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Board Rule 61b1 Form Wc1 Employers First Report Of Injury

Employers shall complete Section A immediately upon knowledge of an injury and submit the form to their insurer.  The insurer, self-insurer, or group self-insurer shall place their SBWC ID Number in the appropriate box on this form.  Insurers who receive a Form WC-1 from an employer shall clearly stamp the date of receipt on the form.  Insurers and self-insurers shall complete Section B or C and mail the original to the Board and a copy to the employee within 21 days of the employer’s knowledge of disability.  Use this form to report accidents and injuries for cases involving more than seven days of lost time.  Cases with seven or less days of lost time should be reported on Form WC-26.  For previously designated “medical only” claims, you must check the appropriate box in Section B or C.  In death cases with accident dates before July 1, 1995, a copy of Form WC-1 shall also be filed with the Administrator of the Subsequent Injury Trust Fund at the same time it is mailed to the Board.  In accepted catastrophic claims, Form WC-1 shall be filed within 48 hours of the employer’s acceptance of a catastrophic injury as compensable.

Complete Section B when the insurer/self-insurer commence payment of weekly benefits or when the employer continues to pay salary during compensable disability and when employer/insurer suspend for an actual return to work prior to the filing of Form WC-1. Furnish copy to employee.

The employer, insurer, self-insurer, or group self-insurer shall completely fill out the Form WC-1 and failure to provide the name and address of the employee, employer, insurer, self-insurer, or group self-insurer, date of injury, the employee’s social security number, the insurer’s, self-insurer’s, or group/self-insurer’s SBWC ID Number, or the completion of sections B, C, or D may result in the rejection of the filing with the Board.

Complete Section C within 21 days in accordance with subsection (d) of O.C.G.A. § 34-9-221 when employer/insurer controverts payment of compensation. Furnish copies to employee and, upon request, to any other person with a financial interest in the claim. In addition, complete and file a Case Progress Report, Form WC-4, within 180 days of the date of claimed disability.

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