Official Notice of Workers Compensation Panel of PhysiciansWorkers' Compensation Employee Bill of Rights

 

 

 

HOW TO REPORT WORK-RELATED INJURY 

1. Employees must report all work-related injuries to their supervisor immediately. The benefit could be delayed or denied, if the supervisor is not immediately notified.
2. Notify Richmond County School System (RCSS) Workers' Compensation (WC) Division via email at wellsan@boe.richmond.k12.ga.us.  Provide the employee's name, employee's title, work location, and description of what happened.
3. Required Forms listed below MUST BE FILLED OUT IN COMPLETION:
• Employee Accident Report
• WC Acknowledgement Form
• Employer Notification of Treatment Form or NOVA Notification of Treatment Form or Urgent MD
• Medical Release Form
• Witness Statement Form
• Supervisor Accident Investigation Report Form
• Obtain & Submit the Supervisor's signature to the Workers' Compensation Department
4. If an employee needs to see a doctor, they must select one from the authorized 'Panel of Physicians' before receiving treatment. Employees are REQUIRED to:
• An authorized TPA representative will call and make the initial appointment
• Take the 'Employer Notification for Treatment' form to the doctor's appointment. {Note: The doctor's office will not see you without the employment notification for treatment form}
• Notify the WC Division via email of all doctors' appointments date and time
5. When an employee goes to the doctor, be sure to note on the accident report which doctor was selected and the date and time of the appointment. The employee must take the 'Employer Notification of Treatment' form to the doctor's appointment. A copy should be kept at the employee's work location.
6. Employees MUST obtain and provide to their supervisor a physician's statement regarding their return-to-work status.
7. All reports and return-to-work status must be faxed to 706-826-4622; originals can be sent via RCSS pony mail

 

 

Workers' Compensation Forms: 

Employee Accident Report  

WC 207 Medical Release Form 

NOVA Medical Authorization Form  

Urgent MD Authorization to Treat Form  

Physician Authorization for Treatment Form  

Workers' Compensation Witness Statement Form 

Workers' Compensation Official Notice - Panel of Physicians  

Workers' Compensation Official Notice - Panel of Physicians - Spanish