Form AR-4 – Report of Compensation Paid/Suspension Of Payments

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

What is a Form AR-4 – Report of Compensation Paid/Suspension Of Payments?

Form AR-4 is a workers’ compensation reporting form used in Arkansas. You use it to tell the state and the injured worker when you start paying wage-loss benefits, what you paid, and when you change or stop those payments. It functions as an official notice and a running accounting of indemnity benefits in a claim.

In plain terms, the AR-4 does two core jobs. First, it reports compensation paid. That includes when payments began, the benefit type, the weekly rate, and totals to date. Second, it documents suspension or change of payments. That includes why payments stopped or changed and the effective date of that change.

Who typically uses this form?

Employers, insurance carriers, third-party administrators (TPAs), and self-insured employers complete and file the AR-4. Defense counsel may prepare it for the adjuster to sign. Injured workers do not fill it out, but they should receive a copy. The state workers’ compensation agency receives the filing to monitor compliance and benefit status.

Why would you need this form?

If you handle a workers’ compensation claim and you issue the first wage-loss check, you must give formal notice. If you later stop benefits because the worker returns to full-duty work, you must report that suspension and the date. If you convert benefits from temporary total disability to permanent partial disability, you must report the change. The AR-4 is the standard way to do all of this. It keeps the claim record clear and gives everyone the same information.

Typical usage scenarios

• You have verified the average weekly wage and are ready to start temporary total disability (TTD) payments. You file an AR-4 showing the start date, benefit rate, and total paid.
• The employee returns to work full duty. You stop TTD as of the return date and file an AR-4 suspending payments, with the reason selected as “returned to work, full duty.”
• A doctor places the employee at maximum medical improvement (MMI) and assigns a permanent impairment rating. You convert from TTD to permanent partial disability (PPD) and report the new benefit type and schedule.
• You pay back-due benefits after a dispute resolves. You file an AR-4 updating the totals paid through the date of the lump-sum catch-up.
• You discover a wage miscalculation. You correct the rate and file an amended AR-4 to reflect the accurate average weekly wage and compensation rate, with revised totals.

The AR-4 is not just paperwork. It is the official financial snapshot of indemnity in the claim. Done well, it reduces disputes, creates a complete record, and helps you stay compliant.

When Would You Use a Form AR-4 – Report of Compensation Paid/Suspension Of Payments?

You use an AR-4 any time you start, change, or stop wage-loss benefits in an Arkansas workers’ compensation claim. Think of each event in the life of a claim as a trigger for a new AR-4.

When you first accept a lost-time claim and cut the first TTD check, you use the AR-4 to report commencement of compensation. You list the average weekly wage (AWW), the weekly compensation rate, and the start date of disability. You also show how much you have paid to date and what period that payment covers.

If the employee transitions to light-duty with reduced earnings, you switch to temporary partial disability (TPD). You file an AR-4 documenting the benefit type change and the calculation of the partial benefit. That tells the worker and the state how you set the new rate based on actual weekly earnings.

When a treating physician finds MMI and returns the worker to full duty, you suspend TTD effective that date. You use the AR-4 to suspend payments, showing the reason as “MMI/returned to full duty,” and you update totals. If a permanent impairment rating exists and you will begin PPD benefits, you file an AR-4 to start PPD. You identify the body part or rating base, the weekly rate, and the number of weeks payable under the rating.

If the worker returns to work without restrictions, you stop TTD or TPD and document the suspension date. If the worker returns to work with the same or higher gross wages, you note the reason for ending partial benefits.

If benefits pause for a short period—for example, the worker fails to provide required earnings information for TPD—you document the suspension with the AR-4. If benefits are later resumed, you file another AR-4 reporting recommencement with updated totals.

If a death benefit begins, you report the commencement for dependents with the AR-4, listing the rate and payees. When those benefits end due to statutory caps or changes in dependency, you file an AR-4 suspending payment with the appropriate reason.

Typical users are claims adjusters for carriers or TPAs, self-insured employer claims teams, and sometimes defense counsel preparing drafts. Employers’ HR or risk managers may help gather payroll data for the AWW. Injured workers and their attorneys receive copies and use them to verify accuracy.

In short, you file an AR-4 at each turning point in indemnity: first payment, any conversion between benefit types, any rate change, any suspension, and final payment.

Legal Characteristics of the Form AR-4 – Report of Compensation Paid/Suspension Of Payments

The AR-4 is a legally required reporting and notice form in Arkansas workers’ compensation claims that involve wage-loss benefits. It is not a contract, and it does not, by itself, create or waive benefit rights. Instead, it documents compliance with benefit obligations under state law and provides official notice of the payment status.

Why is it legally binding in practice?

Because the state requires accurate, timely reporting of indemnity activity, the AR-4 becomes part of the claim record maintained by the agency. It memorializes what was paid, when, at what rate, and why payments changed or stopped. The worker and their attorney rely on it as a formal statement. The agency relies on it to ensure benefits start on time, that rates are correct, and that suspensions are based on valid reasons.

What ensures enforceability?

The form is signed by an authorized representative of the payer, under penalty of making a false statement. You certify the accuracy of the reporting to the best of your knowledge. The state can assess penalties for noncompliance, late reporting, or misrepresentation. The AR-4 also supports due process by giving the injured worker clear notice of any adverse change, such as a suspension or reduction. That notice allows the worker to contest or seek a conference if needed.

General legal considerations

• Timeliness. You must file promptly when you start paying and each time you change or stop payments. Delays can result in penalties or an order to show cause.
• Completeness. You must list the correct AWW, compensation rate, dates of disability, benefit type, and total paid to date. If unknown at the first check, you should document what you know, then amend as soon as you verify wages.
• Accuracy. The reasons for suspension must rest on documented facts: a return-to-work date, a doctor’s release, a refusal to cooperate with vocational rehabilitation, or another recognized basis.
• Transparency. You should send a copy to the injured worker and any attorney of record. That is both good practice and a notice requirement in many circumstances.
• Amendments. If you discover an error, you should correct it by filing an amended AR-4. Do not wait to correct wage or rate errors; fix them and issue any back pay promptly.
• Evidence. While not a substitute for testimony or medical records, the AR-4 is an evidentiary document that shows payment history and the stated reason for suspensions.

In short, treat the AR-4 as part of your compliance program. File it when required, keep it accurate, and use it to give clear notice.

How to Fill Out a Form AR-4 – Report of Compensation Paid/Suspension Of Payments

The AR-4 is straightforward if you approach it methodically. Here is a practical, step-by-step walkthrough.

Step 1: Confirm you are the correct filer

You should be the employer, insurer, TPA, or authorized representative responsible for payment. Make sure the claim has been reported and a claim number exists. Verify you have the authority to certify the information.

Step 2: Gather the required information

Collect the building blocks before you start:

• Employee details: full name, address, date of birth, and, if required, the last four digits of the SSN.
• Employer details: legal name, address, and contact.
• Insurance/TPA details: carrier or claims administrator name, address, claim number, and your contact information.
• Injury details: date of injury, body part, and brief injury description.
• Disability dates: first day of disability, any return-to-work dates (light duty or full duty), and MMI date if known.
• Wage records: the 52-week wage history before the injury or a reasonable representative period, including overtime and shift differentials as applicable.
• Payment records: the first check date, periods covered, weekly rate, and totals paid to date.
• Medical documentation: doctor reports on work status, MMI, and any impairment rating.

Having this on hand prevents incomplete filings and rework.

Step 3: Determine the average weekly wage and compensation rate

Calculate the AWW using the wage data. Use a representative period if the full 52 weeks is not available. Include overtime if it was regular and part of wages. Exclude non-wage fringe benefits.

Compute the compensation rate based on the AWW and the applicable percentage for the benefit type and date of injury. Apply the state maximum and minimum caps for the injury date. If you must start benefits before final wage verification, use the best available information and note that you will amend.

Document your calculations in your file. You may need to share a wage statement with the worker or their attorney.

Step 4: Identify the benefit type you are reporting

Check the appropriate box or section for the benefit type:

• Temporary Total Disability (TTD) for periods of total incapacity during healing.
• Temporary Partial Disability (TPD) occurs when the worker returns with reduced earnings.
• Permanent Partial Disability (PPD) for an impairment rating after MMI.
• Permanent Total Disability (PTD) when applicable.
• Death benefits for dependents, when applicable.

If converting from one type to another, clearly mark both the end of the prior type and the start of the new type.

Step 5: Complete the payment commencement section

If starting benefits, enter:

• First day of disability.
• Three-day waiting period status and whether retroactive benefits will apply if disability lasts long enough under state rules.
• Date of first payment issued.
• Weekly compensation rate.
• Period covered by the first payment.
• Total compensation paid to date, inclusive of the current payment.

Use clear calendar dates. If you paid multiple weekly periods in a single check, list the inclusive dates.

Step 6: Complete the suspension or change section, if applicable

If suspending or changing benefits, enter:

• Effective date of the suspension or change.
• Reason for the suspension or change. Use a recognized reason, such as:
• Returned to work full duty.
• Returned to work at pre-injury wages.
• MMI reached; TTD ended.
• Commencing PPD based on impairment rating.
• Non-cooperation with required vocational rehabilitation or refusal of suitable employment.
• Administrative correction of rate or benefit type.
• Death benefit status change.

Provide a brief note if needed to clarify unusual circumstances. Keep supporting documents in your file, such as the work release or MMI letter.

Step 7: Update totals paid to date

List the cumulative total of indemnity paid through the current filing date. Include all prior payments of the same and different benefit types. If transitioning from TTD to PPD, the total should reflect the sum across both types up to that date. This total helps reconcile the claim later.

Step 8: Attach or reference supporting documents

While attachments may not always be required, have the following ready and include or reference them when appropriate:

• Wage statement showing the AWW calculation.
• Doctor’s work status report or MMI letter.
• Impairment rating report for PPD.
• Earnings statements for TPD calculations.
• Calculation worksheet showing rate and period coverage.

If you do not attach them, maintain them in your file and be ready to provide them on request.

Step 9: Provide parties and contact information

Ensure the form lists complete information for:

• Employee.
• Employer.
• Insurer or TPA.
• Any attorney of record for the worker or employer, if the form has fields for representation.

Accurate contact information ensures proper notice and avoids delays.

Step 10: Sign and date the form

An authorized representative must sign and date the AR-4. Include your printed name, title, and direct contact information. Electronic signatures are acceptable if you file electronically. Your signature certifies that the information is true to the best of your knowledge.

Step 11: File and serve the form

Submit the AR-4 to the state workers’ compensation agency. Send a copy to the injured worker and any attorney of record. Keep proof of filing and service in your claim file. File promptly after the triggering event, such as the issuance of the first check or the date of suspension.

Step 12: Amend if information changes or errors are found

If you later verify wages and the AWW changes, file an amended AR-4 with the corrected rate. If you resume benefits after a suspension, file a new AR-4 reporting recommencement and updated totals. If you discover a date error or a misapplied benefit type, correct it at once. Issue any back pay owed with the correction.

Step 13: Avoid common pitfalls

Watch for these frequent errors:

• Using an estimated AWW and never amending it after wage verification.
• Omitting the waiting period status or failing to pay it retroactively when due.
• Listing the wrong effective date for a suspension, especially when a release is mid-week.
• Changing the benefit type without identifying the end date of the prior type.
• Failing to update the total paid to date creates reconciliation gaps later.
• Not serving the injured worker or their attorney, leading to disputes over notice.

Build a checklist to prevent these issues. Align your AR-4 data with your payment ledger and medical reports.

Step 14: For injured workers reading an AR-4

If you receive an AR-4, review:

• The weekly compensation rate. Does it match two-thirds of your average weekly wage, subject to caps?
• The dates covered by payments. Do they align with your time off work?
• The reason for any suspension. Does it match your medical release or return-to-work status?
• The total paid to date. Does it match the checks you received?

If something looks off, contact the adjuster listed on the form. Ask for the wage statement or calculation. If needed, request an amended AR-4 to correct errors. Keep a copy for your records.

Step 15: Coordinate AR-4 filings with other claim actions

Sync your AR-4 timing with major claim steps:

• Issue the first check and file the AR-4 the same day or shortly after.
• When a doctor issues an MMI note, calendar the suspension date and file the AR-4 immediately upon suspension.
• When starting PPD, file the AR-4 noting the rating basis and schedule.
• When resolving the claim, ensure the final AR-4 matches the closing payment and total indemnity paid.

Consistency across your file, the AR-4, and your payment system avoids compliance problems and helps you close the claim cleanly.

By following these steps, you can complete the AR-4 accurately and on time. You will give clear notice to the worker, maintain compliance, and keep the claim record tight and defensible.

Legal Terms You Might Encounter

• Compensable injury means an injury accepted or found to be work-related. On Form AR-4 – Report of Compensation Paid/Suspension of Payments, you only report compensation paid for a compensable injury. If the claim is denied, you still use the form to document any payments made and any suspension, with a clear reason.
• The average weekly wage is the average of the worker’s pre-injury earnings. It drives the compensation rate used for weekly benefits. On Form AR-4 – Report of Compensation Paid/Suspension of Payments, you show the rate you used to pay benefits. Keep your wage records on hand to support it.
• Compensation rate is the weekly dollar amount you pay in wage-loss benefits. It usually comes from the average weekly wage and legal limits. On Form AR-4 – Report of Compensation Paid/Suspension of Payments, you must show the rate and totals paid. If you change the rate later, you should amend your filing.
• Temporary total disability is when the worker cannot work at all during recovery. You report these payments on Form AR-4 – Report of Compensation Paid/Suspension Of Payments as TTD compensation, with start and end dates. If you stop TTD, you list the reason and the effective date.
• Temporary partial disability is when the worker can work but earns less. You report TPD payments on Form AR-4 – Report of Compensation Paid/Suspension Of Payments with amounts and dates. You should also keep the wage records that support the partial payments.
• Permanent partial disability is paid when the worker has a lasting impairment but can work in some capacity. On Form AR-4 – Report of Compensation Paid/Suspension of Payments, you record PPD paid and the dates. If you start PPD after MMI, show how the benefit type changed.
• Maximum medical improvement is when the worker’s condition is stable and not expected to improve. MMI often triggers a change or suspension of benefits. On Form AR-4 – Report of Compensation Paid/Suspension of Payments, you may list MMI as the reason for suspension or the switch from TTD to PPD.
• Suspension of payments is when you stop or pause wage-loss benefits. The form’s title includes “Suspension Of Payments” because you must notify when and why you stop. On Form AR-4 – Report of Compensation Paid/Suspension of Payments, state the reason and the exact date you suspend.
• Controversion is when you dispute part or all of the claim. You may dispute compensability, the benefit type, or the rate. If controversion affects payment, Form AR-4 – Report of Compensation Paid/Suspension Of Payments documents payments made and the suspension based on the dispute.
• Overpayment or underpayment describes paying too much or too little. On Form AR-4 – Report of Compensation Paid/Suspension of Payments, totals must match your ledger. If you discover an error, you should file a corrected form and explain the adjustment.

FAQs

Do you use Form AR-4 – Report of Compensation Paid/Suspension of Payments to start benefits?

You use this form to report compensation paid and to record a suspension. Some payers also file it at key points, like the first payment or a change in benefits. Follow the latest form instructions on timing and events.

Do you include medical payments on Form AR-4 – Report of Compensation Paid/Suspension of Payments?

The form focuses on wage-loss compensation. If the form includes a space for medical totals, complete it as directed. Do not mix medical bills with indemnity lines unless the form asks for it.

Do you have to send Form AR-4 – Report of Compensation Paid/Suspension of Payments to the worker?

Yes. Send copies to the worker and any listed representatives. Also, send copies to the employer and any claim administrator involved. Keep proof of service in your file.

Do you need to explain why payments stopped on Form AR-4 – Report of Compensation Paid/Suspension of Payments?

Yes. State a clear, factual reason and the stop date. Examples include return to work, MMI, no medical support, or a dispute. Attach supporting documents if requested in the instructions.

Do you file a new Form AR-4 – Report of Compensation Paid/Suspension of Payments if payments resume?

Yes. File a new form to show the restart date and updated totals. This keeps the record complete and prevents confusion about the benefit period.

Do you round dollar amounts on Form AR-4 – Report of Compensation Paid/Suspension of Payments?

Enter exact amounts to the cent. Use your payment ledger to confirm totals. Avoid estimates and avoid mixing benefit types in one total line.

Do you sign Form AR-4 – Report of Compensation Paid/Suspension of Payments electronically?

Follow the current form instructions. Many offices accept electronic signatures or e-filing. If you wet-sign, use blue or black ink, and include your title and contact details.

Do you attach supporting documents to Form AR-4 – Report of Compensation Paid/Suspension of Payments?

Attach only what the form requests or what is needed to explain a change. Typical attachments include a payment history, wage records for TPD, or a release to work. Label each attachment with the claim identifiers.

Checklist: Before, During, and After the Form AR-4 – Report of Compensation Paid/Suspension Of Payments

Before signing

• Claim identifiers: claim number, file number, and any agency number.
• Worker details: full name, address, and last four digits of SSN if required.
• Employer details: legal name and address.
• Insurer or administrator details: name, NAIC or internal ID, and contact info.
• Injury details: date of injury, body part, and description consistent with prior filings.
• Average weekly wage and compensation rate calculations with backup.
• Benefit type history: TTD, TPD, PPD, or other indemnity types paid.
• Payment ledger: dates, amounts, and check numbers for all indemnity benefits.
• Period summaries: start and end dates for each benefit type.
• Reason for suspension with supporting dates and documents.
• Return-to-work information: date, status (full-duty or modified), and wages if known.
• Medical status evidence: MMI date, work restrictions, or treating provider note.
• Representative information: attorneys or authorized representatives for all parties.
• Any offsets or credits applied, with documentation.
• Current version of Form AR-4 – Report of Compensation Paid/Suspension of Payments.

During signing

• Verify all names, addresses, and claim numbers match the claim file.
• Confirm injury date and description match the accepted claim.
• Check the average weekly wage and compensation rate for accuracy.
• Ensure total compensation paid matches your ledger to the cent.
• Confirm benefit type boxes are accurate for each period paid.
• Verify date ranges are complete and in chronological order.
• State the reason for suspension clearly and factually.
• Enter the effective suspension date and any restart date if known.
• Review any attachments and label them with claim identifiers.
• Enter your title, phone, and email so others can reach you.
• Sign and date the form. Confirm any notary requirements.
• Scan or save a clear copy for your records before filing.

After signing

• File Form AR-4 – Report of Compensation Paid/Suspension of Payments with the appropriate office as instructed.
• Use the filing method allowed: e-filing, mail, or hand delivery.
• If mailing, use trackable delivery and keep the receipt.
• Serve copies to the worker and all listed representatives.
• Serve copies on the employer and any third-party administrator.
• Update your claim system with the filing date and service list.
• Calendar any follow-up deadlines or hearings.
• Monitor for objections or requests for more information.
• If an error is found, prepare a corrected Form AR-4 promptly.
• Store the form, proof of filing, and all attachments in the claim file.
• Keep payment and wage records organized for audit or review.

Common Mistakes to Avoid Form AR-4 – Report of Compensation Paid/Suspension Of Payments

• Misstating the compensation rate. This often comes from a bad average weekly wage. Consequence: underpayment or overpayment and potential penalties. Don’t forget to recheck the math and limits.

• Leaving out the suspension reason or date. Reviewers need a clear trigger for stopping pay. Consequence: rejection or an order to resume payments. Don’t forget to state both the reason and the exact date.

• Mixing benefit types in one total. TTD, TPD, and PPD should be distinct. Consequence: unclear records and disputes about credits. Don’t forget to separate totals by benefit type and period.

• Not matching totals to your payment ledger. Even small gaps cause issues. Consequence: delays, audits, or loss of credit for payments. Don’t forget to reconcile down to the cent.

• Failing to serve all parties. The worker and representatives must be notified. Consequence: disputes over notice and avoidable hearings. Don’t forget to send copies and save proof of service.

What to Do After Filling Out the Form AR-4 – Report of Compensation Paid/Suspension Of Payments

1. File the completed Form AR-4 – Report of Compensation Paid/Suspension of Payments using the method allowed. Follow the instructions on the form for where and how to file. If you mail, use a trackable method and keep the receipt.
2. Serve copies to all parties. Send the form to the worker and any representatives. Send copies to the employer and any claim administrator. Keep a service list in your file.
3. Update your claim ledger. Confirm your balances match the totals on Form AR-4 – Report of Compensation Paid/Suspension of Payments. Note the suspension date and reason. Add any upcoming payment or review dates.
4. Monitor for responses. Watch for confirmation, objections, or a request for more detail. If you receive a question, respond with the payment history and supporting documents. Keep all communications in the claim file.
5. If you need to correct the filing, prepare an amended Form AR-4 – Report of Compensation Paid/Suspension of Payments. Mark it clearly as corrected or amended. Explain what changed and why. Re-file and re-serve all parties.
6. If payments resume, file a new Form AR-4 – Report of Compensation Paid/Suspension of Payments. Show the restart date and updated totals. Add any new benefit type or rate changes. Keep your ledger aligned with each filing.
7. If the claim settles or closes, reconcile the final totals. Verify that the compensation shown on Form AR-4 – Report of Compensation Paid/Suspension Of Payments matches your final pay history. Store the final form, proof of filing, and the settlement documents together.
8. Maintain records for the full retention period. Keep the form, attachments, wage data, medical status notes, and all notices. Organized records reduce audit stress and support quick responses.