date the benefits began. This creates a clear record and avoids disputes over timing.

You get a claim for a back injury with a weekend onset and no incident at work. The first medical note reports heavy yard work. You file a controversion. You state that the injury did not arise out of employment based on the current facts. You continue to investigate. If evidence later shows a work event, you file a new Form 2 and accept.

You face a claim with both work and non-work injuries. The worker alleges a fall aggravated a prior knee condition and also claims a shoulder tear. You accept the aggravation of the knee based on the records. You deny the shoulder claim pending imaging and causation. File Form 2 showing partial acceptance and partial controversion. List each accepted and disputed body part or condition.

You begin paying medical bills before you have wage data. File Form 2 showing acceptance of medical treatment only. State that wage benefits are pending wage verification. Then, supplement when you confirm the average weekly wage. You avoid delay penalties and keep the worker informed.

You learn of a claim late. The worker reports a four-month-old incident after leaving employment. You file a controversion due to late reporting and lack of timely notice. You also note prejudice to the investigation. If new proof emerges, you can amend. Arkansas allows you to change your position by filing a new Form 2.

Insurers and TPAs file Form 2 on your behalf as well. They use it when they start indemnity payments. They also use it when they suspend or deny benefits. Defense counsel files it when disputes crystallize and litigation begins. In fatal or catastrophic cases, file Form 2 even as investigations continue. It records your position and benefit status for dependents and medical expenses.

The form is not only for initial decisions. Use it whenever your position changes. For example, after receiving an independent medical exam, you might accept a condition you previously disputed. Or you might suspend temporary total disability based on a release to full duty. File a new Form 2 to reflect that change and the effective date.

Legal Characteristics of the Form 2 – Employer’s Intent to Accept or Controvert Claim

Form 2 is a required notice in the Arkansas workers’ compensation practice. It is not a settlement agreement. It does not replace a Commission order. But it is legally meaningful. It states your binding position on compensability at that time. If you accept, you commit to pay accepted benefits in line with the Act. If you controvert, you assert a formal dispute. The Commission uses this filing to monitor compliance and manage disputes.

Enforceability stems from three elements. First, the form is mandated by statute and rule. Second, it must be signed by an authorized representative. Third, you must serve it on the worker and file it with the Commission. Those steps create an official record. They allow the Commission to enforce payment of accepted benefits. They also allow the Commission to address denials and schedule proceedings if needed.

Accuracy on the form matters. Stating the correct average weekly wage and compensation rate prevents underpayments. Listing accepted body parts and dates clarifies the scope of benefits. A vague denial invites problems. You should state specific grounds for controversion. Examples include the injury did not arise out of work, lack of timely notice, intoxication, idiopathic event, independent contractor status, or a preexisting non-work condition. If you later learn new facts, you can amend your position with a new Form 2.

Timing matters, too. Arkansas expects prompt filing after notice of the claim. Late filing can lead to penalties or litigation disadvantages. Starting benefits without timely notice can also cause confusion. When you start paying, file Form 2 to document the start date and rate. If you must suspend or terminate benefits, file an updated form. That protects the record and informs the worker.

Confidentiality rules apply. Use only necessary personal data. Share the form with the worker and counsel of record. Keep proof of service. When in doubt about complex defenses, consult counsel. But do not delay the filing. File your best good-faith position based on available facts.

How to Fill Out a Form 2 – Employer’s Intent to Accept or Controvert Claim

Follow these steps. Keep copies of everything you file and serve.

1) Identify the claim and parties.

• Enter the employee’s full legal name. Include address, phone, and last four digits of the Social Security Number if requested.
• Enter the employer’s legal name as registered. Include physical address and FEIN if requested.
• Enter the insurer or self-insured employer details. Include the carrier or TPA name, claim number, and contact data.

2) Provide date and details of injury.

• Enter the date of injury or exposure. Use the date the event occurred or the date of disablement for an occupational disease.
• State the location of the incident. Include city and worksite if known.
• Describe the cause and mechanism in brief. For example, “slip on wet floor” or “lifting 80-pound box.”
• List the body part(s) involved. Be specific, such as “right wrist fracture” or “lumbar strain.”

3) State employment status and job information.

• Enter job title and department.
• Note the hire date if requested. Indicate if the worker has returned to work. State the return date and duty level (full or light).

4) Calculate the average weekly wage (AWW).

• Gather wage records for the relevant period. Use the standard 52-week look-back if available. If the worker has a shorter tenure, use the weeks actually worked or a representative period.
• Include overtime, bonuses, and allowances if they count as wages under Arkansas law.
• Compute AWW. Example: Total gross wages over 13 weeks of $9,750 divided by 13 equals $750 AWW.

5) Enter the compensation rates.

• Calculate the temporary total disability (TTD) rate. It is typically two-thirds of AWW, subject to the yearly maximum and minimum set by Arkansas.
• Do the same for permanent partial disability (PPD) if needed. Use the rate applicable to the date of injury.
• Example: AWW $750 yields a tentative TTD rate of $500, subject to caps for that year. Confirm current caps before finalizing.

6) Choose your position: accept or controvert.

• If accepting, check the box for acceptance. State whether you accept medical only, indemnity benefits, or both.
• If controverting, check the box for denial. Provide a clear, concise reason. Reference facts, not speculation. Example: “Incident occurred off premises, outside work hours. No work connection shown.”
• If partially accepting, explain the split. Example: “Accept low back strain. Deny alleged right shoulder tear pending causation.”

7) Document benefit status and dates.

• If you have started benefits, state the start date and type. Note the TTD start date, the weekly rate, and the date of the first check.
• If you authorized medical care, list the authorized treating physician if known. Note the date of the first visit.
• If you have not started benefits, state when you expect to decide, or why you are not paying.

8) Include medical and provider information.

• Identify the authorized treating physician, clinic, or hospital if established.
• Note any referrals or changes in physicians if known. This helps avoid confusion at the pharmacy or clinic.

9) Attach supporting documents if allowed or requested.

• Attach a wage statement showing the AWW calculation. Include weeks and gross pay.
• Include initial medical notes or the first bill if they support acceptance. Do not attach sensitive records not needed for this decision.

10) Complete the certificate of service.

• List the names and addresses of all parties served. Include the worker and any known attorney.
• State the method of service. You may use mail, electronic delivery, or other approved means.
• Enter the date of service. Keep proof.

11) Sign and date the form.

• An authorized representative must sign. This can be the employer, insurer, TPA adjuster, or counsel.
• Print the signer’s name, title, phone, and email. Sign in ink or via the approved electronic signature field.

12) File the form with the Commission.

• Submit the form through the approved filing method. Many filers use electronic submission. Paper filing may be allowed as instructed by the Commission.
• File promptly. Aim to file within 15 days of learning of the claim. Do not wait for perfect information. Update later if facts change.

13) Serve the worker and counsel.

• Send a copy to the worker and any known attorney the same day you file, or as close as possible.
• Keep a copy of your service and any delivery confirmation.

14) Update if your position changes.

• If you accept after a denial, file a new Form 2. State the acceptance and the effective date. Start benefits immediately if owed.
• If you stop TTD due to a full-duty release, file an updated Form 2. State the reason and the date the benefits end.
• If you correct the wage or compensation rate, file a new Form 2. Pay any underpayment promptly.

15) Check for completeness and clarity.

• Confirm names, dates, and claim numbers. Make sure the body parts listed match your position.
• Verify that compensation rates reflect current statutory caps for the injury year.
• Ensure your reason for any controversy is specific. Avoid vague terms like “investigation ongoing” without a factual basis.

Practical tips help filings go smoothly. Use plain language in the reason field. Avoid medical jargon unless quoting a record. Keep your narrative short but precise. If you need more space, attach a brief page titled “Addendum to Form 2.” Reference that addendum on the form. Confirm that your address and contact information are correct. This ensures you receive all future notices.

Finally, remember that Form 2 sets expectations for everyone involved. If you accept, pay on time, and authorize care promptly. If you deny, be prepared to support your position with facts and documents. When new facts arise, update your filing. Clear, accurate, and timely Form 2 filings reduce disputes and keep claims on track in Arkansas.

Legal Terms You Might Encounter

• Acceptance means you agree the injury is covered and you will provide benefits. On Form 2, you show acceptance by checking the appropriate box and listing what you will pay, such as medical care and wage-loss benefits.
• Controversion means you dispute the claim, in whole or in part. On the form, you indicate you controvert and briefly state why. You can controvert everything, or you can controvert only certain benefits or body parts.
• Compensability is the threshold question: is this injury covered by workers’ compensation? Form 2 is where you show your position on compensability based on your initial investigation.
• Medical-only claim refers to claims where you accept responsibility for medical treatment but deny or do not owe wage-loss benefits. If you accept a medical-only claim, Form 2 should reflect acceptance of medical benefits and note that no indemnity benefits are due.
• Indemnity benefits are payments for lost wages or disability. Common types include temporary total, temporary partial, permanent partial, and permanent total. If you accept indemnity benefits, Form 2 should state which type you will pay and your calculated compensation rate.
• Temporary Total Disability (TTD) means the worker is completely unable to work for a limited period while recovering. If you accept TTD, you will show that on the form and include the start date and compensation rate.
• Temporary Partial Disability (TPD) applies when the worker can do limited work or earns less while recovering. On Form 2, if you accept TPD, you note that you will pay wage-loss based on reduced earnings.
• Permanent Partial Disability (PPD) involves lasting impairment after maximum medical improvement, with some ability to work. If you accept PPD later, you can amend your Form 2 to reflect that change.
• Average Weekly Wage (AWW) is the average of the employee’s pre-injury wages, usually based on a defined look-back period. The compensation rate is typically a percentage of the AWW, subject to state maximums and minimums. On Form 2, you input AWW and the resulting compensation rate you will use to pay indemnity benefits.
• Waiting period is the initial number of days an employee must be off work before wage-loss benefits become payable. On Form 2, you indicate if the time lost exceeded the waiting period and whether indemnity benefits are owed.
• Authorized treating physician is the medical provider managing the injured worker’s care. If you accept medical benefits, Form 2 may identify the physician or show you are providing care through your insurer or administrator.
• Reservation of rights is a statement that you are paying benefits while continuing to investigate. If you are uncertain about some facts but want to provide care, you can accept provisionally and later amend your position based on new information.
• Objective findings are medical signs that can be observed or measured. They often matter in determining compensability. While Form 2 doesn’t require medical details, your stated basis for acceptance or controversion often turns on the presence or absence of objective findings.
• Preexisting condition means a prior injury or illness that could affect causation or the extent of disability. If you controvert because you believe the condition is unrelated to work, you note that position on the form.

FAQs

Do you have to file Form 2 if you accept the claim?

Yes. Form 2 is how you formally tell the state and the employee that you accept the claim, what benefits you will pay, and your compensation rate. Filing confirms your position and helps prevent unnecessary disputes.

Do you still file Form 2 if you intend to controvert?

Yes. You must declare your intent to controvert on Form 2. The form records your reasons and notifies the employee. Filing starts the official dispute process and sets expectations for both sides.

Do you need the employee’s signature on Form 2?

No. Form 2 is filed by the employer or insurer. The employee does not sign it. You still must provide a copy to the employee so they know your position and next steps.

Can you accept some parts of the claim and deny others?

Yes. You can accept medical treatment but deny wage-loss, or accept the back injury while controverting a claimed shoulder injury. On the form, you specify what you accept and what you controvert. Clarity here reduces confusion.

What if you do not have all the wage information for AWW?

File on time with the best available information, then amend when you confirm the AWW. State rules value timely filing. It is better to meet the deadline and correct the numbers later than to file late.

Can you change your position after you file?

Yes, if new facts arise. You can amend Form 2 if you find additional medical evidence, new witnesses, or payroll corrections. Send updated copies to all required parties and clearly explain what changed and why.

Does Form 2 replace the initial injury report?

No. The initial injury report records that a work injury occurred. Form 2 states whether you intend to accept or controvert the claim and, if accepted, what benefits you will pay. They serve different purposes.

Do you have to send a copy to the employee?

Yes. Always provide the employee with a copy. Good practice is to send it the same day you file and keep proof of delivery. Clear notice reduces disputes and keeps the claim moving.

What happens after you file a controversion?

The claim enters a dispute phase. Expect requests for more information, medical records, or statements. You may explore resolution or proceed to a formal process. Keep communicating with the employee and the state, and track all deadlines.

How do you calculate AWW for Form 2?

Use the employee’s recent earnings and pay frequency to determine an average weekly amount. Include regular wages and any consistent bonuses or overtime, if applicable. Document the math you used so you can support your compensation rate.

Checklist: Before, During, and After the Form 2 – Employer’s Intent to Accept or Controvert Claim

Before signing: Gather these items

• Employee information: full name, address, phone, date of birth, job title, hire date, and employee ID.
• Employer information: legal name, worksite address, FEIN, and the contact person who can answer claim questions.
• Insurer or administrator information: policy number, claim number, and adjuster contact details.
• Injury details: exact date and time, location, body parts involved, and a brief description of how it happened.
• Notice details: when and how the employee reported the injury to you and to whom.
• Medical information: initial treatment date, treating provider’s name, and any referral information if known.
• Work status: last day worked, first day of lost time, return-to-work date (if any), and offered modified duty.
• Wage data: pay frequency, hours per week, pay rate, overtime, shift differentials, bonuses, and the look-back period used.
• Average Weekly Wage (AWW) calculation: all payroll records used, including irregular pay and seasonal adjustments if applicable.
• Prior claims or conditions: any known preexisting issues related to the same body part, with dates if available.
• Witness list: names and contact information for coworkers who saw the incident or the aftermath.
• Safety and incident records: incident report, photographs, and any equipment logs or maintenance records relevant to the event.
• Internal approvals: confirmation from HR, safety, and management on your proposed accept/controvert position.

During signing: Verify these sections carefully

• Correct employee and employer names, addresses, and identifiers.
• Accurate date of injury, time of injury, and date the injury was reported.
• Proper selection between accept vs. controvert, or a partial acceptance with details.
• Clear statement of benefits accepted: medical-only, TTD, TPD, or PPD.
• AWW and compensation rate entries, with math checked and aligned with payroll records.
• Body parts and diagnosis description consistent with medical notes or incident reports.
• Work status and any waiting-period impact (e.g., whether lost time exceeds the threshold).
• Insurer/administrator and adjuster contacts for follow-up questions.
• Reasons for controversion, if applicable, are stated clearly and factually.
• Signature, title, and date by the authorized employer or insurer representative.

After signing: Filing, notifying, and storing

• File the form with the state workers’ compensation agency using the required method. Do not delay.
• Send copies to the employee and the insurer or administrator the same day you file.
• Keep proof of filing and delivery (e.g., portal confirmation or mail receipt) in the claim file.
• Calendar all next deadlines, including follow-up filings, benefit start dates, and medical updates.
• If you accepted benefits, coordinate with payroll to issue timely wage-loss payments.
• If you controverted, draft a clear, respectful explanation letter mirroring your Form 2 position.
• Update the internal incident log and safety records with the claim number and filing date.
• Create a secure electronic and physical file with payroll, medical, and communication records.
• Set reminders to reassess AWW, modify benefits based on medical changes, and consider return-to-work options.
• Train the supervisor on communication do’s and don’ts with the injured employee.

Common Mistakes to Avoid with Form 2 – Employer’s Intent to Accept or Controvert Claim

• Don’t file late or wait for every record. Consequence: late filings can trigger penalties and damage your credibility. File on time with the best information you have, then amend as needed.
• Don’t leave AWW or compensation rate blank. Consequence: you may underpay or overpay benefits and invite disputes. If you cannot finalize the numbers, mark them as provisional and explain your method.
• Don’t check “accept” while you intend to limit benefits. Consequence: vague acceptance creates confusion and can be read as a full acceptance. If you accept only medical or only certain body parts, say so explicitly.
• Don’t ignore inconsistencies with your initial injury report. Consequence: mismatches can look like errors or bad faith. Align dates, body parts, and descriptions across documents or explain any differences.
• Don’t forget to send the employee a copy. Consequence: lack of notice leads to complaints and delays. Send the employee a copy on the filing date and keep proof of delivery.

What to Do After Filling Out Form 2 – Employer’s Intent to Accept or Controvert Claim

1. Confirm delivery and receipt. Verify that the state, the employee, and your insurer or administrator received the form. Save all confirmations in the claim file.
2. Start benefits if you are accepted. If you accept medical care, authorize treatment, and share billing instructions with the provider. If you accepted wage-loss benefits, issue the first payment based on the compensation rate you listed. Note the benefit start date and payment frequency in your diary.
3. Communicate promptly. Send the employee a clear letter that matches your Form 2. Explain what you accepted, what you controverted, and what to expect next. Provide a contact person for questions.
4. Launch or finish your investigation. If facts are missing, complete witness statements, gather medical records, and review payroll data. If you reserved rights, set a timeline to finalize your position and decide whether to amend Form 2.
5. Recalculate AWW if needed. When you receive complete payroll information, verify your math. If the AWW or compensation rate changes, issue a corrected payment and file an amended Form 2.
6. Coordinate return-to-work. Work with the treating provider to obtain work status notes. Offer light or modified duty if available and appropriate. Document all offers and the employee’s response.
7. Track medical progress. Monitor appointments, referrals, and work restrictions. When the employee reaches maximum medical improvement, reassess benefits. If permanent benefits are involved, document your basis and update your filings.
8. Manage controverted claims proactively. If you controverted, keep records organized and factual. Be ready to provide your reasoning, the documents you relied on, and any witness information. Continue to evaluate whether early resolution makes sense.
9. Amend when facts change. New medical evidence, a corrected injury date, or confirmed wage data may require an amended Form 2. File the amendment, notify all parties, and explain the change.
10. Maintain clean records. Store Form 2, wage calculations, medical notes, payment logs, and correspondence in one place. Use a consistent naming scheme and version control for amendments.
11. Audit your file. Periodically review the claim to ensure benefits match current status, payments are timely, and communications are complete. Close the claim only after final payments and notices are complete and documented.
12. Educate your team. Share lessons learned with supervisors and HR. Update your injury reporting workflow so your next Form 2 is easier and faster to complete.