Within 24 hours of submitting a workers’ compensation claim, employees have to give a verbal statement to both the claims adjuster and the triage nurse (Amerysis) to complete the process.
On-the-Job Injury Reporting Procedures:
All employees who are injured or become ill, either physically or mentally, as a result of their job duties must report the incident to the employer immediately by completing the following instructions:
- IMMEDIATELY report injury to Supervisor or Human Resources Action Coordinator (HRAC) Representative who must report all on-the-job injuries to the Office of Insurance & Risk Management (SRM) within 24 hours. An employee may not call in their own injury. Seek medical attention if necessary.
- Seek medical treatment as needed and according to severity of the injury: Immediate Medical Treatment can be obtained from the following locations:- Concentra Midtown – 688 Spring St NW, Atlanta, GA, 404-881-1155 is open M-F 7:30am-7pm, Sat. 10am-4pm (Closed Dec. 25th& Jan. 1st)
– Non-Urgent Medical Care can be obtained following steps 3-7 below.
– First Aid Only Injuries: Apply necessary first aid and report injuries to Insurance & Risk Management as “Record Only”
(After-hours care should be sought at the nearest hospital’s emergency department)
- Supervisor or HRAC Representative mustobtain the following forms:
– First Report of Injury Form (Modified WC-1 to be completed by Supervisor/HRAC representative)
– Employee Leave Election Forms (completed by injured employee)
– Acceptance / Declination of Medical Treatment Form (completed by injured employee)
– Employee Accident Statement Form (completed by injured employee)
– Witness Accident Statement form (if a witness is available)Forms available here.
- Completed forms must be submitted by email to the Office of Insurance and Risk Management to the attention of:
Occupational Health & Safety Manager
- The Office of Insurance & Risk Management will contact the injured employee, the employee’s supervisor, and HR to provide them with the Workers’ Compensation Claim #.
- Upon receipt of the Workers’ Compensation claim number, employee must call the Workers’ Compensation Managed Care organization (AMERISYS, 800-900-1582, option 2) to arrange in-network medical care.
- Employee is required to submit a work status form from the treating physician to the Supervisor and the Office of Insurance & Risk Management following each medical visit.
Workers’ Compensation Forms:
- To be completed by the injured employee’s supervisor:
- To be completed by the injured employee:
- To be completed by anybody who may have seen the incident occur:
- To be provided to injured Employee when seeking medical treatment
Please seek appropriate treatment according to the severity of the injury.
EMERGENCY: Dial 911
Immediate Medical Treatment can be obtained from the following locations:
- Caduceus USA
145 North Ave NE
Atlanta, GA 30308
Hours: Open 24/7Additional Caduceus locations can be found in and around the City of Atlanta by searching here.
- Concentra Midtown
688 Spring St NW
Atlanta, GA 30308
Hours: Mon-Fri 7:30am-7pmAdditional Concentra locations can be found in and around the City of Atlanta by searching here.
- Piedmont WellStreet Urgent Care
2292 Peachtree Rd NW
Atlanta, GA 30309
Hours: Mon-Fri 9am-9pm, Sat-Sun 8am-8pmAdditional Piedmont WellStreet Urgent Care Locations can be found here.
- After-hours care should be sought in the nearest hospital’s emergency department
Non-Urgent Medical Care can be obtained following normal injury reporting procedures and working with the University System of Georgia’s Managed Care Organization to arrange for in-network medical care.
First Aid Only Injuries: Apply necessary first aid and report injuries to IRM as “record only”