Georgia Required Postings and Forms
Please print and post the following notices in a conspicuous location frequented by employees such as the break room, lunch room or time clock. If you have multiple business locations be sure to post the notices at each location.
- WC Bill of Rights (English and Spanish)
- WC-P3 Form (English and Spanish)
- Anti-Fraud Notice
- Emergency Hospital Worksite Poster
- Copies of the Employee Notice and attachments (includes ID card, Physician Instructions, Dispute/Grievance Form. These are samples of documents that will be automatically generated and sent after the claims adjuster has reviewed and accepted the claim.
Please print and review the following form with your current staff and new employees (at the time of hire):
The following forms need to be completed and submitted to EMPLOYERS when a work-related injury occurs:
- WC-1 First Report of Injury (FROI). As soon as you have been notified of a work-related injury, please fill out this form and submit it to EMPLOYERS. This form must be completed within 10 days from notice of an accident. Fatalities must be reported within 24 hours. You must use this form to notify EMPLOYERS of every work-related injury or disease suffered by an employee, regardless of severity.
- WC-6 Wage Statement. This form enables us to calculate the correct compensation that may be owed to an injured employee. Please complete this form and submit it to EMPLOYERS within five days after your knowledge of any accident that has caused your employee to be disabled for more than seven scheduled work days. Failure to do so allows an administrative law judge to make the final determination of the Average Weekly Wage (AWW).
- Accident Investigation Report. This basic accident form is completed by the employee’s supervisor/manager as soon after the accident as possible. Please send the original completed report to EMPLOYERS as soon as the report has been completed by the supervisor/manager: EMPLOYERS Claim Department, P.O. Box 32036, Lakeland, FL 33802-2036. You should keep a copy on file for your records.
Please print and provide the following items when an employee becomes injured:
- Channeling Letter. This document directs the injured employee where to go for treatment after an injury and find a provider.
- First Fill Form. This form provides your employees with basic information about our Pharmacy Benefit Program, including such things as the phone number to call to locate a First Fill participating pharmacy. When your employee becomes injured, please print and complete this form and provide it to your injured employee. Your employee will need to provide this completed form along with the prescription for his/her work-related injury or illness to the pharmacist. Using this form will help enable quick authorization for your employee’s initial medication and ensure that the initial prescription is provided at no cost to the injured employee.
The following item is to be used as a reference document only.
- EMPLOYERS Georgia Managed Care Program Guide. This document explains important information about the EMPLOYERS Georgia Managed Care (EMP GA MCO) program and the required notices.
- Off-Site Transitional Duty Program - Helping Your Injured Employees Get Back to Work
A successful transition back to work relies on the collaborative efforts of the manager/supervisor, the injured employee and their adjuster. As a manager/supervisor, learn what you can do to help facilitate a successful return to work.