Get 1 Georgia State Board Of Workers' Compensation

Filling out the 1 Georgia State Board of Workers' Compensation form, also known as the Employer's First Report of Injury or Occupational Disease, is an important step in the claims process. This guide will walk you through each section of the form to ensure that it is completed accurately and efficiently.

Follow the steps to complete the form effectively.

1. Press the ‘Get Form’ button to access the form and open it for editing.
2. Begin with the identifying information section. Enter the employee's last name, first name, middle initial, social security number or board tracking number, date of injury, and birthdate. Select the employee's gender by checking the appropriate box.
3. Provide the employee's contact information, including their phone number, email address, and full residential address.
4. Fill in the employer's details by entering the employer's name, address, phone number, and the nature of the business. Include the employer's federal employer identification number (FEIN) as well.
5. Detail the claims office's information, including the insurer or self-insurer's name, address, and their FEIN or SBWC ID number.
6. In the employment and wage section, provide the employee's date of hire, job classification code, average wage rate at the time of injury, and the number of days worked per week.
7. Document the specifics of the injury or illness by including the county of injury, date the employer learned of the injury, time of injury, type of injury/illness, and impacted body part.
8. Indicate the initial treatment provided and the treating physician's information. If the employee has returned to work, including the return date and new wage.
9. Complete the income benefits section, noting any prior medical-only claims, average weekly wage, and compensation details.
10. In the notice to controvert payment of compensation section, specify reasons if applicable.
11. Finally, ensure the report is prepared by the individual completing the form, providing their contact information and the date of the report.
12. Once you have completed all fields accurately, review the form for any errors and then save the changes. You can then download, print, or share the form as needed.

Complete and submit your documents online to ensure a swift processing of your workers' compensation claim.